What questions should I ask my oncologist about locally advanced Pancreatic Cancer

Important Questions to Ask Your Oncologist About Locally Advanced Pancreatic Cancer

Based on current pancreatic cancer treatment guidelines, here are the key questions you should ask your care team:

UNDERSTANDING YOUR DIAGNOSIS & GOALS

1. What exactly does "locally advanced" mean for my specific cancer?

• Ask your doctor to explain the TNM staging (tumor size, lymph node involvement, and whether it has spread)
• Understanding your exact stage helps you grasp what treatment options are realistic

2. What is the goal of my treatment? According to the NCCN Guidelines for Pancreatic Cancer, doctors have specific objectives in mind. Ask:

• Are we trying to shrink the tumor so I become eligible for surgery?
• Are we aiming to control the cancer long-term?
• What does "success" look like for my situation?

3. Have you done molecular profiling (genetic testing) on my tumor? This is now standard of care. According to Dr. [removed] Strickler's guidance on precision cancer medicine, every pancreatic cancer patient should ask: "Can I see the molecular profiling report?" This testing can identify:

• KRAS mutations (found in 87% of pancreatic cancers)
• BRCA mutations
• Mismatch repair defects
• Other actionable mutations that might qualify you for targeted therapies

Keep a printed copy with you—it often doesn't transfer between medical centers.

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TREATMENT OPTIONS & DECISION-MAKING

4. What treatment regimen are you recommending, and why? According to NCCN Guidelines, the main chemotherapy options for locally advanced pancreatic cancer include:

• FOLFIRINOX (four-drug combination: leucovorin, 5-FU, irinotecan, oxaliplatin)
• Gemcitabine + nab-paclitaxel (Abraxane)

Ask your doctor:

• Why did you choose this regimen for me specifically?
• How is it given? (FOLFIRINOX uses a portable pump you take home; gemcitabine/nab-paclitaxel is given weekly)
• Can we switch if this doesn't work well for me?

5. Should I receive neoadjuvant therapy (treatment before surgery)? According to Let's Win Pancreatic Cancer research, neoadjuvant therapy is increasingly important for locally advanced disease because it:

• Allows doctors to test how your cancer responds to chemotherapy
• May shrink the tumor enough to make surgery possible
• Can eliminate micrometastases (tiny cancer cells throughout your body)
• Improves the chance of achieving R0 resection (surgery with no cancer cells at the margins)

Ask: "Am I a candidate for neoadjuvant chemotherapy followed by radiation and/or surgery?"

6. Will I receive radiation therapy, and if so, what type? According to NCCN Guidelines, locally advanced pancreatic cancer may be treated with:

• SBRT (Stereotactic Body Radiation Therapy): Very precise, high-dose radiation delivered in 5 or fewer sessions
• IMRT (Intensity-Modulated Radiation Therapy): More traditional radiation over several weeks
• Chemoradiation: Chemotherapy combined with radiation therapy

Ask: "Which radiation approach is best for me, and when would it start?"

7. Could I eventually become a candidate for surgery? Ask your doctor:

• What would need to happen for surgery to become an option?
• What are the risks and benefits of surgery in my case?
• Would you recommend a second opinion from a pancreatic surgeon?

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CLINICAL TRIALS & EMERGING TREATMENTS

8. Am I eligible for any clinical trials? According to Let's Win Pancreatic Cancer, clinical trials are particularly important because:

• Standard treatments alone often don't provide long-term survival
• Trials may offer access to newer approaches like immunotherapy, cancer vaccines, or combination therapies
• Patients in trials often have better outcomes because they receive closer monitoring

Ask:

• Are there trials available for locally advanced pancreatic cancer?
• What would participation involve?
• Would the trial be covered by insurance?
• Can you help me find trials through ClinicalTrials.gov or Let's Win's Trial Finder?

9. Should I see a genetic counselor? According to current guidelines, genetic counseling is recommended for all pancreatic cancer patients because:

• 5-8% of patients have inherited genetic predisposition
• Certain mutations (BRCA1, BRCA2, PALB2) may qualify you for specific treatments like PARP inhibitors
• Your family members may need screening

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MANAGING SIDE EFFECTS & QUALITY OF LIFE

10. What side effects should I expect—both short-term and long-term? Ask specifically about:

• Nausea, vomiting, and appetite changes
• Fatigue and how long it might last
• Nerve damage (neuropathy) from chemotherapy
• Digestive problems
• What I should do if side effects become severe

11. Should I meet with a registered dietitian? According to Let's Win Pancreatic Cancer, up to 90% of pancreatic cancer patients lose weight during treatment. A dietitian can help you:

• Maintain nutrition and prevent weight loss
• Manage nausea and poor appetite
• Determine if you need pancreatic enzyme supplements (if your cancer is blocking enzyme flow)

12. Should I start exercising during treatment? Research shows that regular physical activity before, during, and after treatment can:

• Reduce fatigue
• Improve sleep quality
• Lower anxiety
• Potentially improve outcomes

Ask: "Can you refer me to a physical therapist or prehabilitation program?"

13. How will we monitor if treatment is working? According to NCCN Guidelines, your care team will track:

• CA 19-9 blood tests: A tumor marker specific to pancreatic cancer (higher numbers = more active disease)
• CT or MRI scans: Imaging to see if the tumor is shrinking, stable, or growing
• Your physical symptoms: Whether pain, nausea, or other symptoms improve

Ask: "How often will we do these tests, and what changes would prompt a treatment change?"

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PRACTICAL & EMOTIONAL SUPPORT

14. What support services are available? Ask about:

• Palliative care (supportive care focused on quality of life—this is NOT the same as hospice)
• Mental health support or counseling
• Support groups for pancreatic cancer patients
• Financial assistance programs

15. Who should I call with questions between appointments? Get specific contact information and response time expectations.

16. How will treatment affect my daily life? Ask about:

• Work and activity restrictions
• Driving (especially if you'll have a chemotherapy port)
• Sexual function and fertility concerns
• Travel limitations

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GETTING A SECOND OPINION

17. Would you recommend I get a second opinion? According to Let's Win Pancreatic Cancer, second opinions are particularly valuable for pancreatic cancer because:

• Staging can be difficult and sometimes missed
• Treatment options are evolving rapidly
• Larger cancer centers may have access to clinical trials
• You may learn about surgical options you didn't know existed

Ask: "Can you provide my records to another pancreatic cancer specialist?"

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BRINGING IT ALL TOGETHER

Before your appointment:

• Write down your questions in advance
• Bring a family member or friend to take notes
• Ask if you can record the conversation
• Request copies of all test results and reports

After your appointment:

• Review your notes and ask follow-up questions via phone/email
• Get a written summary of your treatment plan
• Keep copies of your molecular profiling report and pathology report with you

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Key Resources to Explore

According to the medical guidelines:

• NCCN Guidelines for Patients: Pancreatic Cancer - Free patient-friendly version available at NCCN.org
• Let's Win Pancreatic Cancer - Excellent resource for understanding treatment options and finding clinical trials
• ClinicalTrials.gov - Search for pancreatic cancer trials
• National Cancer Institute (NCI) - Evidence-based information about pancreatic cancer

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