Clinical Decision-Making in Pancreatic Cancer

  • Robert A. Wolff
Reference work entry


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.


Resectable Borderline resectable Locally advanced Metastatic Adjuvant Neoadjuvant Gemcitabine Nab-paclitaxel FOLFIRINOX Radiation 


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of GI Medical Oncology, Division of Cancer MedicineUniversity of Texas, M.D. Anderson Cancer CenterHoustonUSA

Section editors and affiliations

  • James L. Abbruzzese
    • 1
  • Raul A. Urrutia
    • 2
  • John Neoptolemos
    • 3
  • Markus W. Büchler
    • 4
  1. 1.Duke University Medical CenterDurhamUSA
  2. 2.Mayo Clinic Cancer CenterMayo ClinicRochesterUSA
  3. 3.Division of Surgery and OncologyUniversity of LiverpoolLiverpoolUK
  4. 4.Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany

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