Loading
Pancreatic cancer in the UK and the NHS
Around 11,500 people a year are diagnosed with pancreatic cancer in the UK and around 10,200 die of it; almost half of England's cases come to light as emergencies and three in five with a known stage are stage 4. This page follows the NHS route from the GP's referral rules through the 28, 31 and 62 day standards to the specialist HPB centre, sets out what the National Pancreatic Cancer Audit found in September 2026 about diagnosis, treatment, enzyme replacement and nurse support, lists what the NHS funds with every NICE and SMC decision behind it, the tests to ask for, the trials open in the UK, and where England, Scotland, Wales and Northern Ireland differ.
Your pathway in the NHS
How the cancer usually comes to light, then the national standards that time each step. The standards are England's unless the four-nations section says otherwise.
Jaundice at 40 or over
22% urgent referral (England, 2019)NICE NG12 tells GPs to refer anyone aged 40 and over with jaundice on a suspected cancer pathway for pancreatic cancer (recommendation 1.2.4). Painless jaundice from a tumour blocking the bile duct is the classic route; NG85 says a pancreatic protocol CT should be done before the duct is drained. In England 22 percent of pancreatic cancers diagnosed in 2019 came through an urgent suspected cancer referral.
Sources: NICE NG12: suspected cancer, recommendations by site (pancreatic cancer 1.2.4 and 1.2.5; unexplained weight loss 1.13.2), last updated 15 April 2026 (2026-04-15); NICE NG85: pancreatic cancer in adults, diagnosis and management, recommendations (published 7 February 2018; metastatic section updated September 2025 and January 2026) (2026-01); Cancer Research UK: pancreatic cancer statistics (key stats, stage and routes to diagnosis by nation) (2026-09-24)
Weight loss with new-onset diabetes, over 60
The rule most often missed: NG12 asks GPs to consider an urgent direct-access CT scan (or ultrasound if CT is not available) for anyone aged 60 and over with weight loss and any of diarrhoea, back pain, abdominal pain, nausea, vomiting, constipation or new-onset diabetes (1.2.5). The April 2026 update adds that unexplained weight loss of more than 5 percent in six months at 60 or over should prompt urgent investigation or a suspected cancer or non-specific symptoms pathway referral (1.13.2). Pancreatic Cancer UK notes that one in four people with pancreatic cancer are first diagnosed with diabetes; SAFE-D in Southampton is testing a blood test in newly diagnosed diabetics.
Sources: NICE NG12: suspected cancer, recommendations by site (pancreatic cancer 1.2.4 and 1.2.5; unexplained weight loss 1.13.2), last updated 15 April 2026 (2026-04-15); ISRCTN35242058: SAFE-D, the Avantect blood test in people newly diagnosed with diabetes (University Hospital Southampton; recruiting to February 2028) (2026-09-24)
Emergency presentation
45% (England, 2019)Almost half of England's pancreatic cancers (45 percent in 2019) were diagnosed after an emergency presentation. The 2026 audit found people referred from emergency care were the least likely to go on to disease-targeted treatment (29 percent against 43 percent from GP or secondary care referral) even though their diagnosis came fastest (median one day from referral). The emergency team should hand the case to the specialist HPB MDT before any treatment decision.
Sources: Cancer Research UK: pancreatic cancer statistics (key stats, stage and routes to diagnosis by nation) (2026-09-24); NPaCA State of the Nation report 2026, full report (PDF) (2026-09)
- 1Day 0: referralUrgent suspected cancer referral, direct-access CT or a non-specific symptoms pathway
The clock starts at the GP's referral (or, in Wales, at the point of suspicion). NG12's pancreatic rules are jaundice at 40 or over (refer) and weight loss with a listed symptom or new-onset diabetes at 60 or over (urgent CT). Since 1 October 2023 England no longer measures the two-week wait to first appointment; the 28-day Faster Diagnosis Standard replaced it.
Sources: NICE NG12: suspected cancer, recommendations by site (pancreatic cancer 1.2.4 and 1.2.5; unexplained weight loss 1.13.2), last updated 15 April 2026 (2026-04-15); NHS England: changes to cancer waiting times standards from 1 October 2023 (2023-10-01)
- 228 days: diagnosis or all-clearFaster Diagnosis Standard: told you have cancer, or that you do not, within 28 daysTarget 75%, rising to 80% by March 2026
NHS England's best practice timed pathway for HPB cancers asks for diagnosis within 21 days of referral; Pancreatic Cancer UK's Optimal Care Pathway makes the same 21-day ask. The 2026 audit found 68 percent of people in England (trust range 62 to 75 percent) and 66 percent in Wales were diagnosed within 21 days. NG85 sets the work-up: pancreatic protocol CT first, then FDG-PET/CT and/or endoscopic ultrasound with tissue sampling if the diagnosis is unclear, and FDG-PET/CT for anyone with localised disease who will have treatment.
Sources: NHS England: changes to cancer waiting times standards from 1 October 2023 (2023-10-01); NHS England: 2025/26 priorities and operational planning guidance (2025-01); NHS England: implementing a timed HPB cancer diagnostic pathway (the 21-day best practice timed pathway; HTTP 202 to OnCo); NPaCA State of the Nation report 2026, full report (PDF) (2026-09); NICE NG85: pancreatic cancer in adults, diagnosis and management, recommendations (published 7 February 2018; metastatic section updated September 2025 and January 2026) (2026-01)
- 3Specialist pancreatic cancer MDTDiagnosis and care agreed by a specialist pancreatic cancer multidisciplinary team
NG85 recommendation 1.2.1 and NICE quality statement 1 (QS177) require a specialist MDT, partnered with local cancer units, to make a shared decision with the patient. The 2026 audit found 77 percent of people diagnosed in England had a record of MDT discussion (trust range 72 to 88 percent; 27 trusts below 70 percent); those with no recorded stage or performance status were the least likely to have one. Ask which of the 23 English HPB specialist centres holds your MDT.
Sources: NICE NG85: pancreatic cancer in adults, diagnosis and management, recommendations (published 7 February 2018; metastatic section updated September 2025 and January 2026) (2026-01); NICE QS177: pancreatic cancer quality standard, statements 1 to 5 (20 December 2018) (2018-12-20); NPaCA State of the Nation report 2026, full report (PDF) (2026-09)
- 4Clinical nurse specialist and supportive careAn HPB or upper GI clinical nurse specialist as lead contact from diagnosis
The Optimal Care Pathway's third recommendation, adopted by the audit as its goal. Where recorded, 88 percent of people in England saw a CNS around diagnosis (trust range 83 to 98 percent), but the record was missing for 45 percent. NG85 asks teams to assess the psychological impact of fatigue, pain, gut symptoms, nutrition, anxiety and depression throughout care, and to offer a coeliac plexus block for uncontrolled pain.
Sources: Pancreatic Cancer UK: Optimal Care Pathway hub (launched 2021; six recommendations, 21 days to diagnosis, 21 days to treatment) (2026-09-24); NPaCA State of the Nation report 2026, full report (PDF) (2026-09); NICE NG85: pancreatic cancer in adults, diagnosis and management, recommendations (published 7 February 2018; metastatic section updated September 2025 and January 2026) (2026-01)
- 5Enzymes, diet and diabetesEnteric-coated pancreatin (PERT) offered for unresectable disease; considered before and after surgery
NG85 recommendations 1.6.1 and 1.6.2 and QS177 statement 4. The 2026 audit found only 55 percent of everyone diagnosed in England had a primary care prescription for PERT, 67 percent of those who lived at least 90 days (trust range 57 to 76 percent), and 74 percent of those treated against 57 percent of those not treated; its fifth recommendation is assessment for PERT at the first clinical review, including for people who have no treatment. Supplies of Creon, Nutrizym and Pancrex have been disrupted since September 2024 and NICE points prescribers to the Specialist Pharmacy Service tool for equivalents. A specialist dietitian should manage weight loss and steatorrhoea, and new or worsening diabetes (common when the pancreas fails or is removed) needs a diabetes team; early enteral feeding is preferred after pancreatoduodenectomy.
Sources: NICE NG85: pancreatic cancer in adults, diagnosis and management, recommendations (published 7 February 2018; metastatic section updated September 2025 and January 2026) (2026-01); NICE QS177: pancreatic cancer quality standard, statements 1 to 5 (20 December 2018) (2018-12-20); NPaCA State of the Nation report 2026, full report (PDF) (2026-09); Pancreatic Cancer UK: pancreatic enzyme replacement therapy (PERT), updated May 2026 (2026-05); Pancreatic Cancer UK: join our campaigns (an end to PERT shortages, affecting at least 61,000 people) (2026-09-24)
- 631 days: decision to first treatmentTreatment starts within 31 days of the decision to treatTarget 96%
Applies to first and subsequent treatments: surgery, chemotherapy, radiotherapy or a stent as definitive palliation. The Optimal Care Pathway asks for treatment within 21 days of diagnosis and 42 days of referral.
Sources: NHS England: changes to cancer waiting times standards from 1 October 2023 (2023-10-01); Pancreatic Cancer UK: Optimal Care Pathway hub (launched 2021; six recommendations, 21 days to diagnosis, 21 days to treatment) (2026-09-24)
- 762 days: referral to first treatmentFirst treatment within 62 days of the urgent referralTarget 85% (planning target 75% by March 2026)
The headline standard. The 2026 audit measured what actually happens: the median time from referral to disease-targeted treatment was 74 days in England (trust range 65.5 to 82) and 76 in Wales, longest after an urgent GP referral (78 days) because tissue diagnosis, staging and fitness assessment take time. Its first recommendation is to review the pathway of everyone who waited more than three months.
Sources: NHS England: changes to cancer waiting times standards from 1 October 2023 (2023-10-01); NHS England: 2025/26 priorities and operational planning guidance (2025-01); NHS England: cancer waiting times statistics; NPaCA State of the Nation report 2026, full report (PDF) (2026-09)
- 8TreatmentSurgery at one of 23 HPB hubs; chemotherapy locally under the hub's MDT
Pancreatic surgery in England is done only at the 23 surgical hubs, in a hub and spoke network (GIRFT, November 2025). NG85 says people with resectable cancer and jaundice who are fit should go straight to surgery rather than have a stent first; the audit found 57 percent still had a stent before a Whipple's operation without neoadjuvant treatment. In England 57 percent of people with stage 1 to 3 disease and 27 percent with stage 4 had any disease-targeted treatment within nine months (NHS England's target is 65 percent for non-metastatic disease); among people who were fit (PS 0 to 1) with stage 1 to 3 disease the figure was 72 percent, but only 34 percent of those aged 80 or over. Of those who had a Whipple's, 62 percent started chemotherapy within 14 weeks; 17 percent of those resected in 2023 had chemotherapy first, up from 6 percent in 2015. Ninety-day survival after a Whipple's was 96.4 percent.
Sources: GIRFT: pancreatic cancer national specialty report, executive summary (November 2025, PDF) (2025-11); NICE NG85: pancreatic cancer in adults, diagnosis and management, recommendations (published 7 February 2018; metastatic section updated September 2025 and January 2026) (2026-01); NPaCA State of the Nation report 2026, full report (PDF) (2026-09)
- 9Germline and tumour testingGermline BRCA1, BRCA2, PALB2 and CDKN2A testing; tumour panel for NTRK and trial targets
GeNotes describes routine constitutional (germline) testing of BRCA1, BRCA2, CDKN2A and PALB2 in a patient with pancreatic adenocarcinoma; a positive result changes the family's screening and can open a PARP inhibitor trial, though olaparib is not NICE-approved (TA750 terminated). NG85 asks every patient whether a first-degree relative has had pancreatic cancer, and offers surveillance to carriers with an affected relative. The tests section below has the detail.
Sources: GeNotes: patient with pancreatic cancer and a constitutional (germline) pathogenic BRCA variant (reviewed 5 October 2025) (2025-10-05); NICE NG85: pancreatic cancer in adults, diagnosis and management, recommendations (published 7 February 2018; metastatic section updated September 2025 and January 2026) (2026-01); NICE TA750: olaparib for maintenance treatment of BRCA mutation-positive metastatic pancreatic cancer (terminated 8 December 2021, no evidence submission from AstraZeneca) (2021-12-08)
Where you would be treated
32 centre entries across 4 nations, with what each offers for this cancer. The service model note below says what happens only at a specialist centre and what can be given closer to home under its MDT.
England
- HPB surgery
- STARPAC2, Precision-Panc and ginisortamab trial site
- LAP-PIE irreversible electroporation feasibility study
- HPB surgery for South East London and Kent
- Specialist HPB MDT
- Precision-Panc site
- HPB unit for North West London
- Precision-Panc site
- Medical pancreato-biliary service (surgery at the Royal Free)
- EUROPAC, STARPAC2, Precision-Panc and ginisortamab site
- HPB specialist centre for North East London
- STARPAC2 (sponsor Queen Mary University of London) and CRISTAL-APC site
- HPB specialist centre for South West London
- Precision-Panc site
- Cambridge HPB Cancer Service: surgery and oncology
- CRISTAL-APC lead site (Cambridge Clinical Trials Unit)
- STARPAC2 and Precision-Panc site
- HPB surgery
- PACOPS national cohort of resectable cancer (University of Birmingham)
- Precision-Panc site
- Pancreatic cancer MDT and HPB surgery
- EUROPAC and ginisortamab trial site
- The North East's HPB centre
- EUROPAC and Precision-Panc site
- HPB surgery
- Oncology and proton beam therapy at The Christie (GIRFT co-lead Ganesh Radhakrishna)
- STARPAC2, CRISTAL-APC and Precision-Panc at The Christie
Royal Liverpool University Hospital HPB team
Liverpool University Hospitals NHS Foundation Trust
Liverpool
- HPB cancer care for Merseyside, Cheshire, the Isle of Man and North Wales
- Home of the ESPAC trials and the EUROPAC registry (University of Liverpool)
- Oncology at Clatterbridge
- HPB surgery, also for the Isle of Wight and the Channel Islands
- SAFE-D blood test study in new diabetics; EUROPAC and Precision-Panc site
- HPB cancer MDT and surgery
- CRISTAL-APC, ginisortamab and Precision-Panc site; SCALOP-2 and EMERALD-Pancreas radiotherapy trials led from Oxford
- Nottingham HPB Service for Nottingham, Mansfield, Lincoln, Boston, Grantham and Derby
- EUROPAC and Precision-Panc site
- HPB surgery for Leicestershire, Peterborough, Kettering and Northampton
- HPB surgery (Northern General and Royal Hallamshire)
- Oncology at Weston Park; Precision-Panc site
- HPB surgery
- EUROPAC and Precision-Panc site
- Peninsula Liver and HPB Cancer Centre for Devon, Cornwall and the Isles of Scilly
- EUROPAC site
- HPB surgery for Hull and East Yorkshire
- Precision-Panc site
- HPB surgery for Staffordshire, Shropshire and Wolverhampton
- Takes some patients from mid Wales
- HPB surgery for Coventry and Warwickshire
- HPB clinical nurse specialist on the GIRFT team
- Regional HPB unit for Surrey and the South East
- East Lancashire specialist HPB cancer MDT
Scotland
- Surgical centre for the West of Scotland Cancer Network
- Precision-Panc sponsor and lead site; EUROPAC site
- Oncology, STARPAC2 and ginisortamab at the Beatson
- Surgical centre for South East Scotland
- Oncology, STARPAC2 and ginisortamab at the Western General
- Surgical centre for NHS Scotland North
- TAYCAN liquid biopsy study; ginisortamab and Precision-Panc site
- Surgical centre for NHS Scotland North (Grampian, Orkney, Shetland, Western Isles)
- Ginisortamab and Precision-Panc site
- Surgical centre for the Highland area of NHS Scotland North
Wales
- HPB surgery for South Wales
- EUROPAC site
- Oncology at Singleton and Velindre (ginisortamab site)
North and mid Wales
Liverpool University Hospitals (North Wales); University Hospitals of North Midlands, Stoke-on-Trent (some mid Wales patients)
Wales
- Pancreatic surgery for North Wales is in Liverpool and for some of mid Wales in Stoke-on-Trent, under those centres' MDTs; Velindre and Singleton give oncology
Service pageListed by Pancreatic Cancer UK
Northern Ireland
- Northern Ireland's HPB surgical service
- Systemic treatment and the ginisortamab trial at the Northern Ireland Cancer Centre
The service model
Pancreatic cancer care in England runs as a hub and spoke network: 23 surgical hubs, each with a specialist MDT, take referrals from the outlying hospitals (spokes) that see patients first. The hubs are the trusts in Table 7 of the National Pancreatic Cancer Audit's 2026 methodology supplement, which takes the list from Pancreatic Cancer UK's centre page; NHS England commissions HPB surgery as a specialised service under service specification 2260 (September 2024), which covers the liver and biliary side of the same units. The GIRFT pancreatic cancer review (national report November 2025) visited every hub and its spokes and found unwarranted variation in waits for diagnostic procedures, pathology turnaround, resections per head of population, neoadjuvant and adjuvant chemotherapy rates, radiotherapy availability, trial access, nursing, oncology and dietetic capacity and supportive care, with services stretched to single points of failure in places; its recommendations centre on the specialist MDT communicating with its spokes, PACT-UK synoptic radiology reporting, and HPB oncology opinions for every patient. NICE NG85 says the specialist MDT should partner with local cancer units to deliver care, so chemotherapy is usually given nearer home. Scotland runs three surgical networks (West, South East, North), Wales one South Wales centre with cross-border surgery in Liverpool and Stoke, and Northern Ireland a single Belfast service.
Sources: NPaCA State of the Nation 2026 methodology supplement, Table 7: trust codes for the 23 HPB specialist centres (PDF) (2026-09); Pancreatic Cancer UK: your local pancreatic cancer specialist centre (2026-09-24); GIRFT: pancreatic cancer national specialty report, executive summary (November 2025, PDF) (2025-11); NHS England service specification 2260: HPB, primary liver, secondary liver, perihilar biliary tract and gallbladder cancers (September 2024) (2024-09); NICE NG85: pancreatic cancer in adults, diagnosis and management, recommendations (published 7 February 2018; metastatic section updated September 2025 and January 2026) (2026-01)
What the NHS funds today
By line of treatment: England's NICE decision (which binds Wales and is adopted in Northern Ireland) and Scotland's SMC decision, each with its reference and date. Generic medicines were never appraised and are funded through national chemotherapy protocols.
| Line | Treatment | England (NICE) | Scotland (SMC) | Wales and Northern Ireland |
|---|---|---|---|---|
| After surgery (adjuvant) | Gemcitabine plus capecitabine for six cycles (ESPAC-4); gemcitabine alone if not fit for the combination ESPAC-4 was a UK-led trial. The 2026 audit found 62 percent of people who had a Whipple's operation in England started chemotherapy within 14 weeks. Modified FOLFIRINOX (PRODIGE 24) post-dates NG85 and is not in the guideline; ask the MDT whether it is offered to fit patients locally. | NHS England2018-02-07 Routinely available: NG85 recommendations 1.8.6 and 1.8.7 (generic medicines, off-label, funded under national chemotherapy protocols); start once recovered and fit for all six cycles | SMC Not appraised (generics); given under regional protocols | Wales: As England. NI: As England. |
| Before surgery (borderline resectable or resectable) | Neoadjuvant chemotherapy or chemoradiotherapy ESPAC5, the UK phase 2 trial, compared immediate surgery with short-course neoadjuvant gemcitabine plus capecitabine, FOLFIRINOX or chemoradiotherapy. | NHS England2018-02-07 NG85 (2018) recommendations 1.8.1 and 1.8.2 say only within a clinical trial; the 2026 audit calls this outdated and records 17 percent of people resected in 2023 having chemotherapy first, so local practice has moved ahead of the guideline | SMC Not appraised (generics); practice varies by network | Wales: As England (7 percent of resections in Wales had neoadjuvant treatment, NPaCA 2026). NI: As England. |
| Locally advanced, unresectable | Combination chemotherapy if fit; gemcitabine if not; capecitabine as the radiosensitiser when chemoradiotherapy is used | NHS England2018-02-07 Routinely available: NG85 recommendations 1.9.1 to 1.9.3 (generic medicines under national protocols; capecitabine chemoradiotherapy follows the UK SCALOP trial) | SMC Not appraised (generics) | Wales: As England. NI: As England. |
| Metastatic, first line, fit (ECOG 0 to 1) | FOLFIRINOX (oxaliplatin, irinotecan, fluorouracil, folinic acid) | NHS England2018-02-07 Routinely available: NG85 recommendation 1.9.4 (generic medicines, off-label in 2018, funded under national chemotherapy protocols) | SMC Not appraised (generics); given under regional protocols | Wales: As England. NI: As England. |
| Metastatic, first line, less fit | Gemcitabine plus nab-paclitaxel; gemcitabine alone if unfit for any combination Not on the Cancer Drugs Fund list: baseline commissioning since 2017. TA476's recommendations were brought into NG85 in September 2025. | NICE TA4762017-09-06 Recommended only if other combination chemotherapies are unsuitable and the person would otherwise have gemcitabine alone, with the patient access scheme discount; replaced TA360 (2015), which had said no. Gemcitabine alone is NG85 recommendation 1.9.6 | SMC2015-02-09 Accepted for use within NHS Scotland after a resubmission under the end of life and orphan medicine process (SMC 968/14, 9 February 2015) | Wales: Follows NICE TA476. NI: Follows NICE TA476. |
| Metastatic, first line (NALIRIFOX) | Liposomal irinotecan with oxaliplatin, fluorouracil and folinic acid (NAPOLI 3) Conventional FOLFIRINOX, with generic irinotecan, remains the funded four-drug regimen. | NICE TA10522025-04-02 Not available: appraisal terminated because the company did not provide an evidence submission | Wales: Not available (no NICE recommendation). NI: Not available. | |
| Second line | Oxaliplatin-based chemotherapy after gemcitabine; gemcitabine-based chemotherapy after FOLFIRINOX | NHS England2018-02-07 Consider under NG85 recommendations 1.9.7 and 1.9.8 (generic medicines, off-label, under national protocols) | SMC Not appraised (generics) | Wales: As England. NI: As England. |
| Second line after gemcitabine (Onivyde) | Liposomal irinotecan with fluorouracil and folinic acid (NAPOLI-1) | NICE TA4402017-04-26 Not recommended within its marketing authorisation for metastatic pancreatic adenocarcinoma that has progressed after gemcitabine-based therapy; the review of 9 December 2020 found nothing new | SMC2017-03-13 Not recommended (full submission under the orphan and end of life process; SMC 1217/17, 13 March 2017): the cost case was not sufficient | Wales: Not available (NICE TA440). NI: Not available. |
| Maintenance, germline BRCA1 or BRCA2, metastatic | Olaparib after at least 16 weeks of platinum-based first-line chemotherapy without progression (POLO) The one licensed targeted therapy for a germline finding in pancreatic cancer is unfunded across the UK. Carriers may be offered a PARP inhibitor trial; platinum-based chemotherapy (FOLFIRINOX) is the funded route. | NICE TA7502021-12-08 Not available: appraisal terminated because AstraZeneca did not provide an evidence submission; GeNotes confirms olaparib is licensed by the EMA for this use but not approved by NICE | Wales: Not available. NI: Not available. | |
| Any line, NTRK fusion | Larotrectinib (tumour-agnostic) NTRK fusions are rare in pancreatic cancer; GeNotes notes the data are limited but the drugs offer a further choice where options are few. | NICE TA630 · CDF2020-05-27 Recommended through the Cancer Drugs Fund for NTRK fusion-positive solid tumours with no satisfactory treatment options; CDF list Section A, Blueteq form LAR1a from 21 April 2020. NG85 links to it (1.9.11); the entrectinib link was removed in January 2026 because NICE withdrew TA644 | SMC Larotrectinib accepted; check the SMC page | Wales: Follows NICE. NI: Follows NICE. |
| Any line, MSI-high or mismatch repair deficient | Pembrolizumab alone MSI-high pancreatic cancer is rare (about 1 percent); a positive result is a reason to seek a trial and a Lynch syndrome referral. | NICE TA9142023-09-20 Not available for pancreatic cancer: TA914 covers previously treated MSI-high or dMMR endometrial, gastric, small intestine and biliary cancers only, and no pancreatic appraisal exists | SMC No pancreatic indication accepted | Wales: Not available. NI: Not available. |
| Symptom control: exocrine insufficiency | Pancreatic enzyme replacement therapy (enteric-coated pancreatin: Creon, Nutrizym, Pancrex) The 2026 audit found only 55 percent of people diagnosed in England had a PERT prescription (67 percent of those alive at 90 days); Pancreatic Cancer UK's campaign says shortages affect at least 61,000 people. | NHS England2024-12 Routinely available on prescription: NG85 recommendations 1.6.1 and 1.6.2 and QS177 statement 4; supply disrupted since September 2024, with NICE pointing to the Specialist Pharmacy Service tool for equivalent products | SMC Creon micro accepted (abbreviated submission) for pancreatic exocrine insufficiency; other pancreatin products are established medicines | Wales: As England; free prescriptions. NI: As England; free prescriptions. |
NICE's pancreatic cancer topic page listed 19 products on the check date. Only one technology appraisal recommends a medicine (TA476, nab-paclitaxel with gemcitabine, 2017); one refuses (TA440, liposomal irinotecan after gemcitabine, 2017); and two were terminated because the companies made no submission (TA750 olaparib, December 2021; TA1052 NALIRIFOX, April 2025). Everything else the NHS gives for pancreatic cancer is generic chemotherapy under NICE NG85 (2018, metastatic section updated September 2025), which is why the funding table has so few appraisal numbers. The Scottish Medicines Consortium's pancreas search returns the same pattern: nab-paclitaxel accepted (968/14), Onivyde refused twice (1217/17 full submission; SMC2812 non-submission) and olaparib not recommended after a non-submission (SMC2435). The National Cancer Drugs Fund list version 1.365 (6 June 2025) was read in full: no medicine for pancreatic adenocarcinoma is on it, only larotrectinib (form LAR1a) for any NTRK fusion-positive tumour and belzutifan for VHL-associated pancreatic neuroendocrine tumours. In development at NICE: zolbetuximab with nab-paclitaxel and gemcitabine for untreated claudin 18.2-positive metastatic pancreatic cancer (ID6444, in development, publication date to be confirmed) and trastuzumab deruxtecan for previously treated HER2-positive solid tumours (ID6511, expected 13 May 2027). NICE has also published HealthTech guidance on irreversible electroporation for pancreatic cancer (HTG437, 2017) and endoscopic bipolar radiofrequency ablation for malignant biliary obstruction (HTG731, November 2024), and has pancreas SABR at topic prioritisation. A NICE recommendation binds NHS England and NHS Wales to fund within 90 days; Northern Ireland adopts NICE appraisals through its Department of Health; Scotland decides through the SMC. The All Wales Medicines Strategy Group's appraisal list was read and no pancreatic cancer medicine was found on it.
Sources: NICE: all products on pancreatic cancer (19 products on the check date) (2026-09-24); NICE TA476: paclitaxel as albumin-bound nanoparticles with gemcitabine for untreated metastatic pancreatic cancer (6 September 2017; replaces TA360) (2017-09-06); NICE TA440: pegylated liposomal irinotecan for treating pancreatic cancer after gemcitabine (26 April 2017, not recommended; reviewed 9 December 2020, no change) (2017-04-26); NICE TA750: olaparib for maintenance treatment of BRCA mutation-positive metastatic pancreatic cancer (terminated 8 December 2021, no evidence submission from AstraZeneca) (2021-12-08); NICE TA1052: pegylated liposomal irinotecan in combination (NALIRIFOX) for untreated metastatic pancreatic cancer (terminated 2 April 2025, no evidence submission) (2025-04-02); NICE NG85: update information (September 2025 links to TA476 and TA440; January 2026 entrectinib link removed because that guidance was withdrawn) (2026-01); Scottish Medicines Consortium: medicines advice, keyword pancreas (five entries on the check date) (2026-09-24); NHS England: National Cancer Drugs Fund list, version 1.365 (6 June 2025), read in full: no pancreatic adenocarcinoma medicine; larotrectinib form LAR1a; belzutifan for VHL pancreatic neuroendocrine tumours (2025-06-06); NICE HTG437: irreversible electroporation for treating pancreatic cancer (3 May 2017) (2017-05-03)
The NHS position of every approved product is on the NHS coverage page; the same decisions by country are on HTA decisions.
Tests you can ask for
National Genomic Test Directory entries with their codes, what a result opens, and how the request is made. Ask at diagnosis of advanced disease, not at progression.
| Target | Code | Test | What a positive result opens | How to get it |
|---|---|---|---|---|
| Germline BRCA1, BRCA2, PALB2 and CDKN2A | germline panel | Constitutional (germline) testing on a blood sample of the four pancreatic cancer predisposition genes; GeNotes describes it as routine in a patient with pancreatic adenocarcinoma | A PARP inhibitor trial (olaparib is licensed but unfunded, TA750); platinum-based chemotherapy as the funded choice; cascade testing and surveillance for relatives, who have a 50 percent chance of carrying the variant | Ask the oncologist or clinical nurse specialist at diagnosis; the request goes through the regional Genomic Laboratory Hub. About 5 percent of unselected patients carry a BRCA variant, up to 17 percent in familial pancreatic cancer. The Test Directory code could not be read because NHS England's page answered HTTP 202. Sources: GeNotes: patient with pancreatic cancer and a constitutional (germline) pathogenic BRCA variant (reviewed 5 October 2025) (2025-10-05); GeNotes knowledge hub: pancreatic cancer (reviewed 27 December 2023) (2023-12-27); NHS England: National Genomic Test Directory (the page answered HTTP 202 with an empty body to OnCo on 24 September 2026) |
| Family history and surveillance eligibility | clinical | NG85 asks every patient whether a first-degree relative has had pancreatic cancer; surveillance (MRI/MRCP or EUS, CT for hereditary pancreatitis) is offered for hereditary pancreatitis with PRSS1, for BRCA1, BRCA2, PALB2 or CDKN2A carriers with an affected first-degree relative, and for Peutz-Jeghers syndrome, and considered for two or more affected first-degree relatives across two generations or Lynch syndrome with an affected relative | Entry to EUROPAC (ISRCTN62546421), the UK registry and surveillance programme, at ten NHS sites | Ask the MDT or GP for referral to clinical genetics and to EUROPAC; Pancreatic Cancer UK's family history page explains the route. Sources: NICE NG85: pancreatic cancer in adults, diagnosis and management, recommendations (published 7 February 2018; metastatic section updated September 2025 and January 2026) (2026-01); ISRCTN62546421: EUROPAC, the European registry of familial pancreatic cancer and hereditary pancreatitis (University of Liverpool; recruiting to July 2039; ten UK sites) (2026-09-24); Pancreatic Cancer UK: family history of pancreatic cancer (the EUROPAC study) (2026-09-24) |
| NTRK1, NTRK2, NTRK3 rearrangement | somatic panel | Multi-target next-generation sequencing panel on the tumour block for structural variants | Larotrectinib through the Cancer Drugs Fund (TA630) for inoperable or metastatic disease with no satisfactory options | Requested by the oncologist through the Genomic Laboratory Hub on an existing biopsy or surgical specimen; GeNotes' case is a patient who has progressed after two lines of treatment, so ask before that point. Sources: GeNotes: patient with pancreatic cancer and a somatic (tumour) NTRK rearrangement (reviewed 5 October 2025) (2025-10-05); NICE TA630: larotrectinib for NTRK fusion-positive solid tumours (27 May 2020, Cancer Drugs Fund) (2020-05-27) |
| KRAS and other tumour drivers (for trials) | somatic panel | The same tumour panel reports KRAS mutation status (present in around nine in ten pancreatic cancers) and other driver changes | Trial matching: RAS inhibitor trials such as the daraxonrasib programme, and molecularly selected UK trials; Precision-Panc built the UK's capacity to profile at diagnosis | Ask whether the panel has been run and for a copy of the report; a research biopsy may be needed if diagnostic tissue is scant. Sources: ISRCTN14879538: Precision Panc master protocol (NHS Greater Glasgow and Clyde; recruitment 14 December 2017 to 29 March 2022, 27 UK sites; listed as suspended) (2026-09-24); GeNotes knowledge hub: pancreatic cancer (reviewed 27 December 2023) (2023-12-27) |
| DPYD variants (before fluorouracil or capecitabine) | germline | Constitutional DPYD hotspot test on a blood sample | Dose reduction or avoidance of fluoropyrimidines (in FOLFIRINOX, gemcitabine plus capecitabine and chemoradiotherapy) to prevent severe toxicity | Requested before the first dose of any fluoropyrimidine; GeNotes carries a pancreatic cancer case reviewed 15 September 2025. Sources: GeNotes: patient with pancreatic cancer and a constitutional (germline) DPYD variant (reviewed 15 September 2025) (2025-09-15) |
| Mismatch repair deficiency or MSI-high | pathology | Mismatch repair immunohistochemistry on the tumour block, or MSI testing | No NICE-funded immunotherapy for pancreatic cancer (TA914 excludes it); a trial, and a Lynch syndrome referral for the family | Ask histopathology through the MDT; rare (about 1 percent) but decisive when found. Sources: NICE TA914: pembrolizumab for previously treated MSI-high or dMMR solid tumours (20 September 2023; endometrial, gastric, small intestine and biliary cancers, not pancreatic) (2023-09-20); NICE NG85: pancreatic cancer in adults, diagnosis and management, recommendations (published 7 February 2018; metastatic section updated September 2025 and January 2026) (2026-01) |
| CA19-9 and imaging response | pathology | Serum CA19-9 with each cycle and CT reassessment; NG85 specifies a pancreatic protocol CT of chest, abdomen and pelvis at diagnosis and FDG-PET/CT before treatment of localised disease | Decisions on surgery after neoadjuvant treatment and on continuing or changing chemotherapy | Routine in every HPB centre; ask for the trend, not the single value. The 2026 audit found 55 percent of people in England had FDG-PET/CT before surgery (centre range 23 to 80 percent), so ask whether yours is planned. Sources: NICE NG85: pancreatic cancer in adults, diagnosis and management, recommendations (published 7 February 2018; metastatic section updated September 2025 and January 2026) (2026-01); NPaCA State of the Nation report 2026, full report (PDF) (2026-09) |
In England the National Genomic Test Directory sets which tests the NHS funds and the seven Genomic Laboratory Hubs run them. NHS England's Test Directory page answered HTTP 202 with an empty body to OnCo on the check date, so the pancreatic codes are not quoted; the tests above are those GeNotes (the NHS Genomics Education Programme) describes for pancreatic cancer in pages reviewed in 2023 and 2025. Scotland requests through its four regional laboratories and the Scottish Genomic Test Directory; Wales through the All Wales Medical Genomics Service; Northern Ireland through the Regional Molecular Diagnostics Service in Belfast. GeNotes' knowledge hub page notes that under 10 percent of pancreatic cancers arise from germline variants and that PARP inhibitors are not NICE-approved for BRCA-positive metastatic disease, so the practical value of germline testing today is for the family and for trial entry.
Sources: NHS England: National Genomic Test Directory (the page answered HTTP 202 with an empty body to OnCo on 24 September 2026); GeNotes knowledge hub: pancreatic cancer (reviewed 27 December 2023) (2023-12-27); GeNotes: patient with pancreatic cancer and a constitutional (germline) pathogenic BRCA variant (reviewed 5 October 2025) (2025-10-05); GeNotes: genomic testing in the devolved nations (reviewed 6 August 2026) (2026-08-06)
Match a report to targets and drugs on the biomarker matrix.
Trials open in the UK
Registered trials with UK sites, from the ISRCTN registry and the sponsors' pages, with the setting each is for. Eligibility is decided by the trial team.
ISRCTN62546421Recruiting to 1 July 2039
People at inherited risk: family history of pancreatic cancer, hereditary pancreatitis, BRCA2, PALB2, CDKN2A and other predisposition variants
Royal Liverpool (lead)Glasgow Royal InfirmaryFreeman Hospital, NewcastleLeeds Teaching HospitalsNottingham City HospitalMorriston Hospital, SwanseaBristol Royal InfirmaryDerriford, PlymouthUniversity Hospital SouthamptonUCLH
Sponsored by the University of Liverpool; target 10,000. Pancreatic Cancer UK's family history page said EUROPAC would not accept new registrants from 1 January (year not stated on the page as read), so check the current position with the team.
Registry or sponsor page →ISRCTN16463547Recruiting, 4 April 2025 to 31 January 2028
CRISTAL-APC: chemokine receptor inhibition (VP-002) with chemotherapy for advanced pancreatic cancer
Advanced or metastatic pancreatic ductal adenocarcinoma, phase 2 randomised
Cambridge University Hospitals (Cambridge Clinical Trials Unit)The Christie, ManchesterOxford University HospitalsBarts Health, London
Target 120; Cancer Research UK carries a plain-English summary.
Registry or sponsor page →ISRCTN11503604Recruiting, 30 April 2020 to 31 December 2026
STARPAC2 (PRIMUS 005): gemcitabine and nab-paclitaxel with or without all-trans retinoic acid (ATRA) to target the stroma
Locally advanced pancreatic cancer, phase 2 randomised
St Bartholomew's Hospital, London (sponsor Queen Mary University of London)Royal Free LondonUCLHThe Christie, ManchesterNHS Lothian, EdinburghCambridge University HospitalsGuy's and St Thomas', LondonNHS Greater Glasgow and Clyde
Target 170; protocol published in BMC Cancer 2025 with the Precision-Panc team.
Registry or sponsor page →ISRCTN63154609Recruiting, 25 June 2024 to 31 October 2028
Phase 2 trial of ginisortamab (anti-gremlin-1) in metastatic pancreatic ductal adenocarcinoma
Metastatic pancreatic ductal adenocarcinoma, open-label phase 2 (non-randomised module then randomised module)
Beatson, GlasgowUCLHWestern General, EdinburghAberdeen Royal InfirmaryGuy's Hospital, LondonNinewells, DundeeSt James's, LeedsChurchill, OxfordRoyal Free, LondonClatterbridge, LiverpoolNorthern Ireland Cancer Centre, BelfastVelindre, Cardiff
Sponsored by Cancer Research UK; target 156; also open in Norway, Spain and Germany. One of the few trials open in all four UK nations.
Registry or sponsor page →ISRCTN35242058Recruiting, 3 March 2025 to 29 February 2028
SAFE-D: the Avantect blood test for early pancreatic cancer in people newly diagnosed with type 2 diabetes
Adults recently diagnosed with diabetes (the new-onset diabetes route to pancreatic cancer), randomised
Southampton General Hospital (sponsor University Hospital Southampton NHS Foundation Trust)
Target 15,000. An early-detection trial rather than a treatment trial.
Registry or sponsor page →ISRCTN90934212Recruiting, 25 October 2024 to 25 October 2027
PACOPS: observing current practice in potentially resectable pancreatic cancer
Potentially resectable pancreatic cancer; prospective UK cohort of the specialist surgical centres
University Hospitals Birmingham (sponsor University of Birmingham); UK specialist centres joining
Target 300; maps variation in treatment and outcomes across the UK's surgical hubs.
Registry or sponsor page →ISRCTN93548632Recruiting, 1 May 2025 to 1 May 2027
TAYCAN: liquid biopsy (circulating tumour DNA) in pancreatic and colorectal cancer
Pancreatic and colorectal cancer patients in NHS Tayside; observational
Ninewells Hospital, Dundee
Target 100; single centre.
Registry or sponsor page →ISRCTN38972074Recruiting to November 2029
ATTR-01 phase 1-2 master protocol in selected epithelial solid tumours, including pancreatic cancer
Advanced solid tumours including pancreatic cancer; early phase
St James's University Hospital, LeedsChurchill Hospital, OxfordVelindre Cancer CentreBeatson West of Scotland Cancer Centre
Eligibility is by tumour type and prior treatment.
Registry or sponsor page →ISRCTN is the UK registry; a search for pancreatic cancer was run through its public API on the check date (100 records returned) and the records above were read individually for status, dates and centres. The Precision-Panc PRIMUS trials that defined UK pancreatic research from 2017 are no longer open: PRIMUS 001 is no longer recruiting, PRIMUS 002, 004 and 006 are stopped, and the master protocol is listed as suspended. Trials registered only on ClinicalTrials.gov with UK sites (the RAS inhibitor and CLDN18.2 programmes among them) appear on the trial records linked from the cancer page. Pancreatic Cancer UK runs a clinical trial finder, and the NIHR's Be Part of Research site searches by condition and postcode; both render in the browser only and could not be read automatically, so open them directly.
Sources: ISRCTN registry search: pancreatic cancer (2026-09-24); ISRCTN14879538: Precision Panc master protocol (NHS Greater Glasgow and Clyde; recruitment 14 December 2017 to 29 March 2022, 27 UK sites; listed as suspended) (2026-09-24); Pancreatic Cancer UK: clinical trial finder (2026-09-24); NIHR Be Part of Research: pancreatic cancer
The UK trial legacy
ESPAC (2004 to 2023): the Liverpool trials that made adjuvant chemotherapy the standard
The European Study Group for Pancreatic Cancer, run from Liverpool by John Neoptolemos and colleagues, changed practice worldwide. ESPAC-1 (NEJM 2004, 289 patients) showed that chemotherapy after resection lengthened survival and that chemoradiotherapy did not, ending the American habit of radiotherapy after surgery. ESPAC-3 (JAMA 2010, 1,088 patients) found fluorouracil with folinic acid and gemcitabine equivalent, so the gentler gemcitabine became the adjuvant standard. ESPAC-4 (Lancet 2017, 732 patients at 106 hospitals in the UK, France, Germany and Sweden; Neoptolemos, Palmer and Ghaneh) showed six cycles of gemcitabine plus capecitabine beat gemcitabine alone, and that combination is NICE NG85's recommendation 1.8.6 today. ESPAC5 (2023, 90 patients in the UK and Germany) then tested short-course neoadjuvant treatment against immediate surgery for borderline resectable disease, the question NG85 still says belongs in a trial. Liverpool's ESPAC tissue bank went on to yield the hENT1 biomarker work and the GATA6 immunohistochemistry analyses.
Sources: Neoptolemos et al, A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer (ESPAC-1), NEJM 2004 (2004-03-18); Neoptolemos et al, Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection (ESPAC-3), JAMA 2010 (2010-09-08); Neoptolemos, Palmer, Ghaneh et al, Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4), Lancet 2017 (2017-01-24); ISRCTN96397434: ESPAC-4 (recruited 13 October 2008 to 31 October 2017 at 106 hospitals in the UK, France, Germany and Sweden) (2026-09-24); Ghaneh, Palmer et al, Immediate surgery compared with short-course neoadjuvant gemcitabine plus capecitabine, FOLFIRINOX, or chemoradiotherapy in borderline resectable pancreatic cancer (ESPAC5), Lancet Gastroenterology and Hepatology 2023 (2023-02)
EUROPAC (2000 onwards): screening the families at inherited risk
EUROPAC, the European Registry of Familial Pancreatic Cancer and Hereditary Pancreatitis, has been run from the University of Liverpool since 2000 and now registers and follows people at inherited risk at ten NHS sites, with Chris Halloran as clinical lead and Bill Greenhalf on the molecular side. Its 2026 European Journal of Cancer paper reports 893 asymptomatic individuals under surveillance between January 2000 and April 2025 (median age 52); after Family Risk stratification was introduced in 2020, actionable pancreatic findings rose from 0.8 percent to 3.6 percent and operable lesions from 0.6 to 3 percent, with individuals lacking a known variant but carrying a significant lesion offered further germline testing. NICE NG85's surveillance recommendations (1.1.15 to 1.1.19) are the policy this registry informs, and Pancreatic Cancer UK points families to it. The UK Early Detection Initiative (UK-EDI, ISRCTN12805385, also Liverpool) took the same idea to new-onset diabetes, and SAFE-D in Southampton is now testing a blood test in that group.
Sources: Hopley et al, Risk-stratified surveillance for individuals in the UK at high risk of developing pancreatic cancer: outcomes from EUROPAC, European Journal of Cancer 2026 (2026); European Registry of Hereditary Pancreatic Diseases (EUROPAC): protocol for primary and secondary screening, BMJ Open 2025 (2025); ISRCTN62546421: EUROPAC, the European registry of familial pancreatic cancer and hereditary pancreatitis (University of Liverpool; recruiting to July 2039; ten UK sites) (2026-09-24); Pancreatic Cancer UK: family history of pancreatic cancer (the EUROPAC study) (2026-09-24); NICE NG85: pancreatic cancer in adults, diagnosis and management, recommendations (published 7 February 2018; metastatic section updated September 2025 and January 2026) (2026-01)
Precision-Panc and PRIMUS (2017 to 2022): profiling at diagnosis, UK-wide
Led by Andrew Biankin from Glasgow and sponsored by NHS Greater Glasgow and Clyde, the Precision-Panc master protocol opened in December 2017 to take extra tissue at the diagnostic biopsy from people with pancreatic cancer at 27 UK sites, from Aberdeen and Dundee to the Royal Marsden, Southampton and Bristol, profile the tumour and route each patient to a PRIMUS trial matched to its molecular subtype: PRIMUS 001 first line, PRIMUS 002 neoadjuvant, PRIMUS 004 second-line platform, PRIMUS 006, and STARPAC2 as PRIMUS 005. Recruitment to the master protocol ended in March 2022 and most PRIMUS arms are stopped or closed, but the programme left a national network of HPB centres able to take research biopsies and profile tumours at diagnosis, the infrastructure the RAS inhibitor era now needs. GIRFT's 2025 review lists access to clinical trials among the unwarranted variations between networks, so the question for a patient is whether their hub is one of the profiling centres.
Sources: ISRCTN14879538: Precision Panc master protocol (NHS Greater Glasgow and Clyde; recruitment 14 December 2017 to 29 March 2022, 27 UK sites; listed as suspended) (2026-09-24); Kocher et al, STARPAC2 study protocol (Barts Cancer Institute with the Precision-Panc team), BMC Cancer 2025 (2025-01); GIRFT: pancreatic cancer national specialty report, executive summary (November 2025, PDF) (2025-11)
UK data
Each figure with its nation, period and the page it was read from. Survival figures are population averages and sit behind the usual disclosure.
New cases a year
11,479
UK · 2019, 2021-2022 average
Around 5,800 in men and 5,600 in women; the tenth most common cancer, 3 percent of all cases; 31 a day.
Sources: Cancer Research UK: pancreatic cancer statistics (key stats, stage and routes to diagnosis by nation) (2026-09-24)
Deaths a year
10,200
UK · 2022-2024 average
The fifth most common cause of cancer death; 28 a day; 54 percent in people aged 75 and over.
Sources: Cancer Research UK: pancreatic cancer mortality (2026-09-24)
Diagnosed at 75 or over
48%
UK · 2019, 2021-2022
Rates are highest at 90 and over.
Sources: Cancer Research UK: pancreatic cancer incidence (2026-09-24)
Change in incidence rate since the early 1990s
+21%
UK · to 2019, 2021-2022
Up 7 percent in the last decade; projected to rise a further 4 percent by 2038-2040, to about 16,000 cases a year.
Sources: Cancer Research UK: pancreatic cancer incidence (2026-09-24)
Diagnosed after an emergency presentation
45%
England · 2019
22 percent came through an urgent suspected cancer referral.
Sources: Cancer Research UK: pancreatic cancer statistics (key stats, stage and routes to diagnosis by nation) (2026-09-24)
Diagnosed at an early stage (I or II)
26%
England · 2022, cases with a known stage
Around 1,600 people. Scotland 19 percent (2023), Wales 19 percent (2017-2019), Northern Ireland 30 percent (2015-2019), all on known-stage cases.
Sources: Cancer Research UK: pancreatic cancer statistics (key stats, stage and routes to diagnosis by nation) (2026-09-24)
Ten-year survival
Show survival figures (2)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 4.3% ten-year survival (UK, 2018).
- Up from 2.4 percent in the 1970s; similar in women and men. Population averages, not a personal prognosis.
UK · 2018
Sources: Cancer Research UK: pancreatic cancer survival (2026-09-24)
Five-year survival by deprivation
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 7.6% most deprived, 10.3% least deprived five-year survival by deprivation (England, 2018-2022).
England · 2018-2022
Sources: Cancer Research UK: pancreatic cancer survival (2026-09-24)
Preventable cases
37%
UK · current estimate
Smoking and excess weight are the largest contributors.
Sources: Cancer Research UK: pancreatic cancer statistics (key stats, stage and routes to diagnosis by nation) (2026-09-24)
People diagnosed, in the audit
17,672
England · 2022-2023 (two years)
951 in Wales in 2023-2024. Median age 74; 52 percent men. Stage among those with complete staging: I 12 percent, II 12 percent, III 15 percent, IV 61 percent in England (Wales 12, 12, 14, 62); stage was unknown for 5,003 people in England.
Sources: NPaCA State of the Nation 2026 infographic (PDF) (2026-09)
Diagnosed within 21 days of referral
68%
England · 2022-2023
Trust range (IQR) 62 to 75 percent; 66 percent in Wales. Median referral to diagnosis 11 days overall, 20 days after an urgent GP referral, one day after an emergency referral.
Sources: NPaCA State of the Nation report 2026, full report (PDF) (2026-09)
Median time from referral to disease-targeted treatment
74 days
England · 2022-2023
Trust range 65.5 to 82 days; 76 days in Wales; 78 days after an urgent GP referral. People referred from emergency care were less likely to be treated (29 percent) than those referred by a GP or from secondary care (43 percent).
Sources: NPaCA State of the Nation report 2026, full report (PDF) (2026-09)
Record of specialist MDT discussion
77%
England · 2022-2023
Trust range 72 to 88 percent; 27 of 119 trusts below 70 percent.
Sources: NPaCA State of the Nation report 2026, full report (PDF) (2026-09)
Stage 1 to 3 disease treated within nine months
57%
England · 2022-2023
Against NHS England's Cancer Alliance target of 65 percent; 50 percent in Wales. 72 percent of fit (PS 0 to 1) people in England, 80 percent of PS 0, but 34 percent of those aged 80 or over with good performance status. Stage 4: 27 percent (26 percent in Wales), 41 percent among PS 0 to 1.
Sources: NPaCA State of the Nation report 2026, full report (PDF) (2026-09)
Prescribed pancreatic enzyme replacement therapy
55%
England · 2022-2023
67 percent of those who survived at least 90 days (trust range 57 to 76 percent); 74 percent of people who had disease-targeted treatment against 57 percent of those who did not. Not reported for Wales.
Sources: NPaCA State of the Nation report 2026, full report (PDF) (2026-09)
Seen by a clinical nurse specialist around diagnosis
88%
England · 2022-2023, where recorded
Trust range 83 to 98 percent; the record was missing for 45 percent of people. 91 percent in the Welsh subgroup with complete forms.
Sources: NPaCA State of the Nation report 2026, full report (PDF) (2026-09)
Neoadjuvant chemotherapy before resection
17%
England · diagnosed 2023
Up from 6 percent in 2015 and 7 percent in 2019; centre range 9 to 18 percent; 7 percent in Wales. 62 percent of people who had a Whipple's operation started chemotherapy within 14 weeks (63 percent in Wales); 55 percent had FDG-PET/CT before surgery (centre range 23 to 80 percent); 57 percent had a biliary stent before a Whipple's without neoadjuvant treatment.
Sources: NPaCA State of the Nation report 2026, full report (PDF) (2026-09)
One-year survival, all stages
Show survival figures (2)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 23% one-year survival, all stages (England and Wales, diagnosed 2022-2023 (England), 2023-2024 (Wales)).
- 30-day survival 78 percent; 90-day 54 percent; two-year 11 percent (England, diagnosed 2021-2022). Stage 1 to 3: 46 percent at one year; stage 4: 10 percent. After a Whipple's: 96.4 percent at 90 days and 77.1 percent at one year in England. No trust or health board was a negative outlier for one-year survival. Population averages, not a personal prognosis.
England and Wales · diagnosed 2022-2023 (England), 2023-2024 (Wales)
Sources: NPaCA State of the Nation report 2026, full report (PDF) (2026-09)
Surgical hubs providing specialist care
23
England · GIRFT review, November 2025
GIRFT: more than half of patients are diagnosed at stage IV, around half die within three months of diagnosis, about one in ten are eligible for potentially curative surgery and three in ten receive any active anti-cancer treatment.
Sources: GIRFT: pancreatic cancer national specialty report, executive summary (November 2025, PDF) (2025-11)
Receive no active treatment
7 in 10
UK · Pancreatic Cancer UK statistics page
One in ten have potentially curative surgery and two in ten chemotherapy, on the charity's figures; five-year survival is below 7 percent and the UK ranked 29th of 33 comparable countries in CONCORD-3.
Sources: Pancreatic Cancer UK: pancreatic cancer statistics (treatment shares and the four nations) (2026-09-24)
New cases (C25)
955
Scotland · 2024
472 men and 483 women; European age-standardised rate 16.4 per 100,000. 861 in 2023, 878 in 2022, 906 in 2021, 928 in 2020, 921 in 2019 (Public Health Scotland open data CSV, Scotland level).
Sources: Public Health Scotland open data: annual cancer incidence, Scotland-level CSV (opendata_inc0024_scotland.csv; site Pancreas, ICD-10 C25) (2026-08-18)
New cases (C25)
592
Wales · 2022
297 men and 295 women; 573 in 2019, 541 in 2020 and 571 in 2021, summed from the WCISU counts by four-digit ICD-10 code, age band and sex.
Sources: Public Health Wales, WCISU: cancer incidence in Wales 2002-2022, counts by ICD-10 code (xlsx, February 2026) (2026-02)
Deaths (C25)
553
Wales · 2025 (year of registration)
286 men and 267 women; 555 in 2024, 519 in 2023, 537 in 2022 and 488 in 2021, summed from the WCISU counts by ICD-10 code.
Sources: Public Health Wales, WCISU: cancer mortality in Wales 2002-2025, counts by ICD-10 code (xlsx, March 2026) (2026-03)
Stage at diagnosis (C25)
I 9%, II 10%, III 13%, IV 53%, unknown 15%
Wales · 2020-2022 (1,704 cases)
Of the 1,447 cases with a known stage, 22 percent were stage I or II and 63 percent stage IV.
Sources: Public Health Wales, WCISU: cancer incidence in Wales 2011-2022, stage data table (xlsx) (2026-02)
New cases (C25)
283
Northern Ireland · 2023
1,478 cases in 2019-2023, 296 a year (156 men, 140 women); median age 74; European age-standardised rate 17.1 per 100,000. 263 deaths a year in 2019-2023 (factsheet).
Sources: Northern Ireland Cancer Registry: pancreatic cancer data tables 1993-2023 (xlsx, Tables 1, 3, 4, 9, 11 and 12) (2026-09-24)
Stage at diagnosis (C25)
I 16%, II 12%, III 12%, IV 51%, unknown 9%
Northern Ireland · 2019-2023 (1,478 cases)
Of cases with a known stage: I 18 percent, II 13 percent, III 13 percent, IV 56 percent (TNM 8 from 2018).
Sources: Northern Ireland Cancer Registry: pancreatic cancer data tables 1993-2023 (xlsx, Tables 1, 3, 4, 9, 11 and 12) (2026-09-24)
Net survival (C25)
Show survival figures (2)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 29.9% at one year, 9.3% at five years net survival (c25) (Northern Ireland, diagnosed 2014-2018).
- One-year net survival rose to 33.5 percent for 2019-2023 diagnoses. By stage (2014-2018): stage I 59.6 percent at one year and 36 percent at five; stage IV 13.1 percent at one year and 1.3 percent at five. Population averages, not a personal prognosis.
Northern Ireland · diagnosed 2014-2018
Sources: Northern Ireland Cancer Registry: pancreatic cancer data tables 1993-2023 (xlsx, Tables 1, 3, 4, 9, 11 and 12) (2026-09-24)
People under inherited-risk surveillance
893
UK (EUROPAC) · January 2000 to April 2025
Median age 52. Actionable pancreatic findings in 3.6 percent of those under risk-stratified surveillance from 2020 against 0.8 percent before; operable lesions 3 percent against 0.6 percent.
Support in the UK
Charities focused on this cancer, the general cancer charities, and the official schemes that help with costs. Each link goes to the organisation's own page.
Charity
- Specialist nurse Support Line 0808 801 0707, email and WhatsApp
- Information on diagnosis, treatment, diet and PERT, including what to do in a PERT shortage
- Your local specialist centre list and a clinical trial finder
- Optimal Care Pathway and the PERT shortage campaign
Charity
- Symptom awareness and early diagnosis campaigns
- Education for GPs and the public
- Information for people affected
Charity
- Support line and online community
- Macmillan HPB clinical nurse specialists in many centres
- Grants and benefits advice
Charity
- Drop-in centres beside major cancer hospitals
- Benefits advice, psychological support and courses, free
Charity
- Nurse helpline and Cancer Chat forum
- Plain-English information on pancreatic cancer and a trial database
- The UK statistics quoted on this page
Free NHS prescriptions in England (medical exemption certificate)
Cost and benefit- Anyone undergoing treatment for cancer, the effects of cancer or the effects of cancer treatment is entitled to a five-year medical exemption certificate covering every NHS prescription, including PERT, insulin and pain relief; ask your GP or hospital doctor for the form
- Free without a certificate from age 60
Prescriptions in Scotland, Wales and Northern Ireland
Cost and benefit- Scotland: free for everyone; an EC92A form is only needed to have a prescription dispensed free in England
- Wales: free for anyone registered with a Welsh GP and dispensed in Wales; a WP92A medical exemption certificate for cancer covers dispensing anywhere in the UK
- Northern Ireland: all prescriptions dispensed in Northern Ireland are free, with nothing to apply for
Special rules for end of life (SR1)
Cost and benefit- If a doctor, consultant or specialist nurse says you may have 12 months or less to live, claims for PIP, Universal Credit, ESA, Attendance Allowance and DLA for children are fast-tracked, paid at the higher rate and need no medical assessment; the clinician completes an SR1 form
- Relevant early in pancreatic cancer, where half of people die within three months of diagnosis; nothing is lost if you live longer than expected
Personal Independence Payment
Cost and benefit- Non-means-tested payment for people under State Pension age whose illness or treatment affects daily living or mobility; special rules give a fast decision for terminal illness (SR1 form)
- Scotland has Adult Disability Payment instead
Attendance Allowance
Cost and benefit- For people over State Pension age who need help with personal care; special rules for terminal illness
Healthcare Travel Costs Scheme
Cost and benefit- Help with fares to hospital for people on qualifying benefits or low income; matters when the HPB hub is far from home (Devon and Cornwall to Plymouth, North Wales to Liverpool, the islands to Aberdeen)
Macmillan Grants
Cost and benefit- One-off payments for costs such as heating, travel or clothing; a nurse or social worker applies with you
More schemes by country on Assistance; costs of care on Costs.
Across the four nations
Where England, Scotland, Wales and Northern Ireland run different rules for the same step.
| Topic | England | Scotland | Wales | Northern Ireland |
|---|---|---|---|---|
| Waiting-time standards Sources: NHS England: changes to cancer waiting times standards from 1 October 2023 (2023-10-01); NHS England: 2025/26 priorities and operational planning guidance (2025-01); NHS England: implementing a timed HPB cancer diagnostic pathway (the 21-day best practice timed pathway; HTTP 202 to OnCo); Public Health Scotland: cancer waiting times, 1 January to 31 March 2026 (2026); Welsh Government: suspected cancer pathway quality report; NHS Wales Performance and Improvement: Suspected Cancer Pathway; Department of Health (Northern Ireland): cancer waiting times; Department of Health (Northern Ireland): cancer waiting time statistics, January to March 2026 (2026); NPaCA State of the Nation report 2026, full report (PDF) (2026-09) | 28-day Faster Diagnosis Standard (75%, 80% by March 2026); 31 days from decision to treat (96%); 62 days from referral to first treatment (85%, planning target 75% by March 2026); the HPB best practice timed pathway asks for diagnosis in 21 days. | 62 days from urgent suspicion of cancer referral to first treatment and 31 days from decision to treat, both set at 95%; 72.2% met the 62-day standard in January to March 2026. | Single Suspected Cancer Pathway: 62 days from the point of suspicion to first definitive treatment, target 75%; NHS Wales has a National Optimal Pathway for pancreatic cancer that the audit cites. | 31 days from decision to treat (98%) and 62 days from urgent GP referral (95%); performance is published quarterly by the Department of Health. |
| Who decides drug funding Sources: NICE: all products on pancreatic cancer (19 products on the check date) (2026-09-24); Scottish Medicines Consortium: medicines advice, keyword pancreas (five entries on the check date) (2026-09-24); NHS England: National Cancer Drugs Fund list, version 1.365 (6 June 2025), read in full: no pancreatic adenocarcinoma medicine; larotrectinib form LAR1a; belzutifan for VHL pancreatic neuroendocrine tumours (2025-06-06) | NICE technology appraisals (TA476 yes; TA440 no; TA750 and TA1052 terminated) and NG85 for the generics; the Cancer Drugs Fund for managed access (larotrectinib only); NHS England commissions. | Scottish Medicines Consortium: nab-paclitaxel accepted (968/14); liposomal irinotecan refused twice (1217/17, SMC2812); olaparib not recommended (SMC2435). | Follows NICE appraisals; the All Wales Medicines Strategy Group's list carries no pancreatic cancer medicine. | The Department of Health endorses NICE appraisals for the HSC. |
| The national audit Sources: NPaCA State of the Nation report 2026 (published September 2026; England diagnoses 2022-2023, Wales 2023-2024) (2026-09); NPaCA State of the Nation report 2026, full report (PDF) (2026-09); Pancreatic Cancer UK: Optimal Care Pathway hub (launched 2021; six recommendations, 21 days to diagnosis, 21 days to treatment) (2026-09-24) | National Pancreatic Cancer Audit (NATCAN, HQIP) covers every NHS trust; 2026 report on 17,672 people diagnosed 2022-2023, with trust-level dashboards. | Not in NPaCA; Public Health Scotland publishes cancer quality performance indicators and the Prehabilitation for Scotland programme is cited by the Optimal Care Pathway. | In NPaCA (951 people diagnosed 2023-2024, six health boards); MDT, PERT and CNS indicators not reported for Wales because the new Cancer Dataset Forms covered only 28 percent of people. | Not in NPaCA; the NIPANC and Queen's University Belfast pancreatic cancer audit is the local equivalent, cited by the Optimal Care Pathway. |
| Where surgery happens Sources: NPaCA State of the Nation 2026 methodology supplement, Table 7: trust codes for the 23 HPB specialist centres (PDF) (2026-09); Pancreatic Cancer UK: your local pancreatic cancer specialist centre (2026-09-24); GIRFT: pancreatic cancer national specialty report, executive summary (November 2025, PDF) (2025-11); NHS England service specification 2260: HPB, primary liver, secondary liver, perihilar biliary tract and gallbladder cancers (September 2024) (2024-09) | 23 surgical hubs (NPaCA Table 7; GIRFT) in a hub and spoke network, commissioned under specification 2260. | Three networks: Glasgow Royal Infirmary (West), Royal Infirmary of Edinburgh (South East), Aberdeen, Dundee and Inverness (North). | Morriston Hospital, Swansea for South Wales; North Wales to Liverpool; some mid Wales to Stoke-on-Trent; oncology at Velindre and Singleton. | One HPB service in the Belfast Trust; systemic treatment at the Northern Ireland Cancer Centre. |
| Genomic testing route Sources: NHS England: National Genomic Test Directory (the page answered HTTP 202 with an empty body to OnCo on 24 September 2026); GeNotes: genomic testing in the devolved nations (reviewed 6 August 2026) (2026-08-06) | National Genomic Test Directory, seven Genomic Laboratory Hubs (codes not quoted: the directory page answered 202). | Scottish Genomic Test Directory; four regional laboratories in Aberdeen, Dundee, Edinburgh and Glasgow. | All Wales Medical Genomics Service. | Northern Ireland Regional Molecular Diagnostics Service, Belfast. |
| Cancer statistics Sources: NDRS: Cancer Registration Statistics, England 2023 (the page answered HTTP 403 to OnCo on 24 September 2026); Cancer Research UK: pancreatic cancer statistics (key stats, stage and routes to diagnosis by nation) (2026-09-24); Public Health Scotland: cancer incidence in Scotland to December 2024 (published 18 August 2026) (2026-08-18); Public Health Scotland open data: annual cancer incidence, Scotland-level CSV (opendata_inc0024_scotland.csv; site Pancreas, ICD-10 C25) (2026-08-18); Public Health Wales, WCISU: cancer incidence in Wales 2002-2022, counts by ICD-10 code (xlsx, February 2026) (2026-02); Public Health Wales, WCISU: cancer incidence in Wales 2011-2022, stage data table (xlsx) (2026-02); Public Health Wales, WCISU: cancer mortality in Wales 2002-2025, counts by ICD-10 code (xlsx, March 2026) (2026-03); Northern Ireland Cancer Registry: pancreatic cancer (ICD-10 C25), official statistics 1993-2023 (2026-09-24) | National Disease Registration Service (NDRS): Cancer Registration Statistics, England, with counts by stage and routes to diagnosis; its pages returned 403 to OnCo, so England figures are quoted from Cancer Research UK and the audit. | Public Health Scotland: pancreas (C25) in the annual incidence open data CSV and the incidence publication to December 2024 (18 August 2026). | Welsh Cancer Intelligence and Surveillance Unit (Public Health Wales): counts by ICD-10 code, a stage table and mortality counts, as spreadsheets. | Northern Ireland Cancer Registry (Queen's University Belfast): pancreatic cancer tables with stage and survival, as a spreadsheet and factsheet. |
| Prescription charges Sources: NHS Business Services Authority: medical exemption certificates (five years for cancer, the effects of cancer or its treatment) (2026-09-24); NHS inform: prescription charges and exemptions (prescriptions in Scotland are free) (2026-01-07); Welsh Government: free prescriptions (2020-09-18); nidirect: help with health costs (all prescriptions dispensed in Northern Ireland are free of charge) (2026-09-24) | £9.90 an item unless exempt; anyone being treated for cancer or its effects gets a five-year medical exemption certificate, and everyone over 60 is exempt. | Free for everyone; no certificate needed. | Free for everyone registered with a Welsh GP and dispensed in Wales; a WP92A certificate covers cancer patients dispensing elsewhere in the UK. | Free for everyone; nothing to apply for. |
| Benefits under the special rules for end of life Sources: GOV.UK: get benefits if you're nearing the end of life (special rules) (2026-09-24); DWP: the Special Rules, how the benefit system supports people nearing the end of life (SR1 form, for clinicians) (2026-09-24); nidirect: benefits if you are nearing the end of life (2026-09-24); GOV.UK: Personal Independence Payment; GOV.UK: Attendance Allowance | PIP (under State Pension age) or Attendance Allowance (over it) fast-tracked at the higher rate, no assessment, when a clinician says 12 months or less; SR1 form. | Adult Disability Payment through Social Security Scotland instead of PIP; GOV.UK notes different special rules apply in Scotland. | As England (DWP). | The same 12-month test through the Department for Communities; if you live longer the benefit continues, with a review after three years. |
What could not be sourced
Named gaps, so a missing figure is never mistaken for a zero.
- NDRS Cancer Registration Statistics, England 2023: the publication page answered HTTP 403 to OnCo on 24 September 2026 (browser and plain user agents), so no England-only count for ICD-10 C25, stage split or routes-to-diagnosis table is quoted from the registry itself. England figures come from Cancer Research UK (which builds on NDRS) and from the National Pancreatic Cancer Audit, whose stage and route figures cover the audit population.
- NHS England's pages answered HTTP 202 with an empty body: the National Genomic Test Directory (so no pancreatic test codes are quoted; the tests come from GeNotes), the HPB best practice timed pathway, the Cancer Drugs Fund list page and the cancer waiting times standards pages. The standards are quoted as the same day's gallbladder pass recorded them; the CDF list was read from the version 1.365 PDF (6 June 2025), not the current version.
- The GeNotes search page renders its result links in the browser only; the pancreatic pages were reached by reconstructing their addresses from the result titles (four found, HTTP 200). GeNotes' earlier address pattern for a cancer presentation page answered 404.
- Scotland: Public Health Scotland's cancer mortality open data set could not be found at the address tried (HTTP 404 for /dataset/annual-cancer-mortality), so no Scottish death count is quoted from the registry; Pancreatic Cancer UK's statistics page carries 877 deaths in 2020. Scottish stage and survival figures are quoted from Cancer Research UK and Pancreatic Cancer UK rather than a PHS table.
- Northern Ireland: the registry's deaths per year (263 in 2019-2023) is read from the factsheet PDF, whose layout separated the label from the number; the data tables workbook has no mortality sheet.
- East Lancashire Hospitals NHS Trust's website answered OnCo with an Incapsula block page, so the Royal Blackburn entry links to Pancreatic Cancer UK's list. The UHNM and UHCW HPB service pages guessed from their site structures answered 404, so their trust home pages are linked. The University of Birmingham staff page for Keith Roberts (former GIRFT clinical lead) answered 404, so he has no person record and is named only through the GIRFT page.
- Pancreatic Cancer UK's earlier address for its PERT page, its specialist nurse page, its audit page and its campaign page answered 404; the current pages were found from the site's own links. Its family history page says EUROPAC will not accept new people from 1 January without a year visible in the text read, so the registry's current intake should be confirmed with the Liverpool team.
- The GIRFT pancreatic cancer national report (November 2025) is hosted in full on the FutureNHS platform behind a login; only the executive summary PDF was read. The GIRFT site itself answered 200 on this pass (it answered 403 to the gallbladder pass).
- ISRCTN records carry no separate overall-status field in the format read; statuses are the recruitment start and end dates and the WHO-format recruitment status. Be Part of Research and Pancreatic Cancer UK's trial finder render in the browser only and were not searched automatically. Trials registered only on ClinicalTrials.gov are not listed here.
- The All Wales Medicines Strategy Group's appraisal list page (HTTP 200) was searched for pancreatic entries and none was found; the list may be paginated, so a Welsh appraisal could exist unseen. The SMC's 2004 non-submission for erlotinib (141/04) is the only other pancreatic adenocarcinoma entry and is omitted as historic.
- The Test Directory codes for the germline pancreatic panel, the somatic panel and DPYD testing are not quoted because NHS England's page could not be read and GeNotes' pancreatic pages do not print them.
- No Northern Ireland or Scottish pancreatic-specific waiting-time or treatment-rate figure was found; the four-nation standards are quoted from the national performance publications and the audit covers England and Wales only.
- Europe PMC's search found no indexed record for a PRIMUS 001 primary paper under that title, so the PRIMUS results are described from the ISRCTN statuses rather than a publication.
How to read this page. Every figure and decision links to the page it was read from (127 sources, checked 2026-09-24); the drug and trial pills open OnCo records with their own sources. Standards and funding change: confirm with your team and the linked pages. Machine-readable copy at /api/v1/cancers/pancreatic/uk.json. OnCo is orientation, not medical advice.