Synopsis
Recognise obstructive jaundice and other pancreatic-cancer patterns, stage resectability before intervention, obtain tissue before systemic treatment when required and coordinate biliary drainage, surgery, chemotherapy and supportive care safely.
- Obstructive jaundice is a pivotal clue in Pancreatic cancer: Painless jaundice with pale stool, dark urine and pruritus is typical of a pancreatic-head tumour and requires an urgent cancer pathway.
- Immediate priority in unstable Pancreatic cancer: Resuscitate and give antibiotics for sepsis, obtain urgent biliary and pancreatic specialist input, and arrange source control with endoscopic or percutaneous drainage without delaying for a complete elective staging sequence.
- Pancreatic-protocol contrast CT is used early to define tumour, arterial and venous relations, liver and peritoneal metastases and resectability before biliary intervention where stable. This is the first-line staging examination in suspected pancreatic cancer; specialist MDT review, not the report phrase alone, determines resectability.
Key red flags
Painless progressive jaundice, dark urine, pale stool and pruritus suggest distal malignant biliary obstruction.
Fever, rigors, jaundice, hypotension or confusion with obstruction is a source-control emergency rather than routine outpatient staging.
Investigation priorities
Define tumour, arterial and venous relations, liver and peritoneal metastases and resectability before biliary intervention where stable.
Management branches
Pancreatic cancer is suspected in a stable patient with jaundice, pain, weight loss or a pancreatic lesion.
- Obtain pancreatic-protocol CT before biliary drainage when clinically safe, then review resectability at a specialist hepatopancreatobiliary MDT.
- Use MRI for liver or duct uncertainty and endoscopic ultrasound core biopsy when neoadjuvant, systemic or non-operative treatment is planned.
Key medicines
Pancreatin replacementStart a high-strength preparation with all meals and snacks; a common adult starting dose supplies at least 50,000 units of lipase with a main meal and 25,000 units with a snack, titrated to stool, weight and intake.
Modified FOLFIRINOXA common 14-day specialist regimen uses oxaliplatin 85 mg/m² IV, irinotecan 150 mg/m² IV, folinic acid 400 mg/m² IV and fluorouracil 2,400 mg/m² by 46-hour continuous infusion, with protocol-led dose modification.