Who should I consult for possible pancreatic cancer?

Who to Consult for Possible Pancreatic Cancer

For suspected pancreatic cancer, you should immediately consult a multidisciplinary team at a high-volume specialized center that includes surgical oncology, medical oncology, gastroenterology, diagnostic radiology, interventional endoscopy, radiation oncology, and pathology expertise. 1

Primary Referral Pathway

Initial Specialist Contact

• Direct referral to a specialized pancreatic cancer center is the standard of care, as multidisciplinary collaboration should guide all treatment and care planning from the outset 1
• If you are ≥40 years old with jaundice, you require direct specialist referral immediately 2
• If you are ≥60 years old with weight loss combined with abdominal symptoms or back pain, you need urgent computed tomography followed by specialist referral 2

Essential Multidisciplinary Team Members

The core team that should evaluate your case includes 1:

• Surgical oncologist with pancreatic expertise (for resectability assessment and potential surgery)
• Medical oncologist (for systemic therapy planning)
• Gastroenterologist with interventional endoscopy skills (for endoscopic ultrasound, biopsy, and stenting procedures)
• Diagnostic radiologist specialized in pancreatic imaging
• Radiation oncologist (for consideration of chemoradiation)
• Pathologist with expertise in pancreatic malignancies
• Registered dietitian (for nutritional support, which most patients require) 1, 2

Why High-Volume Centers Matter

Specialized centers achieve significantly better outcomes, with operative mortality <10% in experienced hands compared to higher mortality at low-volume centers 3. The NCCN, ASCO, and ESMO guidelines all emphasize that assessment of resectability and treatment planning should occur at high-volume centers 1.

Additional Supportive Consultations

Beyond the core oncology team, you should have access to 1:

• Palliative care specialist (recommended for ALL patients regardless of stage—this is NOT synonymous with hospice and works alongside active treatment) 1
• Pain management specialist (pancreatic cancer frequently causes severe pain requiring specialized interventions like celiac plexus blocks) 1
• Clinical nutritionist (pancreatic enzyme replacement and dietary counseling are often essential) 1, 2
• Genetic counselor (if you are young, have family history of cancer, or are of Ashkenazi Jewish ancestry, as 5-10% of cases have hereditary components) 1

Common Pitfalls to Avoid

• Do not delay referral to a specialized center—general oncology or surgical practices without pancreatic expertise may miss critical staging details or resectability assessments 1
• Do not assume palliative care means "giving up"—early palliative care consultation improves quality of life while pursuing active treatment 1
• Do not overlook nutritional support—pancreatic enzyme replacement can significantly improve weight maintenance and quality of life 1
• Do not accept treatment planning without multidisciplinary review—single-specialty decision-making is substandard care for pancreatic cancer 1

Specific Symptoms Warranting Urgent Referral

Contact a specialist immediately if you have 1, 2:

• Obstructive jaundice (yellowing of skin/eyes)
• Unexplained weight loss with abdominal or back pain
• New-onset diabetes in patients >50 years without family history, obesity, or steroid use
• Unexplained steatorrhea (fatty, floating stools)
• "Idiopathic" acute pancreatitis in patients >50 years (no gallstones, no alcohol)

Geographic Considerations

Cancer centers should serve population bases of 2-4 million people and have sufficient case volume to maintain expertise 1. If your local facility does not meet these criteria, request referral to a regional pancreatic cancer center, as the evidence strongly supports centralization of care for this disease 1.