Areas that require assessment and management in patients with unresectable pancreatic cancer: a toolbox
| Key area | Assessment | Management |
| Diagnosis | Adequate imaging (triple-phase pancreatic CT) and review in MDT. Tissue sampling usually by EUS | Firm histological diagnosis made sufficient to allow systemic chemotherapy |
| Pain | Pain scores Pain ladder | Optimisation of analgesia Use of adjuncts Coeliac plexus neurolysis |
| Biliary obstruction | Liver function tests and imaging showing dilated bile ducts | Predominantly ERCP and stent insertion PTC and stent insertion EUS-guided biliary drainage |
| GOO | GOO symptoms score Imaging showing dilated stomach | Surgical gastrojejunostomy in patients with good prognosis Duodenal stent insertion Evolving role of EUS-guided gastrojejunostomy |
| Pancreatic exocrine insufficiency | Location of tumour increases risk (Head>body> tail) Faecal elastase level in selected cases | Treatment with pancreatic enzyme replacement therapy in the high risk Dietitian assessment |
| Diabetes/glycaemic control | Capillary glucose HbA1c | Dietitian assessment Early involvement of the diabetes team |
| Venous thromboembolic events | High index of suspicion Low threshold for treatment | Use of low molecular weight heparin when thromboembolism detected |
| Mental health | Open discussion Specialist nurse assessment | Review by cancer nurse specialist Early involvement of community palliative care team Consider treatment of depression/anxiety when detected |
ERCP, endoscopic retrograde cholangiopancreatography; EUS, endoscopic ultrasound; GOO, gastric outlet obstruction; HbA1a, Haemoglobin A1c; MDT, Multidisciplinary team meeting; PTC, Percutaneous Transhepatic cholangiography.