Pancreatic cancer arises from the cells of the pancreas and often presents late with nonspecific symptoms. Early detection and a multidisciplinary treatment approach offer the best outcomes.

Why Do I Need Management?

You may require evaluation and treatment if you have:

  • Painless jaundice or dark urine
  • Unexplained weight loss and loss of appetite
  • Upper abdominal or back pain
  • New-onset diabetes or worsening glycemic control
  • Imaging (CT/MRI/EUS) showing a pancreatic mass

How Should I Prepare?

  • Diagnostic Tests:
    • Blood work: liver panel, CA 19-9 tumor marker
    • Imaging: contrast-enhanced CT or MRI pancreas protocol
    • EUS with fine-needle aspiration (FNA) for tissue diagnosis
  • Pre-treatment Assessment:
    • Cardio-pulmonary evaluation for fitness for surgery or chemotherapy
    • Nutritional assessment; enzyme replacement planning
  • Consent & Education:
    • Discussion of treatment options, risks, and expected outcomes
    • Arrange a family member or friend to accompany you to appointments

What Happens During Treatment?

Treatment is personalized by stage, fitness, and goals:

  1. Surgical Resection (for resectable tumors)
    • Whipple procedure or distal pancreatectomy to remove the tumor with clear margins
    • Drain placement for leak monitoring
  2. Neoadjuvant Therapy (borderline resectable)
    • Chemotherapy ± radiation to shrink the tumor before surgery
  3. Adjuvant Therapy (post-surgery)
    • Combination chemotherapy (e.g., FOLFIRINOX or gemcitabine-based) to reduce recurrence risk
  4. Definitive Chemoradiation (locally advanced, unresectable)
    • Concurrent chemotherapy and targeted radiation
  5. Palliative Care (metastatic disease)
    • Systemic chemotherapy regimens
    • EUS-guided celiac plexus neurolysis for pain control
    • Biliary stenting via ERCP or EUS-BD for jaundice
    • Nutritional support with enzyme replacement and specialized diets

What Can I Expect Afterwards?

  • Hospital Stay:
    • Surgery: 7–14 days depending on procedure and recovery
    • Chemotherapy infusions: outpatient or short admission
  • Pain & Symptom Management:
    • IV and oral analgesics; neurolysis for refractory pain
    • Antiemetics to control nausea
  • Nutrition:
    • Pancreatic enzyme supplements with meals
    • Small, frequent, high-protein, high-calorie meals or enteral nutrition
  • Activity:
    • Early mobilization after surgery
    • Gentle activity during chemotherapy; avoid crowds during low blood counts

Risks & Possible Complications

  • Surgical: pancreatic fistula (10–20%), delayed gastric emptying (20–30%), bleeding, infection
  • Chemotherapy: neutropenia, nausea, fatigue, neuropathy
  • Radiation: skin changes, fatigue, GI irritation
  • Neurolysis: transient hypotension, diarrhea
  • Stenting: occlusion, migration, cholangitis

Seek immediate care if you develop fever, uncontrolled pain, jaundice, severe vomiting, or signs of infection.

Follow-Up

  • Surveillance:
    • Imaging (CT or MRI) and CA 19-9 every 3 months for 2 years, then every 6 months
    • Endocrine and exocrine pancreatic function monitoring
  • Supportive Care:
    • Ongoing pain and symptom management
    • Psychosocial support and palliative care involvement as needed