Appointment sheet
Locally advanced unresectable pancreatic ductal adenocarcinoma
Prepared with OnCo (onco.cc/prep/locally-advanced-pdac/). Orientation, not medical advice; your team knows your case.
My details
Name
Date of appointment
Hospital and clinician
Who is coming with me
What I know, what is unclear, changes to discuss
Saved in this browserWhat I know so far
What is unclear to me
Changes since last time
My questions
21 on the sheetNewly diagnosed
- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example Pancreas-protocol CT with arterial encasement, CA 19-9 at baseline and during induction, Restaging CT and PET-CT after induction, Germline BRCA1, BRCA2 and PALB2 status, KRAS and other somatic alterations by tissue or plasma sequencing), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
Induction chemotherapy
- 5.For my situation (induction chemotherapy), which of the standard options do you recommend and why?
- 6.Am I a candidate for FOLFIRINOX / mFOLFIRINOX, Gemcitabine + nab-paclitaxel, and what side effects should I expect?
Tumour treating fields
- 7.For my situation (tumour treating fields), which of the standard options do you recommend and why?
- 8.Am I a candidate for Optune / Optune Pax (TTFields), Gemcitabine + nab-paclitaxel, and what side effects should I expect?
- 9.How do the results of PANOVA-3 apply to someone like me?
Consolidation local therapy
- 10.For my situation (consolidation local therapy), which of the standard options do you recommend and why?
- 11.Am I a candidate for Capecitabine, and what side effects should I expect?
Conversion surgery
- 12.For my situation (conversion surgery), which of the standard options do you recommend and why?
Ablation
- 13.For my situation (ablation), which of the standard options do you recommend and why?
Progression
- 14.For my situation (progression), which of the standard options do you recommend and why?
- 15.Am I a candidate for NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV), Daraxonrasib, and what side effects should I expect?
- 16.How do the results of RASolute 302 apply to someone like me?
Any stage
- 17.Are there clinical trials I could join, for example of Clinical Study of Tumor Treating Fields Combined with Gemcitabine and Albumin-bound Paclitaxel in the First-line Treatment of Locally Advanced Pancreatic Cancer, FOLFIRINOX Versus OncoSil™ in Addition to FOLFIRINOX in Patients With Locally Advanced Pancreatic Adenocarcinoma, Acoustic Cluster Therapy (ACT) With Chemotherapy for the Treatment of Locally Advanced Pancreatic Cancer, A Phase 1 Study to Evaluate Safety and Efficacy of XER-001 (Amifostine for Nasoduodenal Delivery) in Combination With Sterotactic Body Radiotherapy for Treatment in Patients With Locally Advanced Pancreatic Cancer.?
- 18.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 19.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 20.I read that “No local therapy after chemotherapy has lengthened survival in a randomised trial apart from tumour treating fields”. How does that affect my plan?
- 21.I read that “Conversion surgery is uncommon and its benefit over continued non-surgical treatment is unproven”. How does that affect my plan?
The words I may hear
- Desmoplasia (tumour stroma): The dense scar-like tissue that makes up most of a pancreatic tumour, walling off cancer cells from drugs and immune cells.
- Stereotactic body radiotherapy (SBRT / SABR): A course of one to five large, pinpoint-accurate radiation doses that destroy a tumour outside the brain almost like surgery, for patients who cannot or prefer not to have an operation.
- Locally advanced and locoregional disease: Cancer that has grown beyond its organ into nearby tissue or lymph nodes but has not spread to distant sites.
- Resection margins (R0 / R1 / R2): Whether the edge of the removed tissue is free of cancer.
- Stenting (biliary, oesophageal, airway): Placing a small mesh or plastic tube to hold open a duct or passage that a tumour is squeezing shut, relieving jaundice, swallowing difficulty or breathlessness.
- Cancer cachexia: Severe loss of weight and muscle in advanced cancer that eating more cannot reverse on its own.
- Resectable, borderline resectable and unresectable: The surgeon's verdict on whether the tumour can be completely removed.
- Obstructive jaundice and biliary obstruction: Yellowing of the skin and eyes because a tumour blocks the bile duct, most often pancreatic or bile duct cancer.
- CA 19-9: A sugar molecule shed into the blood by most pancreatic cancers; useful to follow treatment, not to screen.
- 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.
Tests and results to bring
Biomarker results to ask for: Pancreas-protocol CT with arterial encasement (defines the stage), CA 19-9 at baseline and during induction (normalisation predicts a useful operation), Restaging CT and PET-CT after induction (occult metastases in a share of patients), Germline BRCA1, BRCA2 and PALB2 status (platinum choice), KRAS and other somatic alterations by tissue or plasma sequencing (trial eligibility), Nutritional status, pancreatic exocrine function and glycaemic control.
Scans and tests linked to this cancer: PET/CT, FAPI PET.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Conversion surgery: Exploration and resection, sometimes with arterial reconstruction, for the minority with stable or responding disease and a normalised CA 19-9 after induction. (Whipple procedure (pancreaticoduodenectomy), Resectable, borderline resectable and unresectable, CA 19-9, Resection margins (R0 / R1 / R2))
- Induction chemotherapy: Modified FOLFIRINOX or gemcitabine plus nab-paclitaxel for four to six months, with biliary stenting, pancreatic enzyme replacement and pain control alongside. (FOLFIRINOX / mFOLFIRINOX, Gemcitabine + nab-paclitaxel, Biliary stenting and drainage, Cancer cachexia)
- Tumour treating fields: Alternating electric fields delivered through skin arrays added to gemcitabine plus nab-paclitaxel (PANOVA-3), approved in 2026. (Tumour treating fields (TTFields), Optune / Optune Pax (TTFields), PANOVA-3, Gemcitabine + nab-paclitaxel)
- Consolidation local therapy: Chemoradiation with capecitabine, stereotactic body radiotherapy or MR-guided ablative radiotherapy after induction chemotherapy for disease that has not spread; LAP07 shows better local control without longer survival. (Chemoradiation (chemoradiotherapy, CRT), SBRT / SABR (stereotactic radiotherapy), MR-guided adaptive radiotherapy, Capecitabine, Hypofractionated radiotherapy)
- Ablation: Irreversible electroporation in selected centres after induction chemotherapy; no randomised evidence. (Irreversible electroporation (NanoKnife))
- Progression: Treat as metastatic disease: switch backbone, daraxonrasib after first-line chemotherapy, clinical trials. (NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV), Daraxonrasib, RASolute 302)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.
Answers and next steps
Saved in this browserWhat I was told
Agreed next steps, dates and who to call