PANC-2 -Resectable Disease

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PANC-2

Resectable Disease

High Risk Patient

Not High Risk

Neoadjuvant therapy

EUS guided biopsy

Stent

See Principles of Stent Management (PANC-B).

PANC-B

CA 19-9

Elevated CA 19-9 does not necessarily indicate cancer or advanced disease. CA 19-9 may be elevated as a result of biliary infection (cholangitis), inflammation, or obstruction, benign or malignant. In addition, CA 19-9 will be undetectable in Lewis antigen-negative individuals.

Chest/Pelvic CT

Imaging with contrast unless contraindicated.

Surgery

Surgery (laparotomy or minimally invasive surgery)

See Principles of Surgical Technique (PANC-D) and Pathologic Analysis: Specimen Orientation, Histologic Sections, and Reporting (PANC-E).

Successful Resection?

See Principles of Surgical Technique (PANC-D) and Pathologic Analysis: Specimen Orientation, Histologic Sections, and Reporting (PANC-E).

PANC-4

PANC-5

Pancreatic CT/MRI

Proceed to surgery (without neoadjuvant therapy)

High Risk: Consider staging laparoscopy

High-risk features include imaging findings, very highly elevated CA 19-9, large primary tumors, large regional lymph nodes, excessive weight loss, extreme pain.

Neoadjuvent therapy

There is limited evidence to recommend specific neoadjuvant regimens off-study, and practices vary with regard to the use of chemotherapy and chemoradiation. See Principles of Systemic Therapy (PANC-F) for acceptable neoadjuvant options.

Subsequent chemoradiation is sometimes included; see Principles of Radiation Therapy (PANC-G).

PANC-G

PANC-F