NCCN Guidelines for Patients
Pancreatic Cancer, Version 1.2017
Treatment guide Locally advanced unresectable pancreatic cancer
shows the tests and treatments that are
recommended when there is a return (recurrence) of
cancer after surgery and adjuvant treatment.
Tests and results
First, you may have a biopsy to confirm pancreatic
cancer if not done previously. A biopsy is the removal
of a sample of tissue from your body to test for
cancer cells. Additional imaging studies will allow
your doctors to know how far the cancer has spread.
Cancer that came back in or near the pancreas is
called a local 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 above
any other option. A clinical trial is a type of research
that studies the safety and effectiveness of a test or
treatment. 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. See Part 4 for supportive
For a local recurrence, there are two other
treatment options. One option is to receive
chemoradiation if you haven’t had it before.
The other option is to receive a different
chemotherapy than you had before.
For metastatic cancer, the other options depend
on how long it has been since the last treatment
was completed. If the cancer recurrence is
more than 6 months after completing the last
treatment, then options include the same
chemotherapy you had before or a different
chemotherapy. If the recurrence is less than
6 months after completing the last treatment,
then the other option is to receive a different
chemotherapy than before.
Locally advanced unresectable
This section describes the tests and treatments
recommended for cancer that has spread outside the
pancreas to nearby blood vessels or other tissues
and can’t be removed by surgery. This is called
locally advanced unresectable.
Cancer that can be removed by surgery is
Cancer that can’t be removed by surgery is