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Clinical Decision-Making in Pancreatic Cancer

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Pancreatic Cancer

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Abstract

The management of pancreatic cancer relies on clinical staging for the majority of patients. High-quality cross-sectional imaging, and in some cases adjunctive staging modalities, partitions pancreatic cancer into one of four categories: localized and potentially resectable, borderline resectable, locally advanced/unresectable, or metastatic. Subsequent decisions regarding specific anticancer therapies and palliative interventions should be based on patient-centered, defined goals of care. Clinical decision-making should be evidence based, accounting for the patient’s performance status and psychosocial circumstances, and developed with multidisciplinary input. Presently, surgical resection provides the only meaningful chance for long-term survival and, in general, is relevant only to those patients with potentially resectable or borderline resectable disease. However, there appears to be an expanding subset of patients with locally advanced disease who may eventually be considered surgical candidates. Nevertheless, surgical resection with curative intent should be linked to the delivery of additional therapy either as adjuvant therapy or neoadjuvant treatment. Enrollment in prospective clinical trials is always encouraged provided participation is not an undue burden on the patient or caregivers. Lastly, patients in need of expert clinical services should be encouraged to seek cancer care in pancreatic cancer centers of excellence as current evidence suggests improved outcomes in these settings.

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Authors and Affiliations

  1. Department of GI Medical Oncology, Division of Cancer Medicine, University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA

    Robert A. Wolff

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  1. Robert A. Wolff
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Correspondence to Robert A. Wolff .

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Editors and Affiliations

  1. Div. Surgery & Oncology, University of Liverpool, Liverpool, United Kingdom

    John P. Neoptolemos

  2. Rochester, Minnesota, USA

    Raul Urrutia

  3. Dept. Gastrointestinal Medical Onco, Duke University Medical Center Dept. Gastrointestinal Medical Onco, Durham, North Carolina, USA

    James Abbruzzese

  4. Heidelberg, Germany

    Markus W. Büchler

Section Editor information

  1. Duke University Medical Center, Durham, NC, USA

    James L. Abbruzzese

  2. Mayo Clinic Cancer Center, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA

    Raul A. Urrutia

  3. Division of Surgery and Oncology, University of Liverpool, Daulby Street, Liverpool, UK

    John Neoptolemos

  4. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Markus W. Büchler MD

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Wolff, R.A. (2016). Clinical Decision-Making in Pancreatic Cancer. In: Neoptolemos, J., Urrutia, R., Abbruzzese, J., Büchler, M. (eds) Pancreatic Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6631-8_26-2

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