Table 7.
Summary of recommendations
| General and pre-diagnosis |
| 1. PC has been classically associated with a certain nihilistic medical approach. In recent years, therapeutic improvements and new treatment options justify leaving behind this skepticism in the face of more encouraging prospects |
| 2. There are currently not enough data to support systematic screening for PC in asymptomatic patients. Since the initial symptoms are nonspecific or not very noticeable, a high degree of suspicion, especially in primary care, is crucial for a faster diagnosis of the disease |
| 3. The occurrence of diabetes, especially in patients aged over 50 years, without metabolic syndrome, or non-specific gastrointestinal changes or involuntary weight loss may facilitate suspicion |
| 4. In primary care, the presence of jaundice in a patient over 40 years old should be a reason to refer the patient to the emergency room. In patients aged over 60 years, weight loss with other associated clinical problems (diarrhea, abdominal pain, nausea, vomiting, constipation, or new-onset diabetes) should be a reason for referral to an specialist within 15 days |
| Diagnosis |
| 5. The standard diagnostic procedure should include first steps anamnesis, physical examination, analytical and ultrasound tests |
| If there is a substantial delay in performing ultrasound scans, mention of the suspected PC in the application should determine an expedited scanning |
| If ultrasound results are not diagnostic, there must be a protocol that leads directly to performance of a MCT scan |
| If the ultrasound is negative but symptoms are sufficiently indicative of PC, refer the patient to a specialist for the assessment of the case and selection of the appropriate tests |
| 6. Suspected cases while in primary care should be referred to a hospital with multidisciplinary tumor committees with experience in the diagnosis and treatment of PC. Centers that do not have these committees should send the patient with diagnosis or clear suspicion of PC to a referral center that does. The diagnostic study in such unit should be completed within 2 weeks |
| Treatment |
| 7. The treatment to be applied (or alternatively new diagnostic tests) should always be established by a multidisciplinary tumor committee. The committee should meet at least weekly |
| 8. The multidisciplinary tumor committee should always include specialists in medical and radiotherapeutic oncology, surgery, pathology, radiology, digestive system, ecoendoscopy and nutrition/dietetics. Optionally, each center may opt for additional participation of specialists in critical care endocrinology, interventional radiology or other specialties |
| 9. The maximum delay time to initiate treatment should not exceed the following deadlines: |
| Surgical treatment with curative intent: surgery should be performed in less than 15 days and no later than 4 weeks after tumor staging. When adjuvant chemotherapy is needed, it is recommended to initiate it after 3–4 weeks from the intervention, but no later than 6–8 weeks after the intervention, unless there is an insufficient recovery of the patient |
| In patients who are not candidates for surgery, the maximum time from staging to initiation of chemotherapy should be 7 days, or 15 days for chemoradiotherapy |
| In patients with borderline resectable tumors, preoperative chemotherapy or chemoradiotherapy should be started preferably in less than 15 days and no later than 4 weeks after staging |
| Palliative chemotherapy: no later than 7 days after staging |
| Follow-up |
| 10. The type of follow-up to be performed should be defined by the multidisciplinary tumor committee. In order to avoid repetitions and redundancies, each center must establish a consensual protocol to define which specialties or units assume the follow-up of the different types of patients in the different phases. Each patient should have a specific physician responsible for their follow-up |
| 11. Participation in the multidisciplinary tumor committee of an endocrinology / nutrition specialist for screening and nutritional assessment, preoperative immunonutrition and nutritional support, as well as its involvement in the follow-up of all patients for the control of diabetes, pancreatic insufficiency and vitamin deficiencies, as appropriate |
| Recommendations for the future |
| 12. It is recommended to create specialized diagnostic functional units with rapid circuits to manage certain suspected PC defined according to the patient’s risk characteristics and possible alarm signals |