Pancreatic-biliary cancer

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    Emergency treatment required - needs discussion with on call specialist and/or emergency department.

    • Significant bleeding
    • Uncontrolled or disabling pain or severe uncontrolled dyspnoea
    • Symptomatic malignant hypercalcaemia
    • Patients with a visceral crisis from suspected but not confirmed malignant diagnosis (e.g. significant liver dysfunction from malignant infiltration)
    • Biliary obstruction from suspected malignant disease
    • Malignant bowel obstruction
    • Febrile neutropenia
    • Acute onset jaundice from suspected malignancy biliary obstruction
    • Refer to local HealthPathways or local guidelines
    • Refer patients with acute obstructive jaundice with suspected primary pancreatic and biliary malignancy through to the Emergency department to expedite management and for further investigation.
    • If the referring clinician organises a biopsy – a core or excisional biopsy is preferable to an FNA if available
    • Patients with some stages of pancreatic cancer may receive chemotherapy or chemotherapy and radiation as their first cancer treatment / as neoadjuvant therapy prior to surgery. However, the referral for initial assessment should be made to the General or Hepato-biliary surgical service, not medical oncology.
    • Serum tumour bio-markers such as CEA, CA19.9 or others should not be used as diagnostic tests
    • For women and men who have not completed their family, fertility preservation needs to be discussed
    • For patients with incurable (metastatic or recurrent) cancer consider the following:
      • documentation of discussions with the patient (and their carers where appropriate) regarding the intent of treatment (anti-cancer therapy to improve quality of life and/or longevity without expectation of cure or symptom palliation), the Women's and men's prognosis and their understanding of their prognosis
      • whether Advance Care Planning (ACP) conversations have been undertaken and their outcome
      • specific patient goals and values that may impact on treatment choices
      • whether the patient has been referred to a palliative or supportive care service
    • Quick reference guide
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)

Patients with suspected pancreatic or biliary tract cancer should be referred to the General or Hepato-biliary surgical team for evaluation and further investigation. Patients are usually then presented in a multi-disciplinary meeting for treatment planning and further referral if required for Medical Oncology input.

Patients with Multiple pancreatic cysts or IPMNs for investigation or surveillance should be referred to the General or Hepato-biliary surgical team.

  • Neoadjuvant chemotherapy prior to surgery (usually referred by Surgeon after MDT). For optimum care, patient should be seen within 2 weeks.
  • Adjuvant treatment after surgery (usually referred after MDT by surgeon)
  • Metastatic or locally advanced unresectable pancreatic or biliary cancer with rapid progression of symptoms or organ dysfunction. For optimum care, patient should be seen within 2 weeks.
Category 2
(appointment within 90 calendar days)
  • Transfer of care from another health service
  • Pancreatic ductal adenocarcinoma or cholangiocarcinoma in continuous remission for ≥3 years
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Detailed history of present signs and symptoms
  • Past medical history/pertinent social history
  • Current medications and allergies
  • Histology report
  • FBC, U&E, LFT, LDH results
  • CT abdomen report

3. Additional referral information Useful for processing the referral

  • Other available imaging

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 28 January 2025

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