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Pancreatic cancer, resectable

Pancreatic ductal adenocarcinoma →

A major operation, two to three months to recover, then six months of combination chemotherapy, which roughly doubled the time patients stay cancer-free in the trial that set the standard.

01234567891011Months from diagnosis · solid bar = shortest typical duration, hatched = up to the longest · arrow = continues for yearsPhaseDiagnosis and stagingDiagnosis and tests · 2-4 wkPancreatic resectionSurgery and recovery · 1-2 wkRecoverySurgery and recovery · 8-12 wkAdjuvant mFOLFIRINOXAfter surgery · 24 wkSurveillanceSurveillance · yearsResectable, borderline or locally advanced?decision 1Diagnosis and testsSurgery and recoveryAfter surgerySurveillance
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Typical sequence for Resectable disease; durations are protocol values (cycle counts and lengths, fraction schedules, guideline follow-up intervals), not averages of real patients. Your team's plan will differ in detail.

Phase by phase

  1. 1. Diagnosis and staging
    weeks 0-4

    Pancreas-protocol CT, endoscopic ultrasound biopsy, CA19-9; germline testing for BRCA and other genes; biliary stent if jaundiced.

    Source
    Decision: Resectable, borderline or locally advanced?
    • Resectable: surgery first, then adjuvant chemotherapy
    • Borderline resectable: neoadjuvant FOLFIRINOX (and sometimes chemoradiotherapy) before an attempt at surgery
    • Locally advanced: chemotherapy, surgery only if the tumour shrinks
  2. 2. Pancreatic resection
    weeks 2-4

    Whipple procedure (head) or distal pancreatectomy (body and tail); 1-2 weeks in hospital.

    Source
  3. 3. Recovery
    weeks 3-15

    Chemotherapy starts once eating and weight are stable, within 12 weeks of surgery (PRODIGE 24 window).

    Source
  4. 4. Adjuvant mFOLFIRINOX
    weeks 11-35

    Twelve 2-week cycles of oxaliplatin, irinotecan, fluorouracil and leucovorin; gemcitabine-based chemotherapy for those not fit for it.

    Source
  5. 5. Surveillance
    from week 35, continues for years

    CA19-9 and CT every 3-6 months for 2 years, then every 6-12 months.

    Source

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