NCCN Guidelines for Patients® | Pancreatic Cancer - page 46

NCCN Guidelines for Patients
Pancreatic Cancer, Version 1.2014
Treatment guide
Pancreatic cancer testing
Chart 5.1.2
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 chart above will help your doctor decide if surgery
is a good option for you. But 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 are also high when there is too much
bilirubin in the blood. Bilirubin is a yellow-brown
substance removed from blood by the liver. It drains
out of the liver through tiny tubes called bile ducts.
If a bile duct is blocked, then bilirubin will build up
in the blood. Too much bilirubin in the blood causes
jaundice—a yellowing of the eyes and skin. You may
have jaundice because a tumor has blocked a bile
duct. In this case, your doctors should wait to test
your CA 19-9 levels, because they won’t know if
the high CA 19-9 level is being caused by cancer or
Symptom control
If you have jaundice
and symptoms of cholangitis
or fever, then your doctors will place a stent in the bile
duct to unblock it. You will be given antibiotic drugs
along with the stent. Your doctor may also place a
stent if you are very itchy from jaundice or won’t have
surgery within a week. If bilirubin levels return to
normal before surgery, a CA 19-9 test can be done.
Based on the results of the tests in Chart 5.1.1
and Chart 5.1.2, your doctors will decide if the
Symptom control
No jaundice
Chart 5.1.2. Pre-surgical evaluation
CA 19-9
CA 19-9
Jaundice + symptoms of
cholangitis or fever
• Short metal stent, and
• Antibiotics
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