Diagnosis and management of pancreatic cancer in adults: A summary of guidelines from the UK National Institute for Health and Care Excellence

Pancreatic cancer: An update on diagnosis and management

“…3 Individuals with pancreatic cancer risk increased more than five-fold may be referred to a familial cancer service for consideration of imaging surveillance, including those with Lynch syndrome or BRCA2 mutation and at least one affected FDR. 5,6 There is no screening test for individuals with standard or mildly increased risk.…”

“…14 Positron emission tomography (PET)/CT is increasingly being used to determine staging and may change the treatment plan for up to 20% of patients. 6 Use of PET/CT in this setting varies between institutions and is not currently considered standard care for all cases. Indeterminate extrapancreatic lesions are commonly identified by staging imaging, and it can be unclear whether they represent metastatic disease, a second primary neoplasm or an unrelated benign lesion.…”

“…38 All patients with unresectable or metastatic disease require enteric-coated pancreatic enzyme replacement. 6 Enzymes should be considered before and after pancreatic resection. Faecal elastase may be used to determine the level of pancreatic exocrine insufficiency.…”

“…Coeliac plexus neurolysis should be considered to manage pain. 6 Early referral to palliative care services allows for prompt management of symptoms and provides additional psychological support for the patient and their family.…”

“…The role of follow-up is to identify new, unexplained or unresolved symptoms that can be further investigated or better managed. 6 However, evidence that surveillance imaging prolongs survival is very weak at best, and therefore no strong recommendations can be made. National Comprehensive Cancer Network guidelines recommend CT scanning and CA 19-9 testing every 3-6 months for two • Pancreatic cancer is categorised as resectable, borderline resectable, locally advanced or metastatic.…”