Table of Contents Table of Contents
Previous Page  47 / 86 Next Page
Information
Show Menu
Previous Page 47 / 86 Next Page
Page Background

43

NCCN Guidelines for Patients

®

:

Pancreatic Cancer, Version 1.2017

5

Treatment guide

Borderline resectable pancreatic cancer

Guide 9

shows the recommended options for

neoadjuvant treatment for borderline resectable

pancreatic cancer. The goal of neoadjuvant treatment

is to shrink the cancer so all of the cancer can be

removed with surgery.

Tests

First, your doctor will remove a sample of the tumor

to test for cancer cells. This is called a biopsy. There

is more than one type of biopsy, but an EUS-FNA

biopsy is preferred. Your doctor may also want to

do a staging laparoscopy to make sure there are no

metastases in your abdomen that didn’t show up on

other imaging tests. This is usually considered if you

are at higher risk of having metastases. If the cancer

is blocking a bile duct, then a stent will be placed to

unblock it.

Test results and treatment

If the first biopsy doesn’t confirm cancer, then a

repeat biopsy must be done. Neoadjuvant treatment

isn’t recommended until a cancer diagnosis is

confirmed by biopsy. Consider further testing at a

hospital or cancer center that treats a high number of

people with pancreatic cancer.

Once a biopsy confirms pancreatic cancer, then you

will begin neoadjuvant treatment. There are 3 main

treatment options to choose from: chemotherapy

only, chemotherapy and chemoradiation, or

chemoradiation alone. There is not enough evidence

to recommend which of these approaches is best

or which specific chemotherapy regimen to use

for neoadjuvant treatment. Although, the regimens

used for metastatic disease are commonly used

for borderline resectable pancreatic cancer as well.

Joining a clinical trial is encouraged.

Next steps

If you received neoadjuvant treatment, see Guide

10 for follow-up after neoadjuvant treatment. See

Guide 11 for further treatment recommendations after

neoadjuvant treatment.

Guide 9. Planned neoadjuvant treatment

Test Test results Neoadjuvant treatment or further care

• Biopsy

EUS-FNA

(preferred)

• Consider

staging

laparoscopy

• CA 19-9

ª

• Biopsy

confirms

cancer

ª

• Place

metal

stent if

blocked

bile duct

ª

Neoadjuvant treatment including:

• Chemotherapy

or

• Chemotherapy with

chemoradiation

or

• Chemoradiation

ª

• No

cancer

confirmed

ª

• Repeat

biopsy

ª

• Biopsy

confirms

cancer

ª

• See

first row

of this

guide

ª

• No

cancer

ª

• Seek an

expert

opinion