Contents

1.Overview

2. Diagnostic techniques and applications

2.1 Risk factors for pancreatic cancer

2.2 Clinical manifestations

2.3 Physical examination

2.4 Radiological examinations

2.4.1 Ultrosound

2.4.2 Computed tomography (CT)

2.4.3 Magnetic resonance imaging (MRI) and magnetic resonance cholangio-pancreatography (MRCP)

2.4.4 Positron emission tomography-CT (PET-CT)

2.4.5 Endoscopic ultrasonography

2.4.6 Role of ERCP in the diagnosis of pancreatic cancer

2.4.7 Cytology diagnosis via ERCP

2.4.8 ERCP combined with intraductal ultrasound (IDUS)

2.4.9 Bone scans

2.5 Blood immunologic and biochemical examinations

2.5.1 Blood biochemical examinations

2.5.2 Serum tumor markers tests

2.6 Histologic and cytological diagnosis

2.6.1 Cytological pathology diagnosis

2.6.2 Histopathology diagnosis of pancreatic cancer

2.6.3 Immunohistochemistry

2.6.4 Pathologic reports

2.7 Differential diagnosis of pancreatic cancer

2.7.1 Chronic pancreatitis

2.7.2 Carcinoma of ampulla

2.7.3 Pancreatic cystadenoma and cystadenocarcinoma

2.7.4 Choledocholithiasis

2.7.5 Other lesions of pancreas

3. Classification and staging of pancreatic cancer

3.1 Histologic classification of pancreatic cancer

3.2 Staging of pancreatic cancer (AJCC, the 8th edition)

3.2.1 Definition of T, N and M in pancreatic TNM staging

3.2.2 TNM staging for pancreatic cancer

4. Management of pancreatic cancer

4.1 Principles

4.2 Surgery

4.2.1 Principles of surgery

4.2.2 Preoperative biliary drainage

4.2.3 Indications for radical resection

4.2.4 Operation methods

4.2.5 Pancreatic anastomosis

4.2.6 Perioperative drug management

4.2.7 Management principles of postoperative complications

4.2.8 Surgical management of potentially resectable pancreatic cancer

4.2.9 Surgical management of locally advanced unresectable pancreatic cancer

4.3 Medical treatment

4.3.1 Chemotherapy effect for pancreatic cancer

4.3.2 Chemotherapy strategies for pancreatic cancer

4.4 Radiotherapy

4.4.1 Indications for pancreatic cancer radiotherapy

4.4.2 Radiotherapy techniques

4.4.3 Radiotherapy target area

4.4.4 Radiotherapy dose

4.4.5 Concurrent chemotherapy

4.4.6 Intraoperative radiotherapy

4.5 ERCP and related treatment

4.5.1 ERCP for preoperative biliary drainage in pancreatic cancer

4.5.2 Application of ERCP in unresectable pancreatic cancer

4.6 Interventional therapy

4.6.1 Principles of intervention therapy

4.6.2 Transarterial infusion chemotherapy

4.6.3 Ablation therapy

4.6.4 Interventional therapy for pancreatic cancer complications

4.7 Supportive care

4.7.1 Pain control

4.7.2 Nutritional status improvement

4.8 Traditional Chinese medicine treatment for pancreatic cancer

5. Diagnosis and treatment flowchart and follow-up

5.1 Diagnosis and treatment flowchart for pancreatic cancer

5.2 Follow-up

Pancreatic ductal adenocarcinoma is one of the common pancreatic neoplasms, with extremely high malignancy. The latest statistical data from National Cancer Center of China showed that the incidence of pancreatic cancer had increased dramatically from 2000 to 2011. In 2015, the incidence of pancreatic cancer in China ranked ninth among malignant tumors, and the mortality rate was the sixth in malignant tumors.

Recently, with the development of radiology, endoscopy and pathology, the diagnosis of pancreatic cancer has been improved; with the development of new concept and technology of surgery (such as laparoscopy and robotics), locoregional therapy methods (such as stereotactic body radiation therapy, nanoknife ablation and radioactive particles implantation), and antitumor drugs [such as gemcitabine (GEM), nano albumin-bound paclitaxel, S-1, capecitabine, irinotecan, oxaliplatin and nimotuzumab], new opportunities and progress have been made for the management of pancreatic cancer.

For the standard treatment of pancreatic cancer in China, this clinical practice guidelines was made. However, not all the clinical scenarios were included.

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