• Resection margins (R0 / R1 / R2): Whether the edge of the removed tissue is free of cancer.
• 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.
• Germline BRCA mutation (gBRCA): An inherited fault in the BRCA1 or BRCA2 gene, present in every cell from birth, that greatly raises the risk of breast, ovarian, prostate and pancreatic cancer and makes those cancers sensitive to PARP inhibitors and platinum.
• 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.
• Circulating tumour DNA (ctDNA): Circulating tumour DNA (ctDNA) consists of fragments of DNA shed by tumour cells into the blood, detectable with sensitive sequencing.
• Neoadjuvant / adjuvant / perioperative: Neoadjuvant therapy is treatment given before surgery, adjuvant therapy is treatment given after it, and perioperative therapy is both.
• Minimal / molecular residual disease (MRD): Cancer still present after treatment but too small to see on scans, detected by blood or marrow tests.
• Lymphadenectomy (lymph node dissection): Surgically removing the lymph nodes that drain a tumour, both to stage the cancer and to clear any spread.

Staging: Pancreas-protocol CT, chest CT and CA 19-9; endoscopic ultrasound with biopsy when tissue is needed before treatment; biliary stenting only for cholangitis, deep jaundice or delayed surgery.

Biomarker results to ask for: Pancreas-protocol CT for vessel contact and metastases (defines resectability), CA 19-9 before and after surgery (prognosis, response, recurrence), Resection margin status (R0 versus R1) and lymph node ratio, Germline testing for BRCA1, BRCA2, PALB2, ATM and Lynch genes in every patient, Tumour KRAS, TP53, CDKN2A and SMAD4 status (prognostic; SMAD4 loss favours distant spread), Circulating tumour DNA after surgery (investigational marker of residual disease).

Scans and tests linked to this cancer: CT (computed tomography), Endoscopic ultrasound and EBUS systems, Germline (hereditary) testing, Liquid biopsy (ctDNA), High-risk pancreatic surveillance (CAPS / PRECEDE), MRD / molecular residual disease testing.

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

• Surgery: Pancreatoduodenectomy for head tumours, distal pancreatectomy with splenectomy for body and tail tumours, with regional lymphadenectomy; open, laparoscopic or robotic in high-volume centres. (Whipple procedure (pancreaticoduodenectomy), Robotic & minimally invasive surgery, Lymphadenectomy (lymph node dissection), Resection margins (R0 / R1 / R2))
• Adjuvant chemotherapy: Six months of modified FOLFIRINOX for fit patients (PRODIGE 24); gemcitabine plus capecitabine (ESPAC-4) or gemcitabine alone (CONKO-001) for those who cannot tolerate it, started within twelve weeks of surgery. (FOLFIRINOX / mFOLFIRINOX, PRODIGE 24 / CCTG PA6, Gemcitabine, Capecitabine, Neoadjuvant / adjuvant / perioperative)
• Neoadjuvant chemotherapy: Considered for tumours with high-risk features (large size, very high CA 19-9, suspicious nodes) and increasingly offered in trials for all resectable disease; PREOPANC and NORPACT-1 are the evidence for and against. (FOLFIRINOX / mFOLFIRINOX, PREOPANC-1 / PREOPANC-2, Gemcitabine + nab-paclitaxel, Neoadjuvant / adjuvant / perioperative)
• Germline testing: Offered to every patient at diagnosis; carriers of BRCA, PALB2 or ATM variants receive platinum-based chemotherapy and their relatives are offered testing and surveillance. (Germline (hereditary) testing, Germline BRCA mutation (gBRCA), High-risk pancreatic surveillance (CAPS / PRECEDE))
• Follow-up: CA 19-9 and CT every three to six months for two years then less often; recurrence is treated as metastatic or locally advanced disease. (CA 19-9, CT (computed tomography))

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