{
  "schemaVersion": 2,
  "eyebrow": "Gastrointestinal Oncology",
  "title": "Pancreatic Cancer",
  "summary": "Manage pancreatic ductal adenocarcinoma by establishing histology when systemic therapy is planned, defining vascular anatomy and metastatic burden on pancreas-protocol imaging, and selecting surgery-first versus neoadjuvant treatment through multidisciplinary review of resectability and biologic risk.",
  "seoDescription": "Point-of-care approach to pancreatic cancer staging, resectability classification, tissue diagnosis, perioperative treatment, and surveillance decisions.",
  "clinicalQuestion": "How should physicians stage, classify resectability, and sequence treatment for pancreatic ductal adenocarcinoma?",
  "specialty": "Medical Oncology",
  "audience": "U.S. physicians and medical trainees",
  "tags": [
    "pancreatic ductal adenocarcinoma",
    "pancreas protocol CT",
    "borderline resectable pancreatic cancer",
    "neoadjuvant therapy",
    "FOLFIRINOX",
    "CA 19-9"
  ],
  "keyTakeaways": [
    "Obtain high-resolution pancreas-protocol CT angiography or MRI before treatment to assess metastatic disease, vascular involvement, resectability, and operative planning. [19]",
    "Classify tumors with no major vascular involvement or metastases as resectable; limited arterial contact of 180° or less or reconstructable portal/superior mesenteric venous involvement supports a borderline-resectable designation. [19]",
    "Upfront surgery followed by adjuvant chemotherapy remains a standard approach for anatomically resectable disease, whereas borderline-resectable disease should receive neoadjuvant chemotherapy, with or without radiotherapy, before resection is attempted. [19][20]",
    "For resectable disease, consider neoadjuvant chemotherapy when elevated CA 19-9, suspicious regional nodes, or equivocal radiographic findings suggest biologically higher-risk disease. [19]",
    "Interpret CA 19-9 as a contextual biomarker rather than a stand-alone diagnostic test; tumors in Lewis antigen Le(a−b−) individuals may not secrete CA 19-9. [8]"
  ],
  "sections": [
    {
      "id": "initial-staging-and-tissue-diagnosis",
      "eyebrow": "Initial Assessment",
      "heading": "Stage before committing to surgery or systemic therapy",
      "intro": "The initial decision is whether disease is potentially curable by multimodality treatment or metastatic and managed primarily with systemic therapy.",
      "paragraphs": [
        "Use high-resolution pancreas-protocol CT angiography as the principal preoperative study for local staging, vascular mapping, resectability assessment, and surgical planning; MRI is an alternative or complementary modality when needed for staging clarification. Review images in a pancreas-focused multidisciplinary conference before assigning resectability or scheduling resection. [19][20]",
        "Establish the diagnosis and stage with cross-sectional imaging plus tissue confirmation when neoadjuvant or palliative systemic therapy is planned. Imaging alone may establish a surgical pathway for a clearly resectable pancreatic mass, but treatment sequencing should be revisited if radiographic findings are equivocal, regional adenopathy is suspicious, or CA 19-9 is elevated. [19]",
        "Use CA 19-9 as a baseline disease-burden and longitudinal monitoring adjunct, not as a screening or independent diagnostic test. A normal result does not exclude pancreatic ductal adenocarcinoma because some tumors do not secrete CA 19-9 in patients with Lewis antigen Le(a−b−). Interpret interval values with imaging-based response assessment rather than using marker change alone to declare progression or response. [8]"
      ],
      "bullets": [
        "Review pancreas-protocol imaging for distant metastases before potentially curative surgery. [19]",
        "Document arterial and portal-mesenteric venous tumor contact in the staging report because this changes the initial treatment sequence. [19]",
        "Use RECIST 1.1 CT assessment as a current radiographic monitoring standard during systemic treatment; recognize that imaging can be difficult to interpret in patients receiving immunotherapy. [8]"
      ],
      "subsections": [],
      "table": {
        "caption": "Anatomic resectability directs the initial therapeutic sequence. [19][20]",
        "columns": [
          "Clinical category",
          "Defining imaging features",
          "Initial management implication"
        ],
        "rows": [
          [
            "Resectable",
            "No metastases and no major vascular involvement. [19]",
            "Upfront resection is a standard approach, followed by adjuvant chemotherapy; consider neoadjuvant chemotherapy for elevated CA 19-9, suspicious nodes, or equivocal imaging. [19]"
          ],
          [
            "Borderline resectable",
            "Limited contact of 180° or less with the celiac axis, superior mesenteric artery, common hepatic artery, or inferior vena cava, or reconstructable portal vein/superior mesenteric vein involvement. [19]",
            "Use neoadjuvant chemotherapy, with or without radiotherapy, then reassess for surgical resection. [19][20]"
          ],
          [
            "Locally advanced",
            "Unresectable because of extensive vascular involvement. [19]",
            "Begin individualized nonsurgical management; radiotherapy may improve local control, and surgery may be considered only in selected patients after downstaging. [19]"
          ],
          [
            "Metastatic",
            "Distant metastatic disease on staging imaging. [19]",
            "Use systemic therapy as the central treatment modality; surgery is not the routine initial strategy. [19][23]"
          ]
        ]
      }
    },
    {
      "id": "resectable-disease",
      "eyebrow": "Potentially Curative Disease",
      "heading": "Sequence therapy for anatomically resectable disease",
      "intro": "The key choice is surgery-first versus neoadjuvant treatment for patients with technically resectable disease.",
      "paragraphs": [
        "For resectable pancreatic ductal adenocarcinoma, surgery-first followed by adjuvant chemotherapy remains a standard pathway. The intent is an R0 resection followed by postoperative systemic treatment; therefore, assess whether the patient can realistically complete multimodality therapy before choosing the sequence. [19][20]",
        "Use neoadjuvant chemotherapy selectively in resectable disease with high-risk biology or uncertain stage, particularly elevated CA 19-9, radiographically suspicious lymphadenopathy, or equivocal imaging findings. This approach may clarify disease trajectory before a major operation, but randomized evidence has not yet conclusively established a survival advantage over surgery-first treatment for all upfront-resectable tumors. [19][14]",
        "After resection, use adjuvant combination chemotherapy when tolerable. Combination regimens including modified FOLFIRINOX and gemcitabine-capecitabine have improved disease-free and overall survival compared with gemcitabine in the postoperative setting. [14]"
      ],
      "bullets": [
        "Refer all apparently resectable cases for review by pancreatic surgery, medical oncology, radiology, and radiation oncology before finalizing treatment order. [14][19]",
        "Avoid interpreting a technically operable scan in isolation; elevated CA 19-9, suspicious nodes, and radiographic uncertainty are reasons to discuss preoperative systemic therapy. [19]",
        "Plan adjuvant therapy before surgery, including postoperative recovery expectations and medical fitness for combination chemotherapy. [14]"
      ],
      "subsections": [
        {
          "heading": "Monitoring after surgery or during perioperative therapy",
          "paragraphs": [
            "Monitor with serial clinical assessment, cross-sectional imaging, and CA 19-9 only when the tumor is a known secretor. CT-based RECIST 1.1 assessment remains a standard radiographic framework for response monitoring, while CA 19-9 has biologic limitations and should not replace imaging. [8]"
          ],
          "bullets": []
        }
      ],
      "table": {
        "caption": "Factors favoring discussion of neoadjuvant treatment despite anatomically resectable imaging. [19]",
        "columns": [
          "Finding",
          "Clinical interpretation",
          "Next action"
        ],
        "rows": [
          [
            "Elevated CA 19-9",
            "Higher-risk feature in otherwise resectable disease. [19]",
            "Discuss neoadjuvant chemotherapy in multidisciplinary review. [19]"
          ],
          [
            "Suspicious lymphadenopathy",
            "Raises concern for higher systemic relapse risk or understaged disease. [19]",
            "Consider preoperative systemic therapy rather than automatic surgery-first management. [19]"
          ],
          [
            "Equivocal radiographic findings",
            "Creates uncertainty regarding local extent or occult metastatic disease. [19]",
            "Re-review pancreas-protocol imaging and consider neoadjuvant chemotherapy. [19]"
          ]
        ]
      }
    },
    {
      "id": "borderline-resectable-and-locally-advanced-disease",
      "eyebrow": "Vascular Involvement",
      "heading": "Use induction therapy before attempted resection in borderline-resectable disease",
      "intro": "Vascular anatomy determines whether resection should be immediate, deferred after therapy, or not initially pursued.",
      "paragraphs": [
        "Treat borderline-resectable pancreatic cancer with neoadjuvant chemotherapy, potentially followed by chemoradiotherapy, before attempting resection. This applies to limited arterial contact of 180° or less and to portal or superior mesenteric venous involvement that is reconstructable. [19][20]",
        "Reassess after neoadjuvant treatment with repeat pancreas-protocol imaging, clinical status, and tumor-marker trajectory when informative. Surgical exploration is appropriate only when the multidisciplinary team judges that an R0 resection is feasible, including vascular reconstruction when required. [19]",
        "Manage locally advanced disease as unresectable at presentation when extensive vascular involvement precludes resection. Systemic therapy is the primary initial modality; radiotherapy may improve local control, while resection is reserved for selected patients with sufficient downstaging and favorable operative anatomy after treatment. [19]"
      ],
      "bullets": [
        "Do not equate all venous involvement with unresectability; reconstructable portal vein or superior mesenteric vein involvement is included in the borderline-resectable category. [19]",
        "Do not proceed directly to surgery for borderline-resectable disease solely because there is no distant metastasis. Neoadjuvant treatment is the recommended sequence. [19][20]",
        "Re-image after induction therapy before operative planning; response assessment is iterative rather than a one-time staging decision. [24]"
      ],
      "subsections": [],
      "table": {
        "caption": "Vascular findings that distinguish borderline-resectable from locally advanced pancreatic cancer. [19]",
        "columns": [
          "Imaging pattern",
          "Resectability interpretation",
          "Treatment sequence"
        ],
        "rows": [
          [
            "Tumor contact of 180° or less with celiac axis, superior mesenteric artery, common hepatic artery, or inferior vena cava",
            "Borderline resectable. [19]",
            "Neoadjuvant chemotherapy with or without radiotherapy, then restaging for possible surgery. [19][20]"
          ],
          [
            "Reconstructable portal vein or superior mesenteric vein involvement",
            "Borderline resectable. [19]",
            "Neoadjuvant treatment before possible venous resection and reconstruction. [19]"
          ],
          [
            "Extensive vascular involvement preventing resection",
            "Locally advanced and initially unresectable. [19]",
            "Systemic therapy; consider radiotherapy for local control and surgery only after selected downstaging. [19]"
          ]
        ]
      }
    },
    {
      "id": "systemic-therapy-and-metastatic-disease",
      "eyebrow": "Systemic Management",
      "heading": "Match systemic treatment intensity to stage and functional reserve",
      "intro": "Combination cytotoxic therapy is central across disease stages, but its use must account for performance status and treatment toxicity.",
      "paragraphs": [
        "For localized disease receiving perioperative treatment, multiagent cytotoxic chemotherapy is integrated with surgery rather than used as an alternative to curative-intent local therapy. Modified FOLFIRINOX is one commonly used combination regimen; full-dose FOLFIRINOX consists of oxaliplatin 85 mg/m², leucovorin 400 mg/m², irinotecan 180 mg/m², and fluorouracil 2,400 mg/m², with or without a fluorouracil bolus. [11][14]",
        "For metastatic pancreatic cancer, systemic therapy is the core treatment modality. Treatment selection must account for performance status because chemotherapy toxicity is clinically significant; contemporary trial and guideline frameworks commonly evaluate systemic treatment in patients with ECOG performance status 0-2. [23]",
        "Do not routinely expect benefit from immune-checkpoint therapy in unselected pancreatic ductal adenocarcinoma. Pancreatic cancer is largely resistant to immunotherapy, with reported response rates below 5%; investigational immune, cellular, and molecularly targeted approaches should not displace established stage-directed treatment outside appropriate clinical contexts. [16][17]"
      ],
      "bullets": [
        "Use performance status as an explicit treatment-selection variable before choosing intensive multidrug chemotherapy. [23]",
        "Discuss molecularly directed approaches in multidisciplinary oncology care, particularly as targeted therapy development is increasingly focused on KRAS alterations, including KRAS G12C. [15]",
        "Use CT and CA 19-9, when secreted, to follow treatment; neither modality should be interpreted without clinical context. [8]"
      ],
      "subsections": [
        {
          "heading": "Response assessment",
          "paragraphs": [
            "Assess treatment response with serial CT using RECIST 1.1 principles and correlate with symptoms, performance status, and CA 19-9 trends when applicable. CT findings can be misleading during immunotherapy because inflammatory infiltration may resemble progression, although immunotherapy has limited activity in unselected pancreatic ductal adenocarcinoma. [8][16]"
          ],
          "bullets": []
        }
      ],
      "table": {
        "caption": "Practical systemic-treatment considerations by clinical setting. [11][14][16][23]",
        "columns": [
          "Setting",
          "Treatment objective",
          "Decision constraint"
        ],
        "rows": [
          [
            "Resectable or borderline-resectable disease",
            "Integrate multiagent chemotherapy with curative-intent resection according to resectability and risk features. [14][19]",
            "Sequence chemotherapy before surgery for borderline-resectable disease; surgery-first remains standard for many resectable tumors. [19][20]"
          ],
          [
            "Locally advanced disease",
            "Control systemic disease and improve local control; reassess selected patients for conversion to surgery. [19]",
            "Extensive vascular involvement precludes initial resection. [19]"
          ],
          [
            "Metastatic disease",
            "Systemic disease control and symptom-directed management. [19][23]",
            "Balance multidrug-treatment toxicity against ECOG performance status and patient goals. [23]"
          ],
          [
            "Unselected PDAC treated with immunotherapy",
            "Routine checkpoint inhibitor monotherapy has limited expected activity. [16]",
            "Reported response rates are below 5%; prioritize established systemic strategies or appropriate trials. [16]"
          ]
        ]
      }
    },
    {
      "id": "multidisciplinary-escalation",
      "eyebrow": "Care Delivery",
      "heading": "Escalate complex anatomy and uncertain staging early",
      "intro": "Treatment quality depends on repeated expert reassessment rather than a single imaging interpretation.",
      "paragraphs": [
        "Refer patients with borderline-resectable or locally advanced disease to a center with pancreatic surgical, vascular reconstruction, medical oncology, radiation oncology, and dedicated radiology expertise. Focused review of pancreas-protocol CT can change resectability assignment, and multidisciplinary management is central to treatment planning across localized disease states. [20][14]",
        "Reconsider surgery after induction therapy only through iterative multidisciplinary assessment of vascular anatomy, metastatic progression, treatment tolerance, and the prospect of an R0 resection. Approximately 20% of patients undergo surgery overall, underscoring the need to avoid nonbeneficial exploration in persistently unresectable disease. [19]",
        "Use shared decision-making when choosing surgery-first, neoadjuvant, or nonsurgical treatment, explicitly discussing anatomic resectability, likelihood of completing multimodality therapy, performance status, toxicity burden, and the patient's goals. [18][23]"
      ],
      "bullets": [
        "Request dedicated re-review when an outside CT is not pancreas protocol or when arterial or venous involvement is uncertain. [19][20]",
        "Escalate high-risk resectable disease for preoperative oncology discussion rather than defaulting directly to surgery. [19]",
        "Reassess resectability after neoadjuvant treatment instead of relying on the initial staging label. [24]"
      ],
      "subsections": [],
      "table": {
        "caption": "Triggers for multidisciplinary reassessment. [19][20][24]",
        "columns": [
          "Trigger",
          "Why it changes management",
          "Required next step"
        ],
        "rows": [
          [
            "Outside or equivocal staging imaging",
            "Resectability classification depends on high-quality vascular assessment. [19][20]",
            "Obtain or review pancreas-protocol CT angiography or MRI with dedicated pancreatic radiology input. [19]"
          ],
          [
            "Elevated CA 19-9 or suspicious nodes in resectable disease",
            "These are high-risk features that can favor neoadjuvant treatment. [19]",
            "Discuss treatment sequencing before surgical scheduling. [19]"
          ],
          [
            "Completion of neoadjuvant therapy",
            "Operability may change with treatment response or progression. [24]",
            "Repeat staging and review candidacy for resection in multidisciplinary conference. [24]"
          ],
          [
            "Extensive vascular involvement",
            "Defines locally advanced disease and makes initial surgery inappropriate. [19]",
            "Initiate nonsurgical therapy and reconsider surgery only after selected downstaging. [19]"
          ]
        ]
      }
    }
  ],
  "faq": [],
  "references": [
    {
      "number": 1,
      "title": "European evidence-based guidelines on pancreatic cystic ...",
      "detail": "gut.bmj.com",
      "url": "https://gut.bmj.com/content/gutjnl/early/2018/03/28/gutjnl-2018-316027.full.pdf",
      "authors": "gut.bmj.com",
      "host": "gut.bmj.com"
    },
    {
      "number": 2,
      "title": "European evidence-based guidelines on pancreatic cystic neoplasms | Gut",
      "detail": "gut.bmj.com",
      "url": "https://gut.bmj.com/content/67/5/789",
      "authors": "gut.bmj.com",
      "host": "gut.bmj.com"
    },
    {
      "number": 3,
      "title": "Multicenter randomized controlled trial of neoadjuvant ...",
      "detail": "jitc.bmj.com",
      "url": "https://jitc.bmj.com/content/11/12/e007586",
      "authors": "jitc.bmj.com",
      "host": "jitc.bmj.com"
    },
    {
      "number": 4,
      "title": "Pancreatic Incidentalomas",
      "detail": "egastroenterology.bmj.com",
      "url": "https://egastroenterology.bmj.com/content/egastro/2/3/e100082.draft-revisions.pdf",
      "authors": "egastroenterology.bmj.com",
      "host": "egastroenterology.bmj.com"
    },
    {
      "number": 5,
      "title": "Abstracts",
      "detail": "gut.bmj.com",
      "url": "https://gut.bmj.com/content/55/suppl_2/a1",
      "authors": "gut.bmj.com",
      "host": "gut.bmj.com"
    },
    {
      "number": 6,
      "title": "British Society of Gastroenterology and UK-PSC guidelines ...",
      "detail": "gut.bmj.com",
      "url": "https://gut.bmj.com/content/gutjnl/68/8/1356.full.pdf",
      "authors": "gut.bmj.com",
      "host": "gut.bmj.com"
    },
    {
      "number": 7,
      "title": "Treatment of cholangiocarcinoma in patients with primary ...",
      "detail": "egastroenterology.bmj.com",
      "url": "https://egastroenterology.bmj.com/content/egastro/2/1/e100045.full.pdf",
      "authors": "egastroenterology.bmj.com",
      "host": "egastroenterology.bmj.com"
    },
    {
      "number": 8,
      "title": "Genome-wide analyses of cell-free DNA for therapeutic monitoring of patients with pancreatic cancer",
      "detail": "www.science.org",
      "url": "https://www.science.org/doi/10.1126/sciadv.ads5002",
      "authors": "www.science.org",
      "host": "www.science.org"
    },
    {
      "number": 9,
      "title": "Direct detection of early-stage cancers using circulating tumor DNA",
      "detail": "www.science.org",
      "url": "https://www.science.org/doi/10.1126/scitranslmed.aan2415",
      "authors": "www.science.org",
      "host": "www.science.org"
    },
    {
      "number": 10,
      "title": "Treatment Strategy for Borderline Resectable... : Pancreas",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/pancreasjournal/fulltext/2016/11000/treatment_strategy_for_borderline_resectable.13.aspx?Ppt=Article%7Cpancreasjournal%3A2016%3A11000%3A00013%7C10.1097%2Fmpa.0000000000000634%7C",
      "authors": "journals.lww.com",
      "host": "journals.lww.com"
    },
    {
      "number": 11,
      "title": "FOLFIRINOX as Initial Treatment for Localized Pancreatic ...",
      "detail": "academic.oup.com",
      "url": "https://academic.oup.com/jnci/article/114/5/695/6528326",
      "authors": "academic.oup.com",
      "host": "academic.oup.com"
    },
    {
      "number": 12,
      "title": "Oligometastatic pancreatic cancer: current state of ...",
      "detail": "academic.oup.com",
      "url": "https://academic.oup.com/oncolo/article/30/6/oyaf154/8169154",
      "authors": "academic.oup.com",
      "host": "academic.oup.com"
    },
    {
      "number": 13,
      "title": "Cancer of the pancreas: ESMO Clinical Practice Guidelines for ...",
      "detail": "academic.oup.com",
      "url": "https://academic.oup.com/annonc/article/26/suppl_5/v56/344501",
      "authors": "academic.oup.com",
      "host": "academic.oup.com"
    },
    {
      "number": 14,
      "title": "Pancreatic Cancer—Advances in the Last 50 Years : World Journal of Surgery",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/00008139-202608000-00011",
      "authors": "journals.lww.com",
      "host": "journals.lww.com"
    },
    {
      "number": 15,
      "title": "Development of targeted therapy for pancreatic...",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/jpancreatology/fulltext/2026/06000/development_of_targeted_therapy_for_pancreatic.2.aspx",
      "authors": "journals.lww.com",
      "host": "journals.lww.com"
    },
    {
      "number": 16,
      "title": "KRAS-driven immune exclusion in pancreatic ductal ...",
      "detail": "academic.oup.com",
      "url": "https://academic.oup.com/oncolo/article/31/7/oyag160/8699630",
      "authors": "academic.oup.com",
      "host": "academic.oup.com"
    },
    {
      "number": 17,
      "title": "Role of CAR-T cell therapy in pancreatic cancer:...",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/jpancreatology/fulltext/2026/03000/role_of_car_t_cell_therapy_in_pancreatic_cancer_.1.aspx",
      "authors": "journals.lww.com",
      "host": "journals.lww.com"
    },
    {
      "number": 18,
      "title": "ESMO Clinical Practice Guideline: Pancreatic Cancer",
      "detail": "www.esmo.org",
      "url": "https://www.esmo.org/guidelines/esmo-clinical-practice-guideline-pancreatic-cancer",
      "authors": "www.esmo.org",
      "host": "www.esmo.org"
    },
    {
      "number": 19,
      "title": "Multidisciplinary Management of Resectable and Borderline Resectable Pancreatic Cancer: How We Work Together",
      "detail": "dailynews.ascopubs.org",
      "url": "https://dailynews.ascopubs.org/do/multidisciplinary-management-resectable-and-borderline-resectable-pancreatic-cancer-we",
      "authors": "dailynews.ascopubs.org",
      "host": "dailynews.ascopubs.org"
    },
    {
      "number": 20,
      "title": "Exploring Perioperative Therapy in Pancreatic Cancer",
      "detail": "dailynews.ascopubs.org",
      "url": "https://dailynews.ascopubs.org/do/exploring-perioperative-therapy-pancreatic-cancer",
      "authors": "dailynews.ascopubs.org",
      "host": "dailynews.ascopubs.org"
    },
    {
      "number": 21,
      "title": "Contemporary Multidisciplinary Treatment of Borderline- ...",
      "detail": "ascopubs.org",
      "url": "https://ascopubs.org/doi/pdf/10.1200/EDBK-26-515560",
      "authors": "ascopubs.org",
      "host": "ascopubs.org"
    },
    {
      "number": 22,
      "title": "ESMO/ASCO Recommendations for a Global Curriculum in ...",
      "detail": "ascopubs.org",
      "url": "https://ascopubs.org/doi/10.1200/GO.23.00277",
      "authors": "ascopubs.org",
      "host": "ascopubs.org"
    },
    {
      "number": 23,
      "title": "Tumor Treating Fields With Gemcitabine and Nab-Paclitaxel for Locally Advanced Pancreatic Adenocarcinoma: Randomized, Open-Label, Pivotal Phase III PANOVA-3 Study",
      "detail": "ascopubs.org",
      "url": "https://ascopubs.org/doi/10.1200/JCO-25-00746",
      "authors": "ascopubs.org",
      "host": "ascopubs.org"
    },
    {
      "number": 24,
      "title": "Contemporary Multidisciplinary Treatment of Borderline-Resectable and Locally Advanced Pancreatic Adenocarcinoma | American Society of Clinical Oncology Educational Book",
      "detail": "ascopubs.org",
      "url": "https://ascopubs.org/doi/10.1200/EDBK-26-515560",
      "authors": "ascopubs.org",
      "host": "ascopubs.org"
    }
  ],
  "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.",
  "citations": [
    {
      "number": 1,
      "title": "European evidence-based guidelines on pancreatic cystic ...",
      "detail": "gut.bmj.com",
      "url": "https://gut.bmj.com/content/gutjnl/early/2018/03/28/gutjnl-2018-316027.full.pdf",
      "authors": "gut.bmj.com",
      "host": "gut.bmj.com",
      "snippet": "CA 19.9 values in the serum >37 U/mL have been associated with a positive predictive value of 74.0% and accuracy of 81.7% to identify patients with invasive IPMN. Highly elevated levels of CA 19.9 may thus be helpful as an additional but not sole indicator for invasive IPMN.132 A recent large cohort",
      "score": 0.3795859
    },
    {
      "number": 2,
      "title": "European evidence-based guidelines on pancreatic cystic neoplasms | Gut",
      "detail": "gut.bmj.com",
      "url": "https://gut.bmj.com/content/67/5/789",
      "authors": "gut.bmj.com",
      "host": "gut.bmj.com",
      "snippet": "Nine studies, including 1510 surgically resected IPMN, have concluded that the presence of jaundice, a contrast-enhancing mural nodule or solid component, or MPD dilatation of ≥10 mm, has a positive predictive value for malignancy of 56–89%.85–92 Several series including surgically resected IPMN hav",
      "score": 0.34833524
    },
    {
      "number": 3,
      "title": "Multicenter randomized controlled trial of neoadjuvant ...",
      "detail": "jitc.bmj.com",
      "url": "https://jitc.bmj.com/content/11/12/e007586",
      "authors": "jitc.bmj.com",
      "host": "jitc.bmj.com",
      "snippet": "by MHG Katz · 2023 · Cited by 38 — Immune landscape in resected pancreatic ductal adenocarcinoma (PDAC), stratified by treatment ... somatic profiling and routine germline testing",
      "score": 0.3443558
    },
    {
      "number": 4,
      "title": "Pancreatic Incidentalomas",
      "detail": "egastroenterology.bmj.com",
      "url": "https://egastroenterology.bmj.com/content/egastro/2/3/e100082.draft-revisions.pdf",
      "authors": "egastroenterology.bmj.com",
      "host": "egastroenterology.bmj.com",
      "snippet": "Further four-phase CT for the pancreas and MRI then confirmed the diagnosis of a pancreatic cancer (Fig. 1). With the rise of liquid biopsy, blood samples",
      "score": 0.2832834
    },
    {
      "number": 5,
      "title": "Abstracts",
      "detail": "gut.bmj.com",
      "url": "https://gut.bmj.com/content/55/suppl_2/a1",
      "authors": "gut.bmj.com",
      "host": "gut.bmj.com",
      "snippet": "On admission his amylase was 341 μ/ml with an albumin of 28 g/l and normal U&Es and LFTs. His haemoglobin dropped from 11.9 g/dl to 7.3 g/dl during admission. A repeat OGD showed mild duodenitis, and colonoscopy showed diverticular disease. Ultrasound examination of his abdomen showed a dilated comm",
      "score": 0.28031877
    },
    {
      "number": 6,
      "title": "British Society of Gastroenterology and UK-PSC guidelines ...",
      "detail": "gut.bmj.com",
      "url": "https://gut.bmj.com/content/gutjnl/68/8/1356.full.pdf",
      "authors": "gut.bmj.com",
      "host": "gut.bmj.com",
      "snippet": "The usual modes of presentation are with upper abdominal pain, worsening liver biochemistry, jaundice and a raised serum CA19.9. CCA tends to spread by local invasion of the bile ducts and much less often with mass formation, so that cross-sec-tional imaging may fail to identify the tumour. It is di",
      "score": 0.26035228
    },
    {
      "number": 7,
      "title": "Treatment of cholangiocarcinoma in patients with primary ...",
      "detail": "egastroenterology.bmj.com",
      "url": "https://egastroenterology.bmj.com/content/egastro/2/1/e100045.full.pdf",
      "authors": "egastroenterology.bmj.com",
      "host": "egastroenterology.bmj.com",
      "snippet": "is usually required, especially in the absence of a mass lesion.16 41 48 49 Tissue sampling obtained by brush cytology and complementary fluorescence in situ hybridi-sation (FISH) via endoscopic retrograde cholangiopan-creatography improves the diagnosing of a malignant stricture but is limited by p",
      "score": 0.17418572
    },
    {
      "number": 8,
      "title": "Genome-wide analyses of cell-free DNA for therapeutic monitoring of patients with pancreatic cancer",
      "detail": "www.science.org",
      "url": "https://www.science.org/doi/10.1126/sciadv.ads5002",
      "authors": "www.science.org",
      "host": "www.science.org",
      "snippet": "Current tools for monitoring PDAC include radiographic Response Evaluation Criteria in Solid Tumors (RECIST 1.1) assessment using computed tomography (CT) and evaluation of serum CA19-9 (_14_). However, each of these methods has shortcomings. CT scans can be misleading in patients treated with immun",
      "score": 0.36670366
    },
    {
      "number": 9,
      "title": "Direct detection of early-stage cancers using circulating tumor DNA",
      "detail": "www.science.org",
      "url": "https://www.science.org/doi/10.1126/scitranslmed.aan2415",
      "authors": "www.science.org",
      "host": "www.science.org",
      "snippet": "PubMed\n\nGoogle Scholar\n\n4\n\nA. Ruibal Morell, CEA serum levels in non-neoplastic disease. _Int. J. Biol. Markers_7, 160–166 (1992).\n\nCrossref\n\nPubMed\n\nGoogle Scholar\n\n5\n\nC. Galli, D. Basso, M. Plebani, CA 19-9: Handle with care. _Clin. Chem. Lab. Med._51, 1369–1383 (2013).\n\nCrossref\n\nPubMed\n\nWeb of S",
      "score": 0.25712144
    },
    {
      "number": 10,
      "title": "Treatment Strategy for Borderline Resectable... : Pancreas",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/pancreasjournal/fulltext/2016/11000/treatment_strategy_for_borderline_resectable.13.aspx?Ppt=Article%7Cpancreasjournal%3A2016%3A11000%3A00013%7C10.1097%2Fmpa.0000000000000634%7C",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "We evaluated whether neoadjuvant therapy followed by surgical resection improves the clinical outcome for patients with borderline resectable pancreatic cancer",
      "score": 0.41734326
    },
    {
      "number": 11,
      "title": "FOLFIRINOX as Initial Treatment for Localized Pancreatic ...",
      "detail": "academic.oup.com",
      "url": "https://academic.oup.com/jnci/article/114/5/695/6528326",
      "authors": "academic.oup.com",
      "host": "academic.oup.com",
      "snippet": "by QP Janssen · 2022 · Cited by 66 — Full-dose FOLFIRINOX consisted of oxaliplatin (85 mg/m2), leucovorin (400 mg/m2), irinotecan (180 mg/m2), and fluorouracil (2400 mg/m2) with or without bolus (",
      "score": 0.37518036
    },
    {
      "number": 12,
      "title": "Oligometastatic pancreatic cancer: current state of ...",
      "detail": "academic.oup.com",
      "url": "https://academic.oup.com/oncolo/article/30/6/oyaf154/8169154",
      "authors": "academic.oup.com",
      "host": "academic.oup.com",
      "snippet": "by A Khomiak · 2025 · Cited by 7 — This review explores definitions of oligometastatic pancreatic cancer and the current state of management, including systemic therapy, surgery,",
      "score": 0.23842646
    },
    {
      "number": 13,
      "title": "Cancer of the pancreas: ESMO Clinical Practice Guidelines for ...",
      "detail": "academic.oup.com",
      "url": "https://academic.oup.com/annonc/article/26/suppl_5/v56/344501",
      "authors": "academic.oup.com",
      "host": "academic.oup.com",
      "snippet": "Gemcitabine administered for 24 weeks improved disease-free survival (13.4 versus. 6.9 months, P < 0.001) and overall survival (OS) (22.8",
      "score": 0.23351443
    },
    {
      "number": 14,
      "title": "Pancreatic Cancer—Advances in the Last 50 Years : World Journal of Surgery",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/00008139-202608000-00011",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "Traditional paradigms for the treatment of localized pancreatic cancer include a surgery first approach for resectable disease. Over the last 20 years, multiple randomized trials have evaluated initially single agent gemcitabine chemotherapy compared to observation following successful surgical rese",
      "score": 0.6016175
    },
    {
      "number": 15,
      "title": "Development of targeted therapy for pancreatic...",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/jpancreatology/fulltext/2026/06000/development_of_targeted_therapy_for_pancreatic.2.aspx",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "This review synthesizes targeted therapeutics for PDAC reported between 2020 and 2025, G12C is currently the most clinically validated KRAS therapeutic target.",
      "score": 0.59344494
    },
    {
      "number": 16,
      "title": "KRAS-driven immune exclusion in pancreatic ductal ...",
      "detail": "academic.oup.com",
      "url": "https://academic.oup.com/oncolo/article/31/7/oyag160/8699630",
      "authors": "academic.oup.com",
      "host": "academic.oup.com",
      "snippet": "Pancreatic ductal adenocarcinoma (PDAC) remains largely resistant to immunotherapy, with response rates below 5%.",
      "score": 0.44565076
    },
    {
      "number": 17,
      "title": "Role of CAR-T cell therapy in pancreatic cancer:...",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/jpancreatology/fulltext/2026/03000/role_of_car_t_cell_therapy_in_pancreatic_cancer_.1.aspx",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "by G El Bejjani · 2025 — CAR-T cell therapy has emerged as a promising approach to address the clinical needs of PDAC by enabling targeted tumor cell destruction, particularly against",
      "score": 0.3260466
    },
    {
      "number": 18,
      "title": "ESMO Clinical Practice Guideline: Pancreatic Cancer",
      "detail": "www.esmo.org",
      "url": "https://www.esmo.org/guidelines/esmo-clinical-practice-guideline-pancreatic-cancer",
      "authors": "www.esmo.org",
      "host": "www.esmo.org",
      "snippet": "eUpdate 9 April 2025:ESMO Clinical Practice Guideline Express Update on the management of metastatic pancreatic cancer\n\n   The guideline covers diagnosis, staging, risk assessment, treatment, disease monitoring and follow-up.\n   The multidisciplinary expert author group is from different institution",
      "score": 0.8173562
    },
    {
      "number": 19,
      "title": "Multidisciplinary Management of Resectable and Borderline Resectable Pancreatic Cancer: How We Work Together",
      "detail": "dailynews.ascopubs.org",
      "url": "https://dailynews.ascopubs.org/do/multidisciplinary-management-resectable-and-borderline-resectable-pancreatic-cancer-we",
      "authors": "dailynews.ascopubs.org",
      "host": "dailynews.ascopubs.org",
      "snippet": "View larger.\n\n## Concluding Remarks\n\nTreatment of RPC and BRPC requires a nuanced, multidisciplinary, collaborative, and iterative approach. Surgery remains a central tenet for resectable and borderline resectable disease and for select patients with downstaging in locally advanced pancreatic cancer",
      "score": 0.76300776
    },
    {
      "number": 20,
      "title": "Exploring Perioperative Therapy in Pancreatic Cancer",
      "detail": "dailynews.ascopubs.org",
      "url": "https://dailynews.ascopubs.org/do/exploring-perioperative-therapy-pancreatic-cancer",
      "authors": "dailynews.ascopubs.org",
      "host": "dailynews.ascopubs.org",
      "snippet": "1.    Coveler AL, Herman JM, Simeone DM, Chiorean EG. Localized Pancreatic Cancer: Multidisciplinary Management. _Am Soc Clin Oncol Educ Book_. 2016;35(36):e217-e226.\n2.   National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Pancreatic Adenocarcinom",
      "score": 0.7120925
    },
    {
      "number": 21,
      "title": "Contemporary Multidisciplinary Treatment of Borderline- ...",
      "detail": "ascopubs.org",
      "url": "https://ascopubs.org/doi/pdf/10.1200/EDBK-26-515560",
      "authors": "ascopubs.org",
      "host": "ascopubs.org",
      "snippet": "Pancreatic ductal adenocarcinoma remains a highly lethal malignancy, with borderline resectable (BRPC) and locally advanced pancreatic",
      "score": 0.683948
    },
    {
      "number": 22,
      "title": "ESMO/ASCO Recommendations for a Global Curriculum in ...",
      "detail": "ascopubs.org",
      "url": "https://ascopubs.org/doi/10.1200/GO.23.00277",
      "authors": "ascopubs.org",
      "host": "ascopubs.org",
      "snippet": "by T Cufer · 2023 · Cited by 48 — Define the various classifications of pancreatic cancer including resectable, borderline resectable, locally advanced and how this influences",
      "score": 0.6420965
    },
    {
      "number": 23,
      "title": "Tumor Treating Fields With Gemcitabine and Nab-Paclitaxel for Locally Advanced Pancreatic Adenocarcinoma: Randomized, Open-Label, Pivotal Phase III PANOVA-3 Study",
      "detail": "ascopubs.org",
      "url": "https://ascopubs.org/doi/10.1200/JCO-25-00746",
      "authors": "ascopubs.org",
      "host": "ascopubs.org",
      "snippet": "Expand Table\n\n## References\n\n1.\n\nConroy T, Pfeiffer P, Vilgrain V, et al: Pancreatic cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. _Ann Oncol_ 34:987-1002, 2023\n\nView\n\nPubMed\n\nGoogle Scholar\n\n   [a [...] present with advanced disease at diagnosis,](\n   [b [...] 5-y",
      "score": 0.6364215
    },
    {
      "number": 24,
      "title": "Contemporary Multidisciplinary Treatment of Borderline-Resectable and Locally Advanced Pancreatic Adenocarcinoma | American Society of Clinical Oncology Educational Book",
      "detail": "ascopubs.org",
      "url": "https://ascopubs.org/doi/10.1200/EDBK-26-515560",
      "authors": "ascopubs.org",
      "host": "ascopubs.org",
      "snippet": "ASCO Publications\n\n###### Popular Searches:\n\nAmerican Society of Clinical Oncology Educational Book logo\nAmerican Society of Clinical Oncology Educational Book Logo\n\n# Contemporary Multidisciplinary Treatment of Borderline-Resectable and Locally Advanced Pancreatic Adenocarcinoma\n\n###### PREVIOUS AR",
      "score": 0.62742686
    }
  ],
  "publishedAt": "2026-08-24T17:01:00.690014+00:00",
  "updatedAt": "2026-08-24T17:01:00.690014+00:00",
  "readingMinutes": 5,
  "slug": "pancreatic-cancer"
}