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NCCN Guidelines for Patients



Pancreatic Cancer, Version 1.2017


Treatment guide

Boderline resectable pancreatic cancer

Tests and results

First, you may have a biopsy to confirm recurrence

of pancreatic cancer. Based on tests, your doctors

will know how far the cancer has spread. Cancer that

came back in or near the pancreas is called a local or

locoregional recurrence. Cancer that has spread to

sites far away from the pancreas is called metastatic



For pancreatic cancer recurrence, joining a clinical

trial is always the preferred treatment choice. Best

supportive care without active cancer treatment

should also be considered, especially for patients

with a poor health status. Your health status, also

called performance status, is a rating by your doctor

based on your overall health, cancer symptoms,

and ability to do daily activities. Supportive care,

also called palliative care, is treatment to relieve

the symptoms of cancer and side effects of cancer

treatment. The other recommended treatments for

a recurrence depend on how far the cancer has


For a local recurrence, there are other treatment

options. One option is to receive radiation, with or

without chemotherapy, if you haven’t had it before.

Another option is to receive a different chemotherapy

than you had before.

For metastatic cancer, treatment primarily consists

of chemotherapy, with the specific options depend

on how long it has been since your last treatment

was completed. If the cancer recurrence is more

than 6 months after completing primary treatment,

then options include trying the same chemotherapy

you had before or a different chemotherapy. If the

recurrence is less than 6 months after completing

primary treatment, then you should receive a different

chemotherapy than before.

Borderline resectable

pancreatic cancer

This section describes the tests and treatments

recommended for borderline resectable pancreatic

cancer. This is when cancer is confined to the

pancreas but involves nearby blood vessels or

structures to the extent that there is a risk that

it might not be resectable with clear (negative)

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.

Surgery should only be used as primary treatment if

your doctors think all of the cancer can be completely

removed at the time of the operation. Thus, if you

have a borderline resectable pancreatic cancer, your

doctor may plan to give you treatment before surgery

to try to shrink the cancer in order to increase the

chances that it can all be successfully removed.

This is called neoadjuvant treatment. However, your

doctor may also choose not to give neoadjuvant

treatment and just plan to do surgery right away.