Pancreatic cancer

Investigations: FBC, LFT, RFT, CA19-9, CEA, LDH, amylase, lipase; pancreatic-protocol CT; endoscopic ultrasound; biopsy (ERCP, laparoscopy or CT-guided); chest X-ray; ERCP stenting for jaundice.

Stage	Management
Resectable	Whipple pancreaticoduodenectomy (distal pancreatectomy for body/tail); adjuvant gemcitabine + capecitabine, gemcitabine alone or 5-FU-based chemotherapy; chemoradiotherapy if R1 or node-positive
Borderline resectable	Staging laparoscopy, neoadjuvant FOLFIRINOX or gemcitabine + nab-paclitaxel, chemoradiotherapy, then surgery if feasible
Locally advanced	Chemotherapy then chemoradiotherapy; stenting or bypass for obstruction
Metastatic	Good performance: FOLFIRINOX or gemcitabine + nab-paclitaxel; poor: gemcitabine alone + supportive care

Regimens

FOLFIRINOX every 14 days: S: oxaliplatin 85 mg/m², folinic acid 400 mg/m², irinotecan 180 mg/m² IV, 5-FU 400 mg/m² bolus then 2400 mg/m² infusion (modified: irinotecan 150 mg/m², no bolus).
Gemcitabine 1000 mg/m² IV days 1 and 8 + capecitabine 1300 mg/m² PO twice daily days 1–14, every 21 days × 6.
Gemcitabine 1000 mg/m² + nab-paclitaxel 125 mg/m² IV days 1, 8, 15, every 28 days × 6.
CapOX, FOLFOX or FOLFIRI as alternatives; pembrolizumab 200 mg IV every 3 weeks for MSI-H/dMMR tumours.

Imeandikwa:

18 Oktoba 2026, 21:05:21

References:

Ministry of Health, United Republic of Tanzania. Standard Treatment Guidelines and National Essential Medicines List for Tanzania Mainland (STG & NEMLIT). 7th ed. Dodoma: Ministry of Health; 2026. Chapter 22, Malignant Disease Conditions: section 22.6.2 Pancreatic cancer (Table 22.28), pp. 596–598.