Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.

If a pancreatic cancer has been completely removed with surgery, chemotherapy may be given afterwards to try to reduce the chance of the cancer coming back. This is known as adjuvant chemotherapy. If the cancer can only be partially removed you may still be given chemotherapy, to shrink the remaining tumour.

If the cancer can’t be removed at all but has not spread beyond the pancreas, chemotherapy can’t cure the cancer, but may shrink it down and control it for a time.

If the cancer has spread, chemotherapy may be used to try and shrink the cancer and relieve symptoms.

Chemotherapy may be given together with radiotherapy to increase its effectiveness. This is known as chemoradiation.

Chemotherapy drugs are usually given by injection into a vein (intravenously) either in your arm or through a plastic tube (a central line), into your chest.

The chemotherapy drugs used to treat pancreatic cancer include gemcitabine (Gemzar®), 5-flourouracil (5FU), cisplatin, mitomycin, oxaliplatin (Eloxatin®) and capecitabine (Xeloda®).

It’s unusual for more than one chemotherapy drug to be given at the same time in the treatment of pancreatic cancer. Combinations of drugs are sometimes used as part of research trials. Sometimes gemcitabine is given in combination with a drug called erlotinib (Tarceva®). Erlotinib is a biological therapy that works by interfering with the way that cancer cells grow and divide.

The length of time that chemotherapy is given for will depend on the drugs that are used, and how well the treatment is working. This will be monitored by your doctor at regular appointments, and you will have regular blood tests and occasional scans. Any decision to use chemotherapy will be reached after a discussion between you and your doctor.

After you have had your chemotherapy there is usually a rest period of a few weeks, which allows your body to recover from the side effects of the treatment. Chemotherapy is usually given to you as an outpatient, but occasionally it may mean spending a few days in hospital.

Our chemotherapy section discusses the treatment and its side effects in more detail.

A number of research trials are being carried out to try to improve the results of treatment for pancreatic cancer. You may be asked to take part in a trial.

Chemotherapy can sometimes cause unpleasant side effects, but it can also make you feel better by relieving the symptoms of the cancer. Most people have some side effects, but these can often be well controlled with medicines. Some of the possible side effects are described here, along with some of the ways in which they can be reduced.

Reduced resistance to infection

While the chemotherapy is acting on the cancer cells in your body, it also temporarily reduces the number of white blood cells. When these cells are reduced you are more likely to get an infection. During chemotherapy, your blood will be tested regularly and, if necessary, you will be given antibiotics to treat any infection.

Sore mouth

Some chemotherapy drugs can make your mouth sore and cause small ulcers. Regular mouthwashes are important and your nurses will show you how to use these properly. If you don't feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet. Our section on eating well has some useful tips on coping with eating problems.

Diarrhoea

Some drugs used to treat cancer of the pancreas can irritate the lining of the digestive system and cause diarrhoea for a few days. Your doctor can give you medicine to slow down your bowel, and reduce the diarrhoea. You may also be able to help to control it by eating a low-fibre diet. This means avoiding wholemeal bread and pasta, raw fruit, cereals and vegetables for a few days after each treatment.

Feeling sick

Some of the drugs may make you feel sick (nauseated) and you may sometimes be sick. There are now very effective anti-sickness drugs (anti-emetics) to prevent or reduce nausea and vomiting. Your doctor can prescribe these for you. Let your doctor or nurse know if your anti-sickness drugs are not helping you, as different types can be used.

Some anti-emetics can cause constipation. Let your doctor or nurse know if this is a problem.

Hair loss

Ask your doctor whether the drugs you are taking are likely to make your hair fall out. Not all drugs cause hair loss and certain drugs are more likely to make your hair thin. If your hair does fall out, it will start to grow back once your treatment is over.

Skin

Chemotherapy can affect the skin and nails, causing dryness and flaking. Some drugs make your skin more sensitive to the sun, so it is important to cover up and use a high-factor sun cream (SPF 15 or greater).

Although these side effects may be hard to bear at the time, they will gradually disappear over a few weeks once your treatment has finished.