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NCCN Guidelines for Patients



Pancreatic Cancer, Version 1.2017


Treatment guide

Pancreatic cancer testing

Guide 5. Pre-surgery evaluation


Symptom control


No jaundice


• CA 19-9

Jaundice + symptoms of

cholangitis or fever


• Plastic stent or consider metal

stent if cancer confirmed


• Antibiotic


• CA 19-9

Jaundice + no symptoms

of cholangitis and fever


Guide 5

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.

Symptom control

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.