Surveillance Testing for Patients with History of Pancreatic Cancer
For patients with a history of pancreatic cancer who had elevated preoperative CA19-9 levels, CA19-9 should be assessed every 3 months for 2 years, and an abdominal CT scan should be performed every 6 months during this period. 1
Post-Treatment Surveillance Protocol
The ESMO Clinical Practice Guidelines provide specific recommendations for follow-up after pancreatic cancer treatment:
- CA19-9 monitoring every 3 months for 2 years if the marker was elevated preoperatively 1
- Abdominal CT scan every 6 months during the first 2 years 1
This surveillance schedule is designed to detect recurrences, though it's important to understand that there is no survival advantage in earlier detection of recurrences since curative treatment options remain limited even when recurrence is identified early 1.
Important Clinical Context
The follow-up schedule should be individualized and discussed with each patient to balance the potential benefits of early recurrence detection against the emotional stress and economic burden of frequent testing 1. The guidelines explicitly acknowledge that even early-detected recurrences cannot be cured, which fundamentally changes the risk-benefit calculation for intensive surveillance 1.
During Active Chemotherapy
For patients receiving ongoing chemotherapy for advanced disease, more frequent monitoring is required:
- Evaluation at each chemotherapy cycle for toxicity 1
- Response assessment every 2 months using clinical benefit measures, CA19-9, and imaging 1
- CT scans are particularly indicated in locally advanced disease to rule out metastases and guide decisions about adding radiotherapy 1
Critical Pitfall to Avoid
Do not assume that intensive surveillance improves outcomes—the evidence shows no possibility of cure even for early-detected recurrences 1. The surveillance protocol serves primarily to monitor disease status and guide palliative interventions rather than to improve survival through early intervention.