DEAR DR. ROACH: My husband, who is 78 and about 100 pounds overweight, was diagnosed with Parkinson’s disease in July 2022. In November 2025, he was diagnosed with stage I pancreatic cancer. He’s currently getting chemo treatments that started in early January of this year. He has two options — get surgery or get radiation treatments. His pancreatic surgeon seems to be discouraging the surgery, saying that he could end up in a nursing home for the rest of his life.

We saw his Parkinson’s doctor yesterday, and he told us that he didn’t think the surgery would be a problem. This is weighing heavy on our minds, so we welcome your opinion.

— S.B.

ANSWER: Something isn’t making sense. The most common cancer of the pancreas — exocrine pancreatic cancer — accounts for 95% of pancreatic cancer and is what most people think of as “pancreatic cancer.” It’s almost never found in stage I because there are rarely any symptoms at this time. It’s usually found in stage I incidentally when looking for something else.

When it is, surgery is recommended immediately for anyone in whom it can be attempted and anyone who can tolerate the surgery, as surgery has long been the only chance for a cure. (As I write this, I’m aware that a significant breakthrough in the medical treatment of exocrine pancreatic cancer, KRAS-targeted therapy, is showing what looks like spectacular potential.)

Unfortunately, chemotherapy has only had modest benefits until recently. Pancreatic cancer tends to be resistant to radiation. Even the combination of chemotherapy and radiation hasn’t historically shown a possibility for a cure, although it’s used for palliation in some people.

Although surgery for a pancreatic cancer cure is challenging, surgical advancements have made it less risky than it was decades ago. Since his surgeon seems to be recommending against surgery in favor of radiation and chemotherapy, I wonder whether your husband has an uncommon type of pancreatic cancer, such as a neuroendocrine tumor.

Being very overweight does make surgery more risky, which may be why the surgeon seems to be discouraging it, but he shouldn’t be withholding a potentially lifesaving surgery because of technical difficulty or because of the Parkinson’s, especially when the Parkinson’s expert says that your husband should be able to tolerate it.

Since he’s getting chemotherapy, he ought to be seeing a medical oncologist. I recommend discussing this with the oncologist to help make sense of his treatment, as something just isn’t adding up to me here.