NCCN Guidelines for Patients® | Pancreatic Cancer - page 49

NCCN Guidelines for Patients
Pancreatic Cancer, Version 1.2014
Treatment guide
Resectable pancreatic cancer
metastases—cancer that has spread far from the first
tumor in the pancreas. If your doctors think all the
cancer can be removed, then you will have surgery.
Primary treatment and follow-up
The type of surgery you will have depends on the size
and location of the tumor. Read Part 3 on page 24
for details about each type of surgery for pancreatic
cancer. NCCN experts recommend that surgery
for pancreatic cancer should only be done at a
hospital that does more than 15 pancreatic surgeries
each year. Hospitals that perform many pancreatic
surgeries often have better results.
If all of the cancer can be removed,
the surgery will be completed. After completing
surgery, you will have more treatment to try to kill
any remaining cancer cells. This is called adjuvant
treatment. See
Next steps
at the end of this section.
At the start of the surgery, your doctors may
find that the cancer has spread too much and
can’t be removed by surgery.
At this time, you
will have a biopsy to confirm pancreatic cancer if not
done previously. The next recommendations depend
on whether or not you have jaundice. Jaundice is
a yellowing of the eyes and skin due to a buildup
of bilirubin in the body. Bilirubin is a yellow-brown
substance in bile—fluid made by the liver to help
digest food. A tumor in the pancreas can cause
jaundice by blocking a duct that drains bile from the
If you do not have jaundice,
your doctor may want
to do a surgery to re-route the path between the
stomach and duodenum, the first part of the small
intestine. This is called a duodenal bypass and it may
be done if cancer is blocking the stomach. If you have
severe pain, your doctor may inject alcohol (ethanol)
into the nerves near the pancreas to destroy them to
relieve the pain. This is called a nerve block.
If you have jaundice, then your doctor may place a
stent in the bile duct to unblock it. Or, your doctor may
do a surgery to re-route the flow of bile around the
blocked part of the bile duct. This is called a biliary
bypass. In addition, you may have a duodenal bypass
or nerve block as described above.
For cancer that couldn’t be removed by surgery, the
next treatments depend on how far the cancer has
spread. Cancer that has spread outside the pancreas
to nearby blood vessels or other tissues is called
locally advanced unresectable. Cancer that has
spread outside the pancreas to far sites in the body is
called metastatic.
Next steps:
If surgery was completed, see
Chart 5.2.2 for adjuvant treatment
recommendations. If surgery wasn’t
completed, see Part 5.4 for treatments
that are recommended for locally
advanced unresectable pancreatic
cancer or Part 5.5 for treatments that
are recommended for metastatic
pancreatic cancer.
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