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Borderline Resectable, Neoadjuvant therapy options, Adjuvant Chemotherapy…
Borderline Resectable
Perfom biopsy
Cancer
confirmed
Consider ERCP with stent place
Perform Neoadjuvent Therapy
Assess:
Pancreatic protocol CR or MRI
Chest/Pelvic CT
CA 19-9 test
Cancer spread
Check if Locally Advanced or Metastatic Disease
Surgery possible
Consider staging Laparoscopy
Surgery resection
After surgery give adjuvant therapy to prevent recurrence
1 more item...
Unresectable disease during surgery
Check if there is Jaundice
2 more items...
Cancer not confirmed
Repeat biopsy
Still not confirmed
Refer to high volume center for evaluation
Neoadjuvant therapy options
Folifirinox or modified Folifirinox ( PS 0-1)
Gemcitabine with albumin bound Paclitaxel
In BRCA1, BRCA 2, PALB2 Mutations
Folifirinox or Modified Folifirinox (PS 0-1)
or
Gemcitabine with cisplatin
Adjuvant Chemotherapy Options
Modified Folifirinox (PS0-1)
Gemcitabine with capecitabine