NCCN Guidelines for Patients® Version Updates: Pancreatic Cancer

Following are the major updates that were included in the NCCN Guidelines for Patients®: Pancreatic Cancer, Version 1.2014.

  • Part 5 – Treatment guide
    • Page 40
      • Recommendations in the Treatment guide are now organized and grouped by the following pancreatic cancer stages:
        • Resectable
        • Borderline resectable
        • Locally advanced unresectable
        • Metastatic
  • Part 5.1 – Pancreatic cancer testing
    • Page 42 – Chart 5.1.1
      • Under "Test results" – Added new pathways for "No metastases" and "Metastases"
      • The following changes were made under "Next tests"
        • Changed "Chest CT" to "Chest imaging"
        • Added that MRI/MRCP or ERCP is now only recommended "as needed" Added EUS recommendation when metastases are present but initial imaging tests didn't show a tumor in the pancreas
    • Page 44 – Chart 5.1.2
      • This chart is new to the Treatment guide.
  • Part 5.2 – Resectable pancreatic cancer
    • Page 46 – Chart 5.2.1
      • Under "Follow-up" – Added recommended treatments for symptoms based on presence or absence of jaundice
    • Page 48 – Chart 5.2.2
      • Added "continuous infusion 5-FU" as an option for chemotherapy given alone and for chemotherapy given before or after chemoradiation
  • Part 5.3 – Borderline resectable pancreatic cancer
    • Pages 52 and 56
      • Treatment recommendations now separated based on "Planned neoadjuvant treatment" and "Planned surgery"
    • Page 52 – Chart 5.3.1
      • Under "Neoadjuvant treatment" – Added chemoradiation alone as an option
    • Page 54 – Chart 5.3.2
      • Under "Test results" – Possible staging laparoscopy is now only recommended if there is no cancer growth or spread
    • Page 56 – Chart 5.3.3
      • This chart is new to the Treatment guide
    • Page 58 – Chart 5.3.4
      • Added "Test results" column and pathways for adjuvant treatment recommendations based on test results
      • Added "continuous infusion 5-FU" as an option for chemotherapy given alone and for chemotherapy given before or after chemoradiation
  • Part 5.4 – Locally advanced unresectable pancreatic cancer
    • Page 62 – Chart 5.4.1
      • Under "Tests" – Removed "consider laparoscopy"
      • Under "Results and symptom control" – For cancer not confirmed, added "place stent with brushings" and "EUS-FNA preferred" for repeat biopsy
    • Page 64 – Chart 5.4.2
      • Under "First-line treatment" – For good health status, added two new options: "gemcitabine + nab-paclitaxel" and "continuous infusion 5-FU"
  • Part 5.5 – Metastatic pancreatic cancer
    • Page 68 – Chart 5.5.1
      • Under "First-line treatment" – For good health status, added two new options: "gemcitabine + nab-paclitaxel" and "continuous infusion 5-FU"
    • Page 70 – Chart 5.5.2
      • Under "Second-line treatment" – For good health status, added "Radiation therapy for severe pain resistant to medication"