Pancreatic Cancer
Pancreatic Ductal Adenocarcinoma · PDAC · Pancreatic Carcinoma
12th most common but 7th leading cause of cancer death — ~500,000 cases/year
Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers — 5-year survival is ~12% overall due to late diagnosis and resistance to therapy. KRAS is mutated in ~95% of cases and drives the disease. Only ~15–20% are surgically resectable at diagnosis. Germline testing is essential — BRCA1/2 and PALB2 mutations identify PARP inhibitor eligibility. FOLFIRINOX and gemcitabine-nab-paclitaxel are the two main chemotherapy regimens.
4
Subtypes
9
Diagnostic Tests
10
Treatment Options
For Informational Purposes Only
Content on this page is for educational purposes only and does not constitute medical advice.
🗺 What Do I Do Next? — Your Roadmap
Just diagnosed with Pancreatic Cancer? Here are your essential next steps.
Get the Full Diagnostic Workup
Before any treatment begins, you need 9 key tests — imaging, blood markers, biopsy, and molecular profiling. See the Diagnostic Workup section below. Do NOT start treatment without molecular testing — it determines which therapies work for your specific subtype.
Know Your Molecular Subtype
Pancreatic Cancer is not one disease — it has 4 distinct subtypes defined by biomarkers (KRAS, BRCA1, BRCA2, PALB2, and more). Your subtype determines which treatments apply to you. See Subtypes & Mutations below.
Assemble Your Care Team
You need a multidisciplinary team: oncologist (medical, surgical, radiation), pathologist, radiologist, and ideally a molecular tumour board review. Seek a second opinion at a major cancer centre for any Stage III-IV diagnosis.
Review All Treatment Options
Treatment for Pancreatic Cancer spans Surgery, Chemotherapy, Radiation, Targeted Therapy, Immunotherapy. See the full Treatment Options section below. Ask your oncologist which options apply to your specific subtype and stage.
Ask About Clinical Trials
Many of the most effective treatments started as clinical trials. Ask your oncologist about eligibility. Search clinicaltrials.gov with your cancer type + molecular profile. Academic centres have the most trials.
Key Biomarkers & Mutations
Subtypes & Molecular Profiles
The most therapeutically actionable subgroup. POLO trial established olaparib maintenance after platinum-based chemotherapy in BRCA1/2-mutant metastatic PDAC — significantly extends PFS. Platinum-based chemotherapy (cisplatin, oxaliplatin) has higher response rates in HRR-deficient PDAC. Family members should be referred for genetic counselling.
KEY THERAPIES FOR THIS SUBTYPE
Diagnostic Workup
9 testsIMAGING
CT Abdomen / Pelvis (pancreatic protocol)
At diagnosisGold standard for PDAC staging. Assesses resectability (involvement of SMA, SMV, portal vein, coeliac axis). Must be dedicated pancreatic protocol (arterial + venous phases).
MRI / MRCP
At diagnosis when CT equivocal or liver mets suspectedLiver metastases characterisation, cystic lesions, biliary anatomy. Complements CT.
PET-CT
Before surgery for apparently resectable diseaseDetect occult distant metastases before planned resection. Changes management in ~10–15% of 'resectable' patients.
ENDOSCOPY & PROCEDURE
EUS-guided FNA / Core Biopsy
At diagnosis when surgery not immediately plannedTissue diagnosis — endoscopic ultrasound-guided biopsy. Required before chemotherapy. Avoids seeding with percutaneous biopsy.
ERCP + Biliary Stenting
When bilirubin elevated and causing symptomsRelieve obstructive jaundice — plastic or metal biliary stent before surgery or for palliative drainage.
BLOOD & TUMOUR MARKERS
CA 19-9
At diagnosis, then every 6–8 weeks during treatmentMost useful PDAC tumour marker. Baseline, response monitoring, and recurrence detection. Note: falsely low in Lewis antigen-negative patients (~10%). CEA co-measured.
LFTs, Bilirubin, Albumin
At diagnosis and before each cycleAssess biliary obstruction, liver function, and nutritional status — critical for chemotherapy eligibility.
GENETIC & MOLECULAR
Comprehensive Germline Testing (BRCA1/2, PALB2, ATM)
All pancreatic cancer patients at diagnosisBRCA1/2 and PALB2 mutations identify PARP inhibitor eligibility (olaparib). ATM mutations may also predict HRR deficiency.
Somatic NGS (MSI, NTRK, KRAS, TP53)
All patients — preferably at diagnosisMSI-H (pembrolizumab), NTRK/RET fusions (larotrectinib/entrectinib), KRAS WT (other targets). Guides clinical trial eligibility.
Treatment Options
10 optionsSURGERY
Whipple Procedure (Pancreaticoduodenectomy)
Resectable head of pancreas tumour. Only potentially curative treatment. ~80% of resectable tumours are in head. Major surgery requiring specialist pancreatic centre.
Distal Pancreatectomy + Splenectomy
Resectable body/tail PDAC. Less complex than Whipple.
CHEMOTHERAPY
FOLFIRINOX (5-FU + Leucovorin + Oxaliplatin + Irinotecan)
First-line metastatic PDAC in fit (ECOG 0–1) patients — PRODIGE 4/ACCORD 11 trial. Doubles response rate vs gemcitabine. Also neoadjuvant for borderline/locally advanced.
Gemcitabine + Nab-Paclitaxel (Abraxane)
First-line metastatic PDAC — more tolerable than FOLFIRINOX, suitable for ECOG 0–2. MPACT trial.
Gemcitabine Monotherapy
Elderly or frail patients unfit for combination regimens. Also used adjuvant (though capecitabine now preferred).
Capecitabine Adjuvant
Adjuvant after resection — ESPAC-4 trial: capecitabine superior to gemcitabine monotherapy adjuvant.
Modified FOLFIRINOX Adjuvant
Adjuvant after resection in fit patients — PRODIGE 24/ACCORD 24: superior OS vs gemcitabine adjuvant.
RADIATION
Stereotactic Body Radiotherapy (SBRT)
Locally advanced unresectable PDAC — ablative doses to primary after chemotherapy. Pain control. Does not improve OS vs chemotherapy alone but can achieve local control.
TARGETED THERAPY
Olaparib Maintenance (Lynparza)
BRCA1/2 germline mutant metastatic PDAC — maintenance after ≥16 weeks platinum-based chemotherapy without progression. POLO trial: doubles PFS.
IMMUNOTHERAPY
Pembrolizumab
MSI-H / dMMR PDAC — tumour-agnostic FDA approval. Rare but highly responsive subgroup.