What the diagnosis means
Most pancreatic cancers are adenocarcinomas of the pancreatic duct; less common neuroendocrine tumours behave and are treated very differently, so the exact type on the biopsy matters. At diagnosis, cancers are grouped as resectable (surgery possible), borderline resectable (surgery may become possible after treatment), locally advanced (wrapped around major blood vessels) or metastatic. Staging uses a pancreas-protocol CT, often endoscopic ultrasound for biopsy, and sometimes PET-CT or diagnostic laparoscopy.
Where medical oncology fits
The pancreatic surgeon determines resectability; medical oncology provides the systemic treatment that most patients need at some point:
- Before surgery (neoadjuvant) for borderline-resectable and, increasingly, resectable disease — to treat hidden spread early and improve the chance of complete removal.
- After surgery (adjuvant) — several months of chemotherapy improves survival after successful resection.
- Locally advanced disease — chemotherapy, sometimes followed by chemoradiation with the radiation oncologist.
- Metastatic disease — chemotherapy combinations chosen by fitness; a targeted maintenance drug for the minority whose cancer carries a BRCA mutation.
Genetic testing (germline BRCA and related genes) is recommended for all patients with pancreatic adenocarcinoma because it changes treatment and has implications for relatives.
Supportive care is part of treatment
Jaundice from a blocked bile duct is relieved with an endoscopic stent before chemotherapy can start. Enzyme capsules taken with meals help digestion and weight; pain is controlled proactively, including nerve-block procedures where needed; blood sugar is monitored because the pancreas also makes insulin. Nutrition and symptom control are reviewed at every visit.
What to expect
Chemotherapy regimens vary in intensity; the choice depends on fitness, age and other illnesses as much as on the cancer. Cycles are every two or three weeks, with scans and the CA 19-9 blood marker used to track response. Side effects include tiredness, nausea, diarrhoea, low blood counts and, with some drugs, nerve tingling or hair loss.
Questions to ask
- Is my cancer resectable now, or could it become resectable after chemotherapy?
- Which chemotherapy regimen is proposed and why that intensity for me?
- Has germline genetic testing (BRCA) been arranged?
- How will jaundice, pain, digestion and weight be managed alongside treatment?
- What is the realistic goal of treatment in my situation?
Preparing for your consultation
Bring the CT (pancreas protocol) and any EUS/biopsy reports, liver function tests and CA 19-9, records of any stent procedure, weight history, and a medicine list. If you have jaundice, itching or severe pain, say so when booking.