Synopsis
Recognise pancreatic malignancy promptly, stage it without avoidable procedural delay, and coordinate resection, systemic treatment, biliary care, nutrition and symptom control through a specialist multidisciplinary team.
- New obstructive jaundice in a person aged 40 or over warrants an urgent suspected-cancer pathway; fever, hypotension or confusion additionally suggests cholangitis requiring emergency care.
- Pancreas-protocol contrast CT of chest, abdomen and pelvis usually defines the primary lesion, vascular relationships and distant spread before any planned biliary drainage.
- A normal CA 19-9 does not exclude cancer, while cholestasis can raise it substantially; the marker supports assessment and follow-up but never establishes the diagnosis alone.
Key red flags
Jaundice with fever, rigors, hypotension or altered consciousness suggests acute cholangitis and demands immediate sepsis management plus urgent biliary-source control advice.
Investigation priorities
Define cholestasis, organ reserve and immediate complications before contrast imaging or intervention.
Management branches
Jaundice or cholestatic symptoms without an established benign explanation.
- Assess immediately for cholangitis, dehydration, coagulopathy and renal injury; admit and treat urgently when systemic illness is present.
- Arrange pancreas-protocol CT before elective biliary drainage whenever the patient is stable enough, preserving accurate staging information.
Key medicines
Pancreatin pancreatic enzyme replacementBegin with a substantial lipase dose at every meal and a smaller dose with snacks, then titrate to food and symptoms under local guidance.
Opioid analgesia with bowel protectionTitrate an immediate-release preparation to effect, then convert to a regular regimen with breakthrough rescue according to local palliative guidance.