Objectives
  • To be able to perform specialist assessment, treatment and counselling of patients with pancreatic adenocarcinoma

Awareness
  • Awareness of the existence of different biological and pathological subtypes of pancreatic adenocarcinoma for the selection of the appropriate treatment strategies; specifically distinguish between cancers of the exocrine and endocrine part of the pancreas; for neuroendocrine tumours, see subchapter 4.5.9.b

  • Awareness of the existence of specific lifestyle risk factors and premalignant conditions for pancreatic adenocarcinoma

  • Awareness of different prognostic factors

  • Appreciation of the importance of the multimodality approach to treat patients with pancreatic adenocarcinoma

  • Appreciation of the importance of adequate imaging techniques to allow for exact pretreatment staging

  • Appreciation of the use of specific surgical techniques and their respective complications in the management of pancreatic adenocarcinoma

Knowledge
  • Familiarity with the implications of the different biological and pathological subtypes of pancreatic adenocarcinoma in order to select the appropriate treatment strategies

  • Understanding of the pattern of metastasis of pancreatic adenocarcinoma

  • Familiarity with the indications and diagnostic tools available for pancreatic adenocarcinoma (such as upper endoscopy with or without endoscopic ultrasound, computed tomography (CT) and positron emission tomography (PET)/CT imaging, diagnostic laparoscopy) and their implications for an appropriate therapeutic strategy

  • Understanding of the role of endoscopic techniques to address biliary tract stenosis

  • Understanding of the importance of cancer precursor lesions and premalignant conditions for the development of pancreatic adenocarcinoma

  • Familiarity with the risk assessment of prognostic factors, especially the TNM staging system for pancreatic adenocarcinoma

  • Familiarity with the indications and value of the multimodality approach of surgery and chemotherapy in non-metastatic pancreatic adenocarcinoma

  • Familiarity with the controversial role of radiotherapy in the postoperative setting and its established role in the palliative management of unresectable disease

  • Familiarity with defining pancreatic adenocarcinoma as primarily resectable, borderline resectable, locally advanced and metastatic based on imaging staging

  • Understanding of the role of chemotherapy and targeted therapy in the management of patients with advanced pancreatic adenocarcinoma

  • Familiarity with hereditary syndromes, the management of families with these and the implications for individual patients

  • Understanding of the value of first- and second-line therapy in advanced pancreatic adenocarcinoma

  • Understanding of the symptoms and complications that derive from disease progression and those that are treatment-associated in the context of being familiar with supportive and palliative care settings

Skills
  • Ability to contribute actively to a variety of pancreatic adenocarcinoma scenarios and patient presentations

  • Ability to discuss critically the treatment options and recommendations for various phases of the disease (early and metastatic disease)

  • Ability to perform a history and physical examination in pancreatic adenocarcinoma patients, including different subtypes and different stages of disease

  • Ability to follow individual patients with pancreatic adenocarcinoma throughout their patient history from initial diagnosis to hospice care

  • Ability to contribute to discussions on general management strategies in order to understand all the considerations on which treatment to use and which sequence to select for the multidisciplinary strategy

  • Ability to prescribe various chemotherapeutic agents and targeted therapy considering their potential interactions with radiation therapy

  • Ability to contribute to the actual status of the pre- and perioperative treatment settings

  • Ability to correctly allocate patients to the neoadjuvant, perioperative and adjuvant treatment setting

  • Ability to recognise conditions or clinical prognostic factors such as performance status, tumour load, number of metastases, prior adjuvant chemotherapy, concomitant diseases and other previous therapies that are important for considering when to start and to stop a treatment or switch to another option

  • Ability to manage side effects of various therapeutic agents