1. See in clinic and assess/ CA19-9
GP referral
Emergency admission
Clinical assessment/Suspicion of pancreatic/peri-ampullary tumour with or without jaundice
Pancreatic protocol CT or MRI +/- ERCP
Video-link
PHNT
No mets
**Exception may be ampullary tumour with resectable met(s)
SMDT
Metastatic disease**
No mets
Consider EUS/CT/US Bx
ONCOLOGY +/- PALLIATIVE CARE
Check CA 19-9
**Locally advanced
*Borderline resectable
Resectable tumour
No mass lesion on imaging
Double duct sign +/- jaundice
MRCP//EUS+/- CA19-9/+/-ERCP
Not fit
See in clinic and assess/ CA19-9
Consider resection/neo-adjuvant treatment/
See in clinic and assess.
For Surgery
Suspicious
CPET testing
Neo-adjuvant chemo-rad/EUS/CT biopsy / CA19-9
No evidence of malignancy
Surgery
Restage
Histology
No progression
SMDT
SMDT
Progression
Adjuvant chemo
Local follow up
*Borderline resectable tumours - venous involvement of SMV/PV with distortion or occlusion with normal vein above and below for safer replacement and anastomosis/ GDA encasement up to the hepatic artery, either shot segment encasement/ or abutment of common hepatic artery without extension to the coeliac axis/ Tumour abutment of the SMA not to exceed 180 degree circumference of the wall
** Locally advanced tumours - Unreconstructable SMV/PV occlusion
Greater than 180 degree abutment of SMA, Coeliac axis involvement