A pancreatic cancer diagnosis can feel overwhelming. In those first moments, it’s natural to feel a rush of emotions — fear, confusion, and uncertainty about what comes next. We want you to know: you are not alone, and understanding your diagnosis is the most powerful first step you can take.
How Pancreatic Cancer Is Classified
Unlike many other cancers that are staged from 0 to 4, pancreatic cancer is primarily classified by whether surgical removal of the tumor is possible. This distinction is critical because it directly shapes your treatment path:
- Resectable: The tumor can be surgically removed. This is the most favorable category and offers the best chance for long-term disease control.
- Borderline Resectable: The tumor may be removable, but it’s close to major blood vessels. Chemotherapy is often given first to shrink the tumor before surgery is attempted.
- Locally Advanced: The tumor has grown into nearby blood vessels and cannot be surgically removed at this time. Treatment focuses on chemotherapy, with the goal of potentially making surgery possible later.
- Metastatic: The cancer has spread to other organs, most commonly the liver. Treatment focuses on controlling the disease and maintaining quality of life.
The Importance of Biomarker Testing
One of the most important steps after diagnosis is biomarker testing. About 5–10% of pancreatic cancers carry inherited BRCA1 or BRCA2 mutations, which can open the door to targeted treatments like PARP inhibitors. Other important biomarkers include:
- MSI-H/dMMR status: If your tumor is microsatellite instability-high, immunotherapy (pembrolizumab) may be an option.
- KRAS mutations: Found in about 90% of pancreatic cancers, these are being actively studied in clinical trials.
- NTRK fusions: Rare but treatable with targeted therapies like larotrectinib or entrectinib.
Ask your care team about comprehensive biomarker testing — it can reveal treatment options you might not otherwise know about.
Building Your Care Team
Pancreatic cancer treatment benefits from a multidisciplinary team approach. Your team may include a surgical oncologist, medical oncologist, radiation oncologist, gastroenterologist, nutritionist, and palliative care specialist. Don’t hesitate to seek a second opinion, especially at a high-volume pancreatic cancer center — research shows that outcomes can be better at hospitals that treat a larger number of pancreatic cancer patients.
Reviewed by the XpertPatient Medical Team. Sources: National Cancer Institute (NCI), American Cancer Society (ACS), NCCN Guidelines.
