Appointment sheet
Adenosquamous carcinoma of the pancreas
Prepared with OnCo (onco.cc/prep/pancreatic-adenosquamous-carcinoma/). 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
12 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 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?
- 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?
Resectable
- 5.For my situation (resectable), which of the standard options do you recommend and why?
- 6.Am I a candidate for FOLFIRINOX / mFOLFIRINOX, and what side effects should I expect?
Advanced
- 7.For my situation (advanced), which of the standard options do you recommend and why?
- 8.Am I a candidate for FOLFIRINOX / mFOLFIRINOX, Gemcitabine + nab-paclitaxel, NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV), and what side effects should I expect?
Any stage
- 9.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 10.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 11.I read that “No prospective trial; whether platinum or squamous-directed regimens help is unknown”. How does that affect my plan?
- 12.I read that “The 30 percent threshold depends on sampling, so small biopsies under-diagnose it”. How does that affect my plan?
The words I may hear
- 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.
Tests and results to bring
Biomarker results to ask for: 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.
Scans and tests linked to this cancer: Histopathology & immunohistochemistry.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Resectable: 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)
- Advanced: Chemotherapy as for metastatic pancreatic ductal adenocarcinoma; no histology-specific trial exists. (FOLFIRINOX / mFOLFIRINOX, Gemcitabine + nab-paclitaxel, NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV))
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