NCCN Guidelines for Patients
Pancreatic Cancer, Version 1.2014
Resectable pancreatic cancer
If the tests do not show any signs of recurrence
then you will receive adjuvant
treatment. Adjuvant treatment should only be started
after you’ve fully recovered from surgery. Starting 4 to
8 weeks after surgery is ideal.
There are 3 main options for adjuvant treatment.
Taking part in a clinical trial is strongly recommended
and is the preferred option for adjuvant treatment.
A clinical trial is a type of research that studies the
safety and effectiveness of a test or treatment. Read
Part 3 on page 30 for more details on clinical trials.
If you aren’t able to join a clinical trial, another option
is to receive chemotherapy and chemoradiation.
In this case, chemotherapy may be given before
or after chemoradiation. Another CT scan is
recommended after chemotherapy if it will be followed
by chemoradiation. Recommended chemotherapy
drugs include gemcitabine, 5-FU with leucovorin, or
continuous infusion 5-FU. Chemoradiation may be
fluoropyrimidine-based or gemcitabine-based. Read
Part 3 on page 24 for details on each treatment.
The third option is to receive chemotherapy only.
In this case, chemotherapy drug options include
gemcitabine, 5-FU with leucovorin, continuous
infusion 5-FU, or capecitabine. Gemcitabine is
preferred because its side effects aren’t as severe as
5-FU/leucovorin. Capecitabine is suggested as a last
choice only when other options cannot be used.
After completing adjuvant treatment, you will have
follow-up tests. Follow-up tests are tests given after
treatment to check how well treatment worked. These
tests look for signs of cancer return (recurrence) or
spread (metastasis) after treatment.
Follow-up tests are recommended every 3 to 6
months for 2 years, and then once every year. A
medical history and physical exam can help to find
signs and symptoms of pancreatic cancer early. CA
19-9 is a substance found in blood and high levels
can be caused by pancreatic cancer. Thus, a CA
19-9 blood test is recommended as part of follow-
up testing. A CT scan is also recommended to look
for early signs of cancer recurrence. Read Part 2 on
page 14 for details.
After completing adjuvant treatment,
if follow-up tests show a recurrence,
see Chart 5.2.3 for treatment
recommendations. If you didn’t have
adjuvant treatment because tests after
surgery found metastases, see Part 5.5
for treatment recommendations.