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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Resectable pancreatic cancer is the minority of pancreatic cancer that the surgeon can remove with clear margins because it has not wrapped around the main arteries or spread. Treatment is an operation, usually a Whipple procedure, followed by six months of combination chemotherapy, which is what turns surgery alone into a real chance of cure.
Pancreatic ductal adenocarcinoma is called resectable when CT shows no contact with the superior mesenteric or coeliac arteries, no more than abutment of the portal or superior mesenteric vein, and no metastases. Most such tumours sit in the head of the gland and present with painless jaundice; body and tail tumours present later and are less often removable. Staging is a pancreas-protocol CT, a chest CT and CA 19-9, with endoscopic ultrasound and biopsy where the diagnosis is in doubt or neoadjuvant treatment is planned, and staging laparoscopy in some centres to find small peritoneal or liver deposits that CT misses.
The operation is a pancreatoduodenectomy (Whipple) for head tumours or a distal pancreatectomy with splenectomy for body and tail tumours, both with regional lymphadenectomy, increasingly by robotic or laparoscopic approach in high-volume centres. Surgery alone cures few patients: CONKO-001 (2007) showed that adjuvant gemcitabine roughly doubles the number alive without recurrence, ESPAC-4 (2017) that gemcitabine plus capecitabine does better, and PRODIGE 24 (2018) that six months of modified FOLFIRINOX after surgery gives the longest survival yet seen in the disease for patients fit enough to receive it. Roughly half of patients never complete adjuvant chemotherapy because of slow recovery, which is the main argument for giving some or all of it before surgery.
| Setting | Approach | Guideline |
|---|---|---|
| Staging | Pancreas-protocol CT, chest CT and CA 19-9; endoscopic ultrasound with biopsy when tissue is needed before treatment; biliary stenting only for cholangitis, deep jaundice or delayed surgery. | not mapped |
| Surgery | Pancreatoduodenectomy for head tumours, distal pancreatectomy with splenectomy for body and tail tumours, with regional lymphadenectomy; open, laparoscopic or robotic in high-volume centres. | not mapped |
| Adjuvant chemotherapy | Six months of modified FOLFIRINOX for fit patients (PRODIGE 24); gemcitabine plus capecitabine (ESPAC-4) or gemcitabine alone (CONKO-001) for those who cannot tolerate it, started within twelve weeks of surgery. | not mapped |
| Neoadjuvant chemotherapy | Considered for tumours with high-risk features (large size, very high CA 19-9, suspicious nodes) and increasingly offered in trials for all resectable disease; PREOPANC and NORPACT-1 are the evidence for and against. | not mapped |
| Germline testing | Offered to every patient at diagnosis; carriers of BRCA, PALB2 or ATM variants receive platinum-based chemotherapy and their relatives are offered testing and surveillance. | not mapped |
| Follow-up | CA 19-9 and CT every three to six months for two years then less often; recurrence is treated as metastatic or locally advanced disease. | not mapped |