NCCN Guidelines for Patients
Pancreatic Cancer, Version 1.2017
Pancreatic cancer testing
Guide 5. Pre-surgery evaluation
• CA 19-9
Jaundice + symptoms of
cholangitis or fever
• Plastic stent or consider metal
stent if cancer confirmed
• CA 19-9
Jaundice + no symptoms
of cholangitis and fever
shows the next steps that are
recommended when initial tests show no signs
of cancer outside the pancreas. When cancer is
only in the pancreas, surgery may be a treatment
option. When deciding if surgery is possible, it is
recommended that doctors consult a multidisciplinary
team of experts at a hospital that does more than
15 pancreatic cancer surgeries each year. The tests
in the guide above will help your doctor decide if
surgery is a good option for you. First, your doctors
will treat any symptoms of cancer you may have.
CA 19-9 is a substance found in blood. Pancreatic
cancer can cause high levels of CA 19-9 in the blood.
Thus, a CA 19-9 blood test is recommended before
surgery to check for signs of advanced cancer. CA
19-9 levels can also be high when there is too much
bilirubin in the blood due to a blockage of the bile
duct(s). If you are jaundiced with high bilirubin levels,
your doctors should wait to test your CA 19-9 levels
since they will want to know if the high CA 19-9 level
is being caused by cancer or bilirubin.
Symptoms may include abdominal or back pain,
weight loss, decreased appetite, and jaundice.
Jaundice is a yellowing of the eyes and skin, and can
also be accompanied by itching, tea-colored urine,
and clay-colored stools.
If you have jaundice, then your doctors will place a
stent in the bile duct (typically by ERCP) to relieve
the blockage in your bile duct. You will often be given
antibiotic drugs along with the stent, especially if you
have signs of cholangitis (bile duct infection) such
as fevers or chills. If you will have surgery for your
pancreatic cancer in the very near future, placement
of a bile duct stent may not be necessary.