NCCN Guidelines for Patients® | Pancreatic Cancer - page 54

52
NCCN Guidelines for Patients
®
Pancreatic Cancer, Version 1.2014
5.3
Treatment guide
Borderline resectable pancreatic cancer
5.3 Borderline resectable pancreatic cancer
Part 5.3 describes the tests and treatments that are
recommended for borderline resectable pancreatic
cancer. This is when cancer is confined to the
pancreas but approaches nearby structures or has
severe symptoms, raising concern that the cancer
might not be resectable with clear margins. A clear
margin is when no cancer cells are found in the
normal-looking tissue around the edge of the tumor
removed during surgery. “Borderline resectable”
means that it isn’t clear whether or not all of the
cancer can likely be removed by surgery. Resectable
means the cancer can be removed by surgery.
Unsresectable means it can’t be removed by surgery.
Primary treatment is the main treatment used to rid
the body of cancer. Surgery should only be used
as primary treatment if your doctors think all of the
cancer can be completely removed. Thus, your doctor
may plan to give you treatment before surgery to try
to shrink the cancer to increase the chances that
it can all be removed. This is called neoadjuvant
treatment. However, your doctor may choose not
to give neoadjuvant treatment and just plan to do
surgery right away.
For planned neoadjuvant treatment, see Chart 5.3.1
below. For planned surgery without neoadjuvant
treatment, see Chart 5.3.3.
Chart 5.3.1
shows the recommended options for
neoadjuvant treatment for borderline resectable
pancreatic cancer. The goal of neoadjuvant treatment
is to shrink the cancer so that it can all be removed
with surgery.
Tests
Test results
Neoadjuvant treatment
Chart 5.3.1 Planned neoadjuvant treatment
• Biopsy (EUS-FNA
preferred),
• Possible staging
laparoscopy, and
• Place stent if
blocked bile duct
Biopsy
confirms
cancer
Chemotherapy,
Chemoradiation, or
Chemotherapy + chemoradiation
None
Cancer not
confirmed
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