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50

NCCN Guidelines for Patients

®

:

Pancreatic Cancer, Version 1.2017

Guide 13

shows the recommended pretreatment

steps for locally advanced unresectable pancreatic

cancer. The pretreatment process may include some

tests and managing symptoms caused by the cancer.

Tests

Before beginning cancer treatment, a biopsy is

recommended 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.

Results and symptom control

If a biopsy confirms pancreatic cancer, then the next

step is to treat symptoms caused by the cancer. One

common symptom is jaundice. This is a yellowing

of the skin and eyes due to a buildup of bilirubin

in the blood. Bilirubin is a yellow-brown substance in

bile. It is a digestive fluid made in the liver.

A tumor can cause jaundice by blocking a duct that

drains bile and bilirubin from the liver. 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. You may

not need a stent if you had a biliary bypass during a

previous surgery or laparoscopy.

Guide 13. Pretreatment tests and symptom control

Tests Results Symptom control

Biopsy to

confirm

cancer (if not

done before)

ª

• Cancer

confirmed

ª

• If jaundice

, consider metal stent

ª

• Cancer not

confirmed

ª

• If

jaundice

,

consider

metal

stent, then

repeat

biopsy

ª

• Cancer confirmed, see first

row of this guide

ª

• Cancer not confirmed,

seek an expert opinion

ª

• Other cancer confirmed,

see NCCN treatment

guideline for other cancer

ª

• Other

cancer

confirmed

ª

• See NCCN treatment guideline for other cancer

5

Treatment guide Locally advanced unresectable pancreatic cancer