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NCCN Guidelines for Patients Pancreatic Cancer NCCN GUIDELINES FOR PATIENTS® 2021 Pancreatic Cancer Presented with support from: Available online at NCCN.org/patients Ü Pancreatic Cancer It's easy to get lost in the cancer world Let NCCN Guidelines for Patients® be your guide 9 Step-by-step guides to the cancer care options likely to have the best results 9 Based on treatment guidelines used by health care providers worldwide 9 Designed to help you discuss cancer treatment with your doctors NCCN Guidelines for Patients® Pancreatic Cancer, 2021 1 About National Comprehensive Cancer Network® NCCN Guidelines for Patients® are developed by the National Comprehensive Cancer Network® (NCCN®) NCCN Clinical Practice NCCN Guidelines NCCN Guidelines in Oncology for Patients (NCCN Guidelines®) 9 An alliance of leading 9 Developed by doctors from 9 Present information from the cancer centers across the NCCN cancer centers using NCCN Guidelines in an easy- United States devoted to the latest research and years to-learn format patient care, research, and of experience 9 For people with cancer and education 9 For providers of cancer care those who support them all over the world Cancer centers 9 Explain the cancer care that are part of NCCN: 9 Expert recommendations for options likely to have the NCCN.org/cancercenters cancer screening, diagnosis, best results and treatment Free online at Free online at NCCN.org/patientguidelines NCCN.org/guidelines and supported by funding from NCCN Foundation® These NCCN Guidelines for Patients are based on the NCCN Guidelines® for Pancreatic Cancer, Version 2.2021 – February 25, 2021. © 2021 National Comprehensive Cancer Network, Inc. All rights reserved. NCCN Foundation seeks to support the millions of patients and their families NCCN Guidelines for Patients and illustrations herein may not be reproduced in affected by a cancer diagnosis by funding and distributing NCCN Guidelines for any form for any purpose without the express written permission of NCCN. No Patients. NCCN Foundation is also committed to advancing cancer treatment one, including doctors or patients, may use the NCCN Guidelines for Patients for by funding the nation’s promising doctors at the center of innovation in cancer any commercial purpose and may not claim, represent, or imply that the NCCN research. For more details and the full library of patient and caregiver resources, Guidelines for Patients that have been modified in any manner are derived visit NCCN.org/patients. from, based on, related to, or arise out of the NCCN Guidelines for Patients. The NCCN Guidelines are a work in progress that may be redefined as often National Comprehensive Cancer Network (NCCN) / NCCN Foundation as new significant data become available. NCCN makes no warranties of any 3025 Chemical Road, Suite 100 kind whatsoever regarding its content, use, or application and disclaims any Plymouth Meeting, PA 19462 responsibility for its application or use in any way. 215.690.0300 NCCN Guidelines for Patients® Pancreatic Cancer, 2021 2 Supporters Endorsed by Hirshberg Foundation for guidelines is crucial for navigating through this Pancreatic Cancer Research disease. These NCCN Patient Guidelines are a The Hirshberg Foundation for Pancreatic Cancer valuable resource for helping everyone impacted by Research is focused on finding a cure for pancreatic pancreatic cancer to better understand the disease, cancer, and empowering the patients and families evaluate treatment options, and make informed whose lives are touched by this disease. Founded decisions. lustgarten.org in 1997, the foundation funds groundbreaking scientific research, provides patient education and support, and sustains hope that this cancer will be Pancreatic Cancer Action Network eradicated once and for all. pancreatic.org (PanCAN) As the organization taking bold action to improve the lives of everyone impacted by pancreatic Let’s Win! Pancreatic Cancer cancer by advancing scientific research, building The NCCN Guidelines for Patients are the community, sharing knowledge, and advocating gold standard for pancreatic cancer treatment for patients, the Pancreatic Cancer Action Network information. The guidelines provide comprehensive (PanCAN) supports the NCCN Guidelines for explanations of the disease, stages, and treatments Patients on pancreatic cancer. This evidence- options in language patients can understand. Let’s based resource is a valuable tool to help patients Win! Pancreatic Cancer has included a link to the talk to their healthcare team about the best options NCCN Pancreatic Cancer Patient Guidelines since for treating and managing their disease. pancan.org our launch. letswinpc.org The National Pancreas Foundation Lustgarten Foundation The National Pancreas Foundation provides As the world’s largest private funder of pancreatic hope for those suffering from pancreatitis and cancer research, we are honored to endorse the pancreatic cancer through funding cutting edge NCCN Guidelines for Patients®: Pancreatic Cancer. research, advocating for new and better therapies, Receiving a pancreatic cancer diagnosis is both and providing support and education for patients, overwhelming and life-altering for patients and caregivers, and health care professionals. their loved ones, and having the most up-to-date, pancreasfoundation.org comprehensive information contained in these With generous support from Ken & Lisa Ganiszewski To make a gift or learn more, please visit NCCNFoundation.org/donate or e-mail [email protected]. NCCN Guidelines for Patients® Pancreatic Cancer, 2021 3 NCCN Guidelines for Patients® Pancreatic Cancer, 2021 4 Pancreatic Cancer Contents 6 Pancreatic cancer basics 13 Testing for pancreatic cancer 23 Pancreatic cancer treatment 40 Supportive and palliative care 49 Resectable 56 Borderline resectable 64 Locally advanced 70 Metastatic 76 Making treatment decisions 88 Words to know 92 NCCN Contributors 93 NCCN Cancer Centers 94 Index NCCN Guidelines for Patients® Pancreatic Cancer, 2021 5 1 Pancreatic cancer basics 7 The pancreas 9 Types of pancreatic cancer 10 Risk factors 11 Symptoms 12 How cancer spreads 12 Review NCCN Guidelines for Patients® Pancreatic Cancer, 2021 6 1 Pancreatic cancer basics The pancreas The pancreas is a large gland found The pancreas lies behind the stomach and in the abdomen behind the stomach. across the spine. The liver is located close to It helps digest food and control blood the pancreas, above the gallbladder. The small sugar. This chapter will discuss the intestine is wrapped along the wide end of the pancreas and provide an overview of pancreas. The spleen is found at the tail end of the pancreas. pancreatic cancer. The liver removes waste from blood and makes bile. Bile is a fluid that helps to digest food. The gallbladder stores bile from the liver. The pancreas The common bile duct carries bile from the liver into the main pancreatic duct. From the The pancreas is a large gland found in your main pancreatic duct, bile and enzymes empty abdomen. A gland is an organ that makes into the duodenum. The duodenum is the fluids or chemicals the body needs. The first part of the small intestine, which absorbs pancreas is about 6 inches long. nutrients from food you eat. The jejunum is the middle part of the small intestine. The pancreas The pancreas is located behind the stomach and next to the spleen. The small intestine wraps around the wide end of the pancreas. The liver and gallbladder are found nearby. NCCN Guidelines for Patients® Pancreatic Cancer, 2021 7 1 Pancreatic cancer basics The pancreas The pancreas has 3 parts: It makes powerful substances called pancreatic enzymes that helps digest Wide end called the head (includes neck food in your small intestine. Removing and uncinate) part of the pancreas can decrease the amount of these enzymes. This can Middle part called the body cause oily diarrhea (watery stool), stools Narrow end called the tail that float, abdominal pain, bloating, gas, and weight loss. The pancreas does 2 important things: It makes hormones (insulin and glucagon) that control the amount of sugar (glucose) in your blood. This helps your body use and store energy from food. Removing part of the pancreas might put you at risk for diabetes. If you have diabetes, it might make it worse. Parts of the pancreas The pancreas consists of a wide end called the head (includes neck and uncinate process), a middle part called the body, and a narrow end called the tail. NCCN Guidelines for Patients® Pancreatic Cancer, 2021 8 1 Pancreatic cancer basics Types of pancreatic cancer Types of pancreatic cancer Exocrine An exocrine cell makes or secretes enzymes Cancer is a disease that starts in the cells of into the small intestine that helps digest food. your body. Most cancers are named after the Sometimes, pancreatic cancer is also called cell from which they formed. Pancreatic cancer exocrine cancer. About 9 out of 10 pancreatic starts in exocrine or endocrine cells of the cancers start in exocrine cells that line small pancreas. Cancer that forms in the ampulla of tubes called ducts of the pancreas. These Vater (ducts from the liver and pancreas that ducts carry fluid that contain enzymes into the enter at the small intestine) is often mistaken main pancreatic duct and then into the small for pancreatic cancer. intestine. Most pancreatic cancers are ductal adenocarcinomas. An adenocarcinoma is cancer in the cells that secrete fluids or other Endocrine substances. Endocrine cells of the pancreas make hormones. These are released directly into the Exocrine pancreatic cancer is called pancreatic bloodstream. ductal adenocarcinoma (PDAC) and is the focus of this book. PDAC can grow anywhere Information on in the pancreas, but it is most often found in neuroendocrine the head of the pancreas. tumors can be found in NCCN Guidelines for Patients: Neuroendocrine Tumors, available at NCCN.org/ patientguidelines. NCCN Guidelines for Patients® Pancreatic Cancer, 2021 9 1 Pancreatic cancer basics Risk factors Risk factors Genetic predisposition Certain genetic changes, or mutations, can Anything that increases your chances of increase your chances of developing pancreatic developing cancer is called a risk factor.
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