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For the rest, effective palliative treatments are available: Resectable cancer: surgery followed by adjuvant chemotherapy (gemcitabine + capecitabine or FOLFIRINOX) Borderline resectable: neoadjuvant chemotherapy first to shrink the tumour, then reassess for surgery Locally advanced/metastatic: chemotherapy (FOLFIRINOX or gemcitabine-nab-paclitaxel), targeted therapy (for BRCA mutations: PARP inhibitors), immunotherapy in selected cases Biliary stenting: ERCP to relieve jaundice Coeliac plexus block: for severe pain control Enzyme replacement and nutritional support throughout Aftercare & Recovery Pancreatic enzyme replacement therapy (PERT) taken with every meal to aid digestion Blood sugar monitoring diabetes can develop or worsen after surgery Insulin therapy if needed Nutritional support and dietitian review Regular CT scans and CA 19-9 monitoring Psychological support a pancreatic cancer diagnosis is emotionally challenging

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February 4, 2013