NCCN Guidelines for Patients® | Pancreatic Cancer - page 60

58
NCCN Guidelines for Patients
®
Pancreatic Cancer, Version 1.2014
5.3
Treatment guide
Borderline resectable pancreatic cancer
Chart 5.3.4
shows the tests and treatments that are
recommended after completing primary treatment with
surgery for borderline resectable pancreatic cancer.
Primary treatment is the first or main treatment given
to rid the body of cancer. Adjuvant treatment is given
after primary treatment to try to kill any remaining
cancer cells.
Tests
Before beginning adjuvant treatment, you will have
a CT scan and CA 19-9 blood test. These tests are
done to check for signs of recurrence—the return
of cancer after treatment. They also check for
metastases—cancer that has spread outside the
pancreas to far sites in the body. Read Part 2 on
page 14 for test details.
Test results
If tests show metastases,
then adjuvant treatment
is not recommended. Instead, you will receive
treatment for metastatic pancreatic cancer. See
Next
steps
at the end of this section.
Tests
Test results
Adjuvant treatment
Follow-up
• CT scan
• CA 19-9
No recurrence
or metastases,
No neoadjuvant
treatment
Metastases
found
Chart 5.3.4 Adjuvant treatment after surgery
Consider additional
chemotherapy
Chemotherapy +
Chemoradiation, or
Clinical trial preferred,
Chemotherapy alone
Testing every 3 to 6 months
for 2 years, and then once
a year with:
• Medical history and
physical exam,
• CA 19-9 level, and
• CT scan
Treatment for
metastatic cancer
Options for chemotherapy alone:
• Gemcitabine,
• 5-FU/leucovorin,
• Continuous infusion 5-FU, or
• Capecitabine
Options for chemotherapy given
before or after chemoradiation:
• Gemcitabine,
• 5-FU/leucovorin, or
• Continuous infusion 5-FU
No recurrence
or metastases,
Had neoadjuvant
treatment
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