Cancer types · Common solid tumours
Pancreatic Cancer
Most pancreatic cancers are adenocarcinomas, and most carry a KRAS mutation. Tissue samples are often small, which can limit testing.
Many guidelines recommend offering germline testing to everyone with pancreatic adenocarcinoma, because inherited variants such as BRCA1, BRCA2 and PALB2 are relevant to treatment discussions and to relatives.
Clinical and molecular questions that often arise
- Was germline testing offered, and what did it show?
- If the tumour is KRAS wild-type, were rarer alterations such as fusions looked for?
- Was the tissue adequate for profiling, or could plasma testing help?
- Are there trials for which the molecular profile may be relevant?
Information that may be part of an individual assessment
- Cross-sectional imaging and endoscopic ultrasound with biopsy.
- Germline testing.
- Tumour or plasma profiling, particularly in advanced disease.
- CA 19-9 as an imperfect marker interpreted in context.
Which investigations are appropriate is decided by the treating team for each person.
Molecular profiling and biomarker interpretation
Depending on the setting, molecular and biomarker questions in pancreatic cancer may involve:
- KRAS mutations
- Germline BRCA1, BRCA2 and PALB2
- NRG1, NTRK, ALK and ROS1 fusions in KRAS wild-type tumours
- BRAF alterations
- MSI-high or MMR-deficient status (uncommon)
Biomarkers, panels and available tests vary by subtype, disease setting, assay and guideline version. A detected alteration is not automatically actionable.
How KPCIRC pathways may apply
POAS
POAS may help structure a sparse or complex report, highlight where germline confirmation matters, and identify trial questions for KRAS-driven and KRAS wild-type disease.
Molecular Tumour Board
MTB discussion may help with borderline resectability questions, limited tissue, or unusual molecular findings.
Second opinion and progression review
A second opinion may be considered when resectability or the treatment plan needs clarification. Progression review can help organise next questions after treatment changes.
Hereditary risk and screening
Inherited variants in BRCA1, BRCA2, PALB2, ATM, CDKN2A, STK11 and Lynch-syndrome genes are associated with pancreatic cancer. Families with a known variant or a strong family history may wish to discuss risk assessment and counselling.
How to access the relevant pathway
Patients and families
- Talk to your treating oncologist about whether an additional review may help.
- Request a consultation and tell us which question you want answered.
- Share records only when asked, through the secure route.
Referring doctors
- Define the clinical question and the pathway: POAS, MTB, second opinion or progression review.
- Start a case enquiry without patient identifiers.
- Scope, fees and timing are confirmed before any review proceeds.
Questions and limitations
Why is germline testing recommended for everyone with pancreatic cancer?
Because a meaningful proportion of people carry an inherited variant that can be relevant to treatment discussions and to relatives, even without a strong family history.
What if no actionable alteration is found?
That is common. The report can still clarify the picture and help with trial questions. Your treating team will discuss the overall plan.
Does this page apply to my situation?
This page is educational. It explains common questions but cannot account for individual circumstances. Your treating clinician is best placed to interpret your reports and plan your care.
Educational content reviewed against the KPCIRC service scope. It is not a diagnosis, a treatment recommendation or a statement that a specialist or service is available for this cancer type.