The first 60 days: Adenosquamous carcinoma of the pancreas

What happens now

Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.

Biomarkers your report may list

Squamous component of at least 30 percent on histology (p40 and p63 immunohistochemistry mark the squamous cells)KRAS and TP53 as in ductal adenocarcinoma CA 19-9 for monitoring, as in the parent

Ask which of these were tested and what the results were; see the report reader for what each value means.

Tests and imaging linked to this cancer

Histopathology & immunohistochemistry

Weeks 1 to 3

Who is on your team

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These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.

A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.

Weeks 2 to 6

Decisions coming up

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Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.

1.Resectable NCCN Guidelines: Pancreatic Adenocarcinoma
Pancreatoduodenectomy or distal pancreatectomy with adjuvant chemotherapy as for ductal adenocarcinoma; surgery is the strongest predictor of survival in the population series.
Whipple procedure (pancreaticoduodenectomy)Distal pancreatectomy (removal of the body and tail of the pancreas, usually with the spleen)FOLFIRINOX / mFOLFIRINOX Neoadjuvant / adjuvant / perioperative
2.Advanced NCCN Guidelines: Pancreatic Adenocarcinoma
Chemotherapy as for metastatic pancreatic ductal adenocarcinoma; no histology-specific trial exists.
FOLFIRINOX / mFOLFIRINOX Gemcitabine + nab-paclitaxel NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV)

Every visit

Questions to ask at each visit

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Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.

Newly diagnosed

What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
Which biomarkers have been tested on my tumour (for example Squamous component of at least 30 percent on histology, KRAS and TP53 as in ductal adenocarcinoma, CA 19-9 for monitoring, as in the parent), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Adenosquamous carcinoma with a dominant ductalcomponent, Adenosquamous carcinoma with a dominant squamous component.
Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.

Resectable

For my situation (resectable), which of the standard options do you recommend and why?Guideline options include: Pancreatoduodenectomy or distal pancreatectomy with adjuvant chemotherapy as for ductal adenocarcinoma; surgery is the strongest predictor of survival in the population series.
Am I a candidate for FOLFIRINOX / mFOLFIRINOX, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.

Advanced

For my situation (advanced), which of the standard options do you recommend and why?Guideline options include: Chemotherapy as for metastatic pancreatic ductal adenocarcinoma; no histology-specific trial exists.
Am I a candidate for FOLFIRINOX / mFOLFIRINOX, Gemcitabine + nab-paclitaxel, NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV), and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.

Any stage

Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
I read that “No prospective trial; whether platinum or squamous-directed regimens help is unknown”. How does that affect my plan?Open problems are where trials and second opinions matter most.
I read that “The 30 percent threshold depends on sampling, so small biopsies under-diagnose it”. How does that affect my plan?Open problems are where trials and second opinions matter most.

From day one

Help that costs nothing

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Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.

Any time

What to read next

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Words this page and the cancer page use

Resection margins (R0 / R1 / R2): Whether the edge of the removed tissue is free of cancer.
Distal pancreatectomy (removal of the body and tail of the pancreas, usually with the spleen): Distal pancreatectomy removes the body and tail of the pancreas, the part to the left of the main vessels, usually with the spleen when the cause is cancer.
Whipple procedure (pancreaticoduodenectomy): The big operation for cancers of the head of the pancreas: the surgeon removes the pancreatic head, the duodenum, the gallbladder and part of the bile duct, then reconnects everything.
Grade: How abnormal the cancer cells look under the microscope, from grade 1 (close to normal, slow) to grade 3 or 4 (wildly abnormal, fast).
Neoadjuvant / adjuvant / perioperative: Neoadjuvant therapy is treatment given before surgery, adjuvant therapy is treatment given after it, and perioperative therapy is both.

Every term links to the glossary.