What questions should I ask my oncologist about early stage Pancreatic Cancer

Important Questions to Ask Your Oncologist About Early-Stage Pancreatic Cancer

I'm glad you're preparing to have informed conversations with your care team. Early-stage pancreatic cancer presents unique opportunities, and asking the right questions can help you understand your options and participate actively in your treatment decisions.

STEP 1: UNDERSTANDING YOUR SPECIFIC DIAGNOSIS

Start by getting clarity on exactly what you're dealing with:

1. What stage is my cancer, and what does that mean for my prognosis?

• Ask your doctor to explain whether your cancer is resectable (can be surgically removed), borderline resectable, or locally advanced
• Understanding the functional staging helps determine whether surgery is an option

2. Have you done genetic testing on my tumor?

• According to the CancerPatientLab webinar on "Novel Therapies and New Directions in Pancreas Cancer," you should receive "point-of-care genetic testing" (testing on both your normal cells and tumor cells) at your first meeting
• Ask specifically about testing for: KRAS mutations, BRCA1/BRCA2, PALB2, and other relevant mutations
• Request to see the molecular profiling report—this typically exists outside your regular medical chart

3. Do I have any hereditary risk factors?

• About 12% of people have a hereditary predisposition to pancreatic cancer
• Ask if genetic counseling is recommended for you and your family
• This matters because certain mutations (like BRCA mutations) may qualify you for specific targeted treatments

STEP 2: UNDERSTANDING YOUR TREATMENT OPTIONS

4. What is the goal of my treatment?

• According to Let's Win Pancreatic Cancer's guidance, doctors have specific objectives in mind—whether that's shrinking your tumor to make you eligible for surgery, or extending survival time
• Understanding the goal helps you evaluate whether the treatment plan aligns with what matters most to you

5. Am I a candidate for surgery?

• If your cancer is resectable, surgery may offer the best chance for long-term survival
• Ask: "What type of surgery would be recommended?" (for example, a Whipple procedure)
• Ask about the recovery timeline and what to expect

6. What chemotherapy regimen are you recommending, and why?

• The two most common regimens are:
  • Gemcitabine + nab-paclitaxel (Abraxane): Given once weekly for 4 hours
  • FOLFIRINOX: A combination of four chemotherapy drugs; you receive some through a portable pump at home for up to 2 days
• Ask your doctor why they chose one over the other for your specific situation
• According to Let's Win Pancreatic Cancer, the choice isn't critical—you can switch if one isn't working well for you

7. Will I receive neoadjuvant chemotherapy (before surgery) or adjuvant chemotherapy (after surgery)?

• This timing affects your overall treatment plan and recovery

STEP 3: MANAGING SIDE EFFECTS AND QUALITY OF LIFE

8. What side effects should I expect, and how will we manage them?

• Ask about both immediate side effects and those that might appear months or years later
• Understanding what to expect helps you prepare and know when to call your doctor

9. Should I meet with a registered dietitian?

• Up to 90% of pancreatic cancer patients lose weight after diagnosis and during treatment
• A dietitian can help you maintain nutrition and manage side effects like nausea and poor appetite

10. Are pancreatic enzyme supplements appropriate for me?

• Pancreatic cancer can interfere with your ability to digest food
• If you don't have enough pancreatic enzymes to break down fats, proteins, and carbohydrates, supplemental enzymes can help prevent weight loss and digestive problems

11. Should I start an exercise program?

• According to Let's Win Pancreatic Cancer, research shows that regular exercise before, during, and after treatment can improve outcomes
• Ask about meeting with a physical therapist or enrolling in a "prehabilitation program"
• Exercise can help counteract fatigue, improve sleep, and reduce anxiety

STEP 4: EXPLORING CLINICAL TRIALS AND EMERGING TREATMENTS

12. Am I eligible for clinical trials?

• Clinical trials are particularly important for pancreatic cancer because they may offer access to cutting-edge therapies
• According to the CancerPatientLab webinar, emerging treatments include:
  • KRAS inhibitors (since 90% of pancreatic cancers have KRAS mutations)
  • Immunotherapy approaches like personalized neoantigen vaccines and CD40 agonists
  • PARP inhibitors (if you have DNA repair deficiencies like BRCA mutations)
  • Combination therapies pairing targeted drugs with chemotherapy

13. What clinical trials would be most relevant for my specific genetic profile?

• Ask your doctor to help you search databases like ClinicalTrials.gov or Let's Win Trial Finder
• Consider getting a second opinion from a major academic cancer center—they often have access to cutting-edge trials

14. Should I see a genetic counselor?

• Current guidelines recommend genetic counseling for all pancreatic cancer patients
• Results may reveal mutations that qualify you for specific treatments

STEP 5: MONITORING YOUR RESPONSE TO TREATMENT

15. How will we know if treatment is working?

• According to Let's Win Pancreatic Cancer, there are several indicators:
  • Physical symptoms improve despite chemotherapy side effects
  • Blood tests showing changes in disease markers (particularly CA 19-9 levels—higher numbers indicate active disease, so you want to see this number decrease)
  • Imaging tests like CT scans are the best way to determine if chemotherapy is working

16. What are my key biomarkers, and what do the changes mean?

• Ask your oncologist to explain which markers they're tracking and what the numbers mean
• This helps you understand your progress

STEP 6: GETTING A SECOND OPINION

17. Would a second opinion from a major academic cancer center be helpful?

• According to Let's Win Pancreatic Cancer, academic centers are driven by research and may have access to cutting-edge technology
• Oncologists at these centers often specialize in pancreatic cancer and stay current with the latest information
• Second opinions are particularly valuable before starting any treatment

18. Are there any clinical trials at academic centers I should know about?

• Major cancer centers often have pancreatic cancer trials that could potentially help you

STEP 7: PRACTICAL SUPPORT

19. Who should I call with questions between appointments?

• Know who to contact and how quickly you can reach them

20. What support services are available to me and my family?

• Ask about counseling, support groups, financial assistance, and other resources

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KEY TAKEAWAY: BRING YOUR RECORDS

According to the CancerPatientLab webinar on "Navigating Pancreatic Cancer," when you get a second opinion or consultation, you should:

• Bring your molecular profiling report (genetic testing results)—this typically exists outside your regular medical chart
• Ask directly: "Have you done the molecular profiling on my cancer? Can I see the report?"
• This information is crucial for identifying which targeted therapies you might be eligible for

RESOURCES TO HELP YOU

• ClinicalTrials.gov: Search for pancreatic cancer trials
• Let's Win Trial Finder: Pancreatic cancer-specific trial database
• Massive Bio and myTomorrows: Free services that review your [ID removed] and recommend suitable clinical trials
• Pancreatic Cancer Action Network (PanCAN): Advocacy organization with resources
• Cancer Commons: Offers free second opinions

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This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.