NCCN Guidelines for Patients
Pancreatic Cancer, Version 1.2014
Metastatic pancreatic cancer
in the pancreas can cause jaundice by blocking the
bile duct that drains bilirubin out of the liver. To relieve
symptoms of jaundice, your doctor will place a stent
in the bile duct to unblock it (see page 36 for details).
But, a stent is not needed if you had a biliary bypass
during a previous surgery or laparoscopy.
Health status rating
Which first-line treatment option is recommended
for you depends on your health status rating, also
called performance status. Your health status is a
rating by your doctor based on your overall health,
cancer symptoms, and ability to do daily activities.
Good health status means that your overall health is
good. You’re able to continue doing all of your regular
daily activities very well. You also have very few or
very mild symptoms of the cancer and you’re able to
eat well. Poor health status means that your overall
health is poor. You aren’t able to do your regular daily
activities well. The number and/or severity of cancer
symptoms is increased.
Your health status rating is a very important factor
when choosing the best treatment for you. This
is because healthier patients are able to tolerate
treatments with higher risks of side effects. Certain
treatments and drug combinations have a higher risk
of severe, even lethal, side effects. Your doctor should
explain all of the risks and possible side effects of the
treatments you receive.
If you have a good health status,
then there are
several first-line treatment options to choose from.
The preferred option is to receive treatment within
a clinical trial. A clinical trial is a type of research
that studies the safety and effectiveness of a test or
treatment. (Read page 30 for details on clinical trials.)
Your other options are chemotherapy drugs that have
been tested in clinical trials.
The other options include FOLFIRINOX, gemcitabine
with nab-paclitaxel, gemcitabine with erlotinib, a
different gemcitabine-based combination regimen,
gemcitabine alone, capecitabine, or continuous
infusion 5-FU. FOLFIRINOX is a combination regimen
that includes 5-FU, leucovorin, irinotecan, and
oxaliplatin. (Read Part 3 on page 28 for treatment
If you have a poor health status,
there are two
treatment options to choose from. One option is
to receive gemcitabine alone. The other option is
to receive the best palliative and supportive care
available. Supportive care—also called palliative
care—is treatment for the symptoms and health
conditions caused by pancreatic cancer. Read Part 4
on page 36 for more details on supportive care.
If first-line treatment doesn’t stop
the cancer from growing, see Chart
5.5.2 for second-line treatment