• Familial pancreatic cancer and inherited risk (who qualifies for surveillance): Familial pancreatic cancer means at least two close relatives on the same side of the family have had the disease without a known gene fault to explain it.
• Pancreatic intraepithelial neoplasia (PanIN), the microscopic precursor of pancreatic cancer: PanIN is the name for abnormal cells lining the small pancreatic ducts that can, over years, turn into pancreatic cancer.
• New-onset diabetes as a signal of pancreatic cancer (and the ENDPAC score): A pancreatic cancer can cause diabetes before any other symptom, so new diabetes after the age of 50, especially with weight loss rather than weight gain, is a recognised warning sign.
• Pancreas protocol CT (pancreatic protocol CT, dual-phase thin-slice CT with structured reporting): A pancreas protocol CT is a scan tuned for the pancreas: thin slices taken at two timed moments after contrast dye so that the tumour, the arteries and the veins all show up sharply.
• High-risk stigmata and worrisome features of pancreatic cysts (IPMN and MCN surgical criteria): Most pancreatic cysts never become cancer, so doctors watch them and operate only when warning signs appear.
• Resectable, borderline resectable and unresectable: The surgeon's verdict on whether the tumour can be completely removed.
• Obstructive jaundice and biliary obstruction: Yellowing of the skin and eyes because a tumour blocks the bile duct, most often pancreatic or bile duct cancer.
• CA 19-9: A sugar molecule shed into the blood by most pancreatic cancers; useful to follow treatment, not to screen.
• Whipple procedure (pancreaticoduodenectomy): The big operation for cancers of the head of the pancreas: the surgeon removes the pancreatic head, the duodenum, the gallbladder and part of the bile duct, then reconnects everything.
• Endoscopy (EGD, EUS, ERCP): Looking inside a hollow organ with a camera on a flexible tube, taking biopsies and sometimes treating on the spot.

Biomarker results to ask for: MRI with MRCP or pancreas-protocol CT: cyst size, main duct diameter, mural nodules, growth rate, Endoscopic ultrasound with cyst fluid CEA, glucose, cytology and KRAS, GNAS and other mutations, Serum CA 19-9 (worrisome feature when raised), New-onset diabetes or pancreatitis (worrisome features), Histological subtype of resected IPMN (gastric, intestinal, pancreatobiliary) and grade of dysplasia, TP53, SMAD4 and CDKN2A alterations in cyst fluid (investigational markers of progression).

Scans and tests linked to this cancer: Comprehensive genomic profiling, CT (computed tomography), Endoscopic ultrasound and EBUS systems, Liquid biopsy (ctDNA), MRI, DNA methylation profiling.

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

• High-risk stigmata: Resection (pancreatoduodenectomy or distal pancreatectomy) for obstructive jaundice, an enhancing mural nodule of 5 mm or more, a main duct of 10 mm or more, or positive cytology, in patients fit for surgery. (Whipple procedure (pancreaticoduodenectomy), Obstructive jaundice and biliary obstruction, Robotic & minimally invasive surgery)
• Incidental cyst: Characterise with MRI and MRCP or pancreas-protocol CT; endoscopic ultrasound with fluid analysis when the cyst type is unclear or worrisome features are present. (MRI, CT (computed tomography), Endoscopic ultrasound and EBUS systems, CA 19-9)
• Worrisome features: Endoscopic ultrasound and fluid sampling; resection or short-interval surveillance depending on findings, age and fitness. (Endoscopic ultrasound and EBUS systems, CA 19-9, MRI)
• Invasive carcinoma in an IPMN: Staged and treated as pancreatic ductal adenocarcinoma with resection and adjuvant chemotherapy. (Whipple procedure (pancreaticoduodenectomy), FOLFIRINOX / mFOLFIRINOX, PRODIGE 24 / CCTG PA6)
• Surveillance: MRI or endoscopic ultrasound at intervals set by cyst size, continued while the patient remains a surgical candidate; the remaining pancreas is followed after resection. (MRI, High-risk pancreatic surveillance (CAPS / PRECEDE), Endoscopic ultrasound and EBUS systems)

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.