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Pancreatic Cancer — RACP Adult Medicine MCQ

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ModerateGeneral Internal MedicinePancreatic CancerRACP Adult Medicine

A 62-year-old man presents with painless obstructive jaundice. CT shows a 2.5 cm mass in the head of the pancreas with no vascular involvement or distant metastases. His CA 19-9 is 450 U/mL. He is otherwise fit with good performance status. What is the most appropriate management?

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Correct answer: A — Pancreaticoduodenectomy (Whipple procedure)

A resectable pancreatic head mass (no vascular involvement, no distant metastases) in a fit patient should undergo upfront surgical resection (pancreaticoduodenectomy/Whipple procedure). This provides the only chance of cure. Adjuvant chemotherapy (modified FOLFIRINOX or gemcitabine plus capecitabine) is standard post-operatively. CA 19-9 is useful for monitoring but not for diagnosis. Neoadjuvant therapy is considered for borderline resectable disease.

Reference: Cancer Council Australia – 2020 – Optimal Care Pathway for Pancreatic Cancer