NCCN Guidelines for Patients® | Pancreatic Cancer - page 56

54
NCCN Guidelines for Patients
®
Pancreatic Cancer, Version 1.2014
5.3
Treatment guide
Borderline resectable pancreatic cancer
Chart 5.3.2
shows the follow-up tests and
treatments that are recommended after completing
neoadjuvant treatment for borderline resectable
pancreatic cancer. Follow-up tests are given after
treatment to check how well treatment worked. These
tests look for signs of cancer growth or spread.
Tests
Imaging tests of your belly area (abdomen), pelvis,
and chest are recommended. Imaging tests are tests
that take pictures of the inside of your body. (Read
Part 2 on page 15 for imaging test details.) The
imaging tests of your abdomen should be done in a
certain way, called a pancreatic protocol. A pancreatic
protocol imaging test is done in a special way so that
it focuses specifically on the pancreas. This allows
doctors to clearly see the pancreas, nearby blood
vessels, and tiny tumors.
Test results and primary treatment
If the follow-up tests don’t show any signs of
cancer growth or spread,
then you may have a
staging laparoscopy before surgery to remove the
cancer. A staging laparoscopy is a surgical test used
to see how far the cancer has spread and confirm
if it all can be removed by surgery. If your doctors
still think all the cancer can be removed, then you
will have primary treatment with surgery. There are
3 types of surgery for pancreatic cancer. Which type
of surgery you will have depends on the size and
location of the cancer in your pancreas. Read Part 3
on page 24 for details on the types of surgery used to
remove pancreatic cancer.
Surgery should be done 4 to 8 weeks after
neoadjuvant treatment. Surgery can be done more
than 8 weeks afterward, but radiation-induced fibrosis
Tests
Test results
Primary treatment
Imaging
tests of:
• Abdomen,
• Pelvis, and
• Chest
No cancer growth
or spread:
Possible staging
laparoscopy
before surgery
Cancer growth
or spread:
Surgery is not
an option
Chart 5.3.2 Follow-up after neoadjuvant treatment
Completed surgery
Surgery can’t be completed:
If jaundice, stent or biliary
bypass + duodenal bypass +
nerve block
Surgery
Treatment for locally advanced or
metastatic cancer
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