NCCN Guidelines for Patients
Pancreatic Cancer, Version 1.2014
Borderline resectable pancreatic cancer
First, your doctor will remove a sample of the tumor to
test for cancer cells. This is called a biopsy. There is
more than one type of biopsy, but an EUS-FNA biopsy
is preferred. (Read Part 2 on page 14 for biopsy and
other test details.) Your doctor may also want to do
a surgical test to see how far the cancer has spread.
This is called a staging laparoscopy and it is used to
confirm if all the cancer can be removed with surgery.
It may find metastases that didn’t show up on other
imaging tests. Your doctors may consider this test if
you are at higher risk of having metastases—cancer
that has spread far from the pancreas. If the cancer
is blocking a bile duct, then a stent will be placed to
unblock it (see page 36 for details).
Test results and treatment
If the first biopsy doesn’t confirm cancer,
repeat biopsy must be done. If the repeat biopsy still
doesn’t confirm pancreatic cancer, then neoadjuvant
treatment isn’t recommended. In this case, see
at the end of this section for recommendations.
Once a biopsy confirms pancreatic cancer,
then you will begin neoadjuvant treatment. There
are 3 main treatment options to choose from:
chemotherapy only, chemoradiation only, or
chemotherapy and chemoradiation. However, there
is not enough evidence to recommend one specific
drug regimen over another for neoadjuvant treatment.
Most regimens incorporate radiation therapy, but
chemotherapy alone is currently being studied.
If you received neoadjuvant treatment,
see Chart 5.3.2 for recommended
follow-up and primary treatment. If the
cancer wasn’t confirmed by a repeat
biopsy, see Part 5.3.3 for planned