An expert for pancreatic cancer management should be an experienced oncologist who (1) has sufficient knowledge in gastroenterology / should be a trained gastroenterologist, (2) is working in an oncological treatment center specialized for pancreatic cancer, in which (3) interdisciplinary pancreatic tumor board meetings are done in regular intervals.
Pancreatic cancer is a severe malignant disorder with an increasing incidence. It is characterised by early infiltration of lymph nodes and nearby structures like the biliary tract, the duodenum and the large vessels in the abdominal cavity. It also tends to spread early via the blood stream in other organs. At the time of initial diagnosis, the tumor is locally advanced and non-resectable in 30-40% of all patients, or it has already disseminated in other organs in 40-50%.
An interdisciplinary therapeutic management is of particular importance in this tumor. Only if oncologists, gastroenterologists, radiologists, radiooncologists and surgeons closely cooperate, an optimal treatment strategy can be realized.
An experienced oncologist will help to come to the diagnosis as soon as possible and will assist to assess the stage of disease on which the therapeutic strategy depends. In addition, the clinical oncologist will help to avert symptoms of the disease like pain, loss of appetite, weight loss, and newly diagnosed diabetes. In case of jaundice due to a biliary tract obstruction he will refer you promptly to a gastroenterologist for a biliary stent implantation.
Should the interdisciplinary tumor board rate your pancreatic cancer as operable, you will be introduced to an experienced pancreatic surgeon. This is of particular importance since the success rate of surgery and the frequency of perioperative complications closely correlate with the expertise of the surgeon.
Should the tumor be rated as non-resectable, the oncologist will coordinate a neoadjuvant (preoperative) chemotherapy which should result in tumor shrinkage and allow surgical resection at a later time point. To achieve this goal, in some patients it might also be necessary to perform a subsequent radiotherapy. This will also be coordinated by your oncologist.
If there are metastases in other organs at the time of initial diagnosis, a usually fairly good tolerated palliative chemotherapy with the aim to prolong survival and improve or maintain a good quality-of-life will be started. The oncologist will control the success of treatment clinically, by serial measurements of the tumor markers, and CT scans in regular intervals.