Pancreatic Cancer

Pancreatic cancer usually presents late and carries a poor prognosis - the article puts 5-year survival at approximately 20% and holds that the outlook has barely moved despite advances in cancer therapy. The definitive management is surgical and it is a narrow window: an operation is the only route to cure, and only 20% of these cancers can still be resected by the time they are found. Which operation follows the site - a tumour in the head of the pancreas calls for a Whipple procedure, or pancreaticoduodenectomy, while one in the body or the tail calls for a distal resection. Systemic therapy is oncology's and is individualised, and NO chemotherapy dose is printed anywhere here: most patients judged possibly resectable should have chemotherapy before surgery, the two main regimens being FOLFIRINOX and gemcitabine with protein-bound paclitaxel. Refer urgently, and treat the pain while the referral runs. - Refer, with advice

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

No dose - referral pathway, no medicine given in primary care

Pancreatic cancer usually presents late and carries a poor prognosis - the article puts 5-year survival at approximately 20% and holds that the outlook has barely moved despite advances in cancer therapy. The definitive management is surgical and it is a narrow window: an operation is the only route to cure, and only 20% of these cancers can still be resected by the time they are found. Which operation follows the site - a tumour in the head of the pancreas calls for a Whipple procedure, or pancreaticoduodenectomy, while one in the body or the tail calls for a distal resection. Systemic therapy is oncology's and is individualised, and NO chemotherapy dose is printed anywhere here: most patients judged possibly resectable should have chemotherapy before surgery, the two main regimens being FOLFIRINOX and gemcitabine with protein-bound paclitaxel. Refer urgently, and treat the pain while the referral runs.

Sustained-release oral morphine (MSR). Starting straight on MSR, MSF gives an adult 30 mg every 12 hours, then raises the daily dose by 50% each day until the pain is controlled. It sets no ceiling - no standard dose exists, the right one being whatever relieves the pain, adjusted against regular assessment of pain intensity and of side effects. Where immediate-release morphine is available the preferred sequence is to titrate on it first - an adult takes 10 mg every 4 hours, with rescue doses of the same size between the scheduled ones, and the whole of the previous day's total re-divided every 24 hours - and then to switch across to the sustained-release form once pain is controlled. The effective daily dose is usually settled during that immediate-release phase, and the daily total stays the same across the switch. - For as long as the pain lasts; never stopped abruptly

Paediatric cancer pain is a specialist prescription. MSF's figures, both for a child over 6 months, are 0.5 mg/kg given every 12 hours on the sustained-release form and 0.15 mg/kg given every 4 hours on the immediate-release one. They are NOT wired into the weight calculator, because Egypt registers no paediatric oral morphine liquid and a sustained-release tablet cannot be divided to reach a child's dose. MSF's own warning is that tablets do not suit a young child at all, and that the oral solution should be used in their place.

MSF Essential Drugs 2024 - morphine sustained-release (oral)

The condition's own article calls pain control extremely important and ranks this among the most painful cancers there are, naming opioids, antiepileptics and corticosteroids as the classes that relieve it. The article names the class and no dose; the dose and the indication both come from the MSF monograph, whose Indications line for sustained-release oral morphine covers severe, persistent pain and cancer pain above all. Egypt registers one oral product, MST 30 mg Continus tablets (about 77 EGP for 10), which is exactly the strength MSF starts an adult on, plus 10 mg/mL and 20 mg/mL injectable ampoules. Antiepileptics and corticosteroids are named by the article as classes with no drug and no dose, so neither has a row.

One or two capsules during or immediately after each meal, increased slowly against the symptoms. SmPC verbatim: "Initially one or two capsules during or immediately after each meal. Dose increases, if required, should be added slowly, with careful monitoring of response and symptomatology." A Creon 25000 capsule holds 25,000 units of lipase and a Creon 10000 capsule holds 10,000 units, so the meal dose is one or two capsules of whichever strength the pharmacy stocks. - Long-term, alongside the cancer treatment

No weight-based dose. Pancreatic cancer in childhood is an oncology problem and the enzyme dose is set by the treating team.

NICE NG85 recommendation 1.6.1 for the indication - "Offer enteric-coated pancreatin for people with unresectable pancreatic cancer" - with the dose and the strengths from Creon 25000 Capsules (pancreatin) SmPC sections 2 and 4.2 (eMC product 1168): "Each capsule contains pancreatin PhEur 300 mg equivalent to: Lipase ... 25,000 PhEur units" and "Initially one or two capsules during or immediately after each meal", and Creon 10000 Capsules SmPC section 2 (eMC product 1167) for the smaller strength: "Each capsule contains: Lipase ... 10,000 PhEur units".

Nutrition is part of the treatment of pancreatic cancer, and enzyme replacement is the part of it with a licensed product behind it. NICE names the indication in malignant disease: enteric-coated pancreatin is to be offered where the cancer cannot be resected, and to be considered on either side of a resection. NICE attaches no dose to it, so the dose and the capsule strengths come from the Creon label, whose own indication line is the broader treatment of pancreatic exocrine insufficiency, without naming a cause. The disease article agrees on the principle while naming no drug, holding that nutrition must stay at the front of a patient's care because it bears on how a wound heals.