• Hazard ratio (HR): A hazard ratio is a number comparing the rate of bad events in two groups.
• 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.
• Hot vs cold tumours: 'Hot' tumours are full of immune cells and respond to immunotherapy; 'cold' tumours have kept the immune system out.
• Mechanical theory: stiffness, pressure and force as causes: Cancer cells feel their surroundings.
• Cancer cachexia: Severe loss of weight and muscle in advanced cancer that eating more cannot reverse on its own.
• FOLFOX, FOLFIRI, FOLFIRINOX and CAPOX: The standard chemotherapy recipes for bowel and pancreatic cancer, named from their ingredients: FOL (folinic acid) + F (5-fluorouracil) + OX (oxaliplatin), IRI (irinotecan), or both (FOLFIRINOX).
• KRAS mutation subtypes (G12C, G12D, G12V): KRAS, the most commonly mutated cancer gene, comes in flavours named by the exact amino acid change.
• Downstaging and conversion therapy: Using drugs, radiotherapy or embolisation to shrink a cancer from a stage where curative treatment is impossible to one where it is: for example, shrinking liver metastases until they can be cut out, or liver cancer until it fits transplant criteria.
• 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.
• Fiducial markers: Tiny gold seeds or electromagnetic beacons placed in or near a tumour so the treatment machine can see exactly where it is each day.

Biomarker results to ask for: KRAS (G12D 40%, G12V 30%, G12R 15%, G12C 1-2%), Germline BRCA/PALB2, MSI (rare), NRG1 fusions (KRAS-wild-type), CLDN18.2, CA19-9, CA 19-9 (prognosis and monitoring), KRAS mutation subtype (G12D/V/R/C; wild-type triggers fusion testing), Germline panel (BRCA1/2, PALB2, ATM, CDKN2A, STK11, Lynch), HRD / platinum sensitivity, GATA6 (classical vs basal-like), ctDNA (KRAS-mutant cfDNA) for MRD and response, FAPI PET avidity (investigational), CLDN18.2 IHC (trials).

Scans and tests linked to this cancer: Companion diagnostics, Comprehensive genomic profiling, DPYD genotyping and DPD phenotyping before fluoropyrimidines, Endoscopic ultrasound and EBUS systems, Germline (hereditary) testing, HRD & BRCA testing.

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

• Resectable / borderline: Neoadjuvant mFOLFIRINOX (borderline; increasingly resectable), surgery, then adjuvant mFOLFIRINOX to complete ~6 months (PRODIGE 24); gemcitabine/capecitabine if unfit. Chemoradiation selectively (PREOPANC). (FOLFIRINOX / mFOLFIRINOX, PRODIGE 24 / CCTG PA6, PREOPANC-1 / PREOPANC-2, Robotic & minimally invasive surgery)
• Locally advanced unresectable: FOLFIRINOX or gem/nab-paclitaxel; TTFields with gem/nab-paclitaxel (Optune Pax, 2026); SBRT or MR-guided ablative radiotherapy; IRE in selected centres; reassess for conversion surgery. (PANOVA-3, Optune / Optune Pax (TTFields), Gemcitabine + nab-paclitaxel, SBRT / SABR (stereotactic radiotherapy))
• Metastatic, first line: mFOLFIRINOX or NALIRIFOX (fit) or gemcitabine/nab-paclitaxel; olaparib maintenance if gBRCA after ≥16 weeks platinum; zenocutuzumab if NRG1 fusion; pembrolizumab if MSI-H; trials of RAS inhibitors + chemotherapy. (NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV), NAPOLI 3, POLO, Zoldonrasib)
• Metastatic, second line: Daraxonrasib once approved (RASolute 302: OS 13.2 vs 6.7 months) is expected to become the standard; otherwise switch backbone (gem/nab-pac after FOLFIRINOX, or liposomal irinotecan/5-FU after gemcitabine). (RASolute 302, Daraxonrasib)
• High-risk surveillance: Annual MRI/MRCP or EUS for germline carriers and familial kindreds (CAPS/PRECEDE); germline testing for every diagnosed patient and first-degree relatives. (High-risk pancreatic surveillance (CAPS / PRECEDE), Germline (hereditary) testing, MRI)

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.