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Your Specialist Report — Pancreatic Adenocarcinoma (the most common type of pancreatic cancer)

Prepared for: the family of R.G., a woman, age 63 (sample report, fictional patient) · Location: San Antonio, Texas · Insurance: Medicare + supplement · Report date: November 2, 2026

Bottom line — read this first
• Three Texas options, each with a named doctor we confirmed is still there on November 2, 2026: (1) MD Anderson, Houston — surgeon Matthew H.G. Katz, MD, with medical oncologist Shubham Pant, MD; (2) UT Southwestern, Dallas — pancreatic surgeon Jason B. Fleming, MD; (3) Pancreas Tumor Center, San Antonio (University Health with Mays Cancer Center) — medical oncologist Lei Zheng, MD, PhD, in a one-day team visit close to home.
• Time-sensitive: several trials in this report accept only people who have had no treatment yet, and some need the spread to have been found within the last 6 to 12 weeks. Questions for the local oncologist are in the box at the top of Section 4.
• Insurance: with Original Medicare, Medicare.gov says you "can use any doctor or hospital that takes Medicare, anywhere in the U.S." Confirm the supplement is a standard Medigap policy and not a Medicare Advantage plan (Section 3, step 3).
• Fastest first calls: San Antonio Pancreas Tumor Center 210-743-4306 · MD Anderson 1-855-941-6456 · UT Southwestern pancreatic cancer team 214-645-4673.

1. What this condition is

Pancreatic adenocarcinoma is a cancer that starts in the cells lining the ducts of the pancreas, the organ behind the stomach that makes digestive juices and insulin. MD Anderson's page says most pancreatic cancers are this type (MD Anderson, pancreatic cancer page). Care is run by a team: a medical oncologist (cancer medicine doctor), a pancreatic surgeon, often a radiation oncologist, a gastroenterologist who does endoscopy, and a dietitian. They usually meet as a "tumor board" to review the scans together.

The first big question is which of four groups the cancer is in (NCI stages page):

NCI says the two most common chemotherapy combinations are FOLFIRINOX and gemcitabine with nab-paclitaxel, and that "many experts believe it's important for all people with pancreatic cancer to join a clinical trial, even if they have early-stage cancer" (NCI treatment page, posted July 30, 2026). The same NCI page says a new pill, daraxonrasib, was approved by the FDA on August 26, 2026 for advanced pancreatic cancer that has already been treated. Your doctors will decide what applies to your mother; this report helps you prepare for those conversations.

What usually happens next — a typical sequence (ask her team which steps apply and in what order):

  1. Staging is confirmed: scans of the pancreas and chest (CT, MRI or PET) place the cancer in one of the four groups above. It helps to have that group in writing.
  2. Tumor testing is ordered. NCI says molecular testing of the tumor is important (NCI treatment page), and PanCAN "strongly recommends biomarker testing of your tumor" (PanCAN Patient Services). Several trials below need one result in particular: whether the tumor carries the KRAS G12D change. MD Anderson's page says inherited gene changes (for example BRCA1 or BRCA2) may account for about 10% of pancreatic cancers, so a blood or saliva test for inherited genes is also worth asking about.
  3. Chemotherapy starts, often through a port (a small device under the skin of the chest).
  4. Repeat scans after some months show how the tumor responded. One trial in this report (LAP100, Section 4) enrolls people with locally advanced cancer only after 4 to 8 months of chemotherapy.
  5. If surgery becomes possible: a Whipple operation for tumors in the head of the pancreas, or a distal pancreatectomy for the body and tail (NCI treatment page). In two patients' accounts in Section 5, the path from first chemotherapy to surgery took about 6 months (May to November 2013) and about 8 months (February to October 2017).

Paths families take — none is right for everyone:

2. Specialists to consider

How we compared programs. We found no public, audited, comparable count of pancreatic cancer operations or results for Texas hospitals. The Leapfrog Group's hospital ratings site, which reports whether hospitals meet its yearly minimum for pancreatic cancer surgery, blocked our check. What the research does show, in plain terms: in a study of all Medicare patients who had pancreatic surgery from 2005 to 2016 (average age 73), deaths within 30 days were 3.5% at the busiest fifth of hospitals and 5.8% at the least busy fifth. That is about two fewer deaths per 100 operations, and the authors found the difference statistically significant, meaning it is very unlikely to be chance (JAMA Surgery, 2019). The same study found that a single cutoff of "20 operations a year" told hospitals apart for pancreatic surgery, but did not do so for three other cancer operations. Hospitals' own numbers below are labeled "the hospital's own figure": self-reported, not audited, and not comparable between hospitals.

We ranked by depth of pancreatic cancer experience first, then by distance from San Antonio. Each doctor was checked on the hospital's or university's own website on November 2, 2026, plus a dated record from 2026.

1. Matthew H.G. Katz, MD — Pancreatic Cancer Surgeon, Chair of Surgical Oncology, MD Anderson Cancer Center (Houston, about 200 miles)

2. Jason B. Fleming, MD — Pancreatic Cancer Surgeon, UT Southwestern Harold C. Simmons Comprehensive Cancer Center (Dallas, about 275 miles)

3. Lei Zheng, MD, PhD — Pancreatic and GI Medical Oncologist, Pancreas Tumor Center and Mays Cancer Center (San Antonio, at home)

Closer to home and other Texas options

Leads we checked and did not list

3. Next steps

Your first call — three questions
No hospital page we read answers these, so ask them on every call:
1. Is Dr. [name] seeing new patients with pancreatic adenocarcinoma, and how soon — before chemotherapy is scheduled to start?
2. What is the current wait for a first visit? None of the three programs publishes wait times.
3. Do you need a referral, or can we self-refer? With Original Medicare, Medicare.gov says, "In most cases you don't need a referral to see a specialist" (Medicare.gov). The hospital may still want a doctor's referral.

How to reach each program (from each institution's own page):

Your 3 steps this week:

  1. Ask the local oncologist's office to send you copies of:
  2. the pathology report from the biopsy;
  3. the CT, MRI or PET reports AND the image files (disc or secure link), especially any scans done before treatment starts, which some trials require;
  4. blood tests including CA 19-9 and bilirubin;
  5. any tumor gene (molecular) test report, or a note that none was ordered. Ask whether leftover biopsy tissue is stored and where.
  6. Call the San Antonio Pancreas Tumor Center (210-743-4306) and one of MD Anderson (1-855-941-6456) or UT Southwestern (214-645-4673). At each, ask the three questions in the box above, plus:
  7. Can your team review her scans and pathology before chemotherapy starts?
  8. Will her case go to your tumor board?
  9. Can she be screened for clinical trials before any treatment?
  10. Call the number on the supplement card and on her Medicare card:
  11. Is this a standard Medigap policy, a Medicare SELECT policy (Medicare.gov calls it "another type of Medigap policy"; Medigap basics), or a Medicare Advantage plan? Medicare.gov says Advantage plans may require doctors "in the plan's network" (Medicare.gov).
  12. Does the supplement pay the 20% coinsurance for outpatient chemotherapy and for the routine costs of a clinical trial? Medicare.gov says Part B usually leaves 20% after the deductible for both (chemotherapy; clinical research studies).
  13. Does she have Part D drug coverage for pills, and what would an oral cancer drug cost?

4. Clinical trials in Texas

A question for the local oncologist before the first infusion: "Several first-treatment trials only accept people who have had no chemotherapy yet, and some require the spread to have been found within the last 6 to 12 weeks. Can we check trial options and gene test results before the first infusion, or tell us how long we can safely wait?"

We searched ClinicalTrials.gov (the U.S. government registry) on November 2, 2026 for pancreatic cancer studies marked Recruiting with sites in Texas, then read each record. We set aside studies that only collect data, are for other cancer types, or are not yet open in Texas. Being "recruiting" does not mean she qualifies; the study team decides. Small studies (under about 30 people) can show whether a treatment looks promising, but they cannot prove it works better.

If her team says surgery may be possible (resectable or borderline)

1. Tislelizumab + SX-682 before surgery — NCT05604560 · Phase 2, 25 people · last updated October 7, 2026

2. FOLFIRINOX + pembrolizumab before surgery — NCT05132504 · Phase 2, 30 people · last updated August 4, 2026

3. Anakinra with chemotherapy around surgery — NCT04926467 · Phase 2, 24 people · last updated October 15, 2026

If the cancer has spread (metastatic) — first treatment

These four studies accept only people with no prior treatment for metastatic disease. Three of them set a time window:

4. DAWN-303 — NCT07522073 · Phase 3, 588 people · last updated October 30, 2026

5. RASolute 305 — NCT07621718 · Phase 3, 670 people · last updated October 13, 2026

6. MAPKeeper 301 — NCT07562152 · Phase 3, 510 people · last updated October 30, 2026

7. Relacorilant + nab-paclitaxel + gemcitabine — NCT07259317 · Phase 2, 80 people · last updated September 25, 2026

Also open in Texas for first treatment of metastatic disease:

If the spread is limited to a few spots

8. PHOLIPANC — NCT07340151 · 40 people · last updated April 14, 2026

9. EXPAND — NCT06593431 · Phase 3, 80 people · last updated October 6, 2026

Later, if the cancer is locally advanced

10. LAP100 — NCT06958328 · Phase 3, 356 people · last updated August 25, 2026

Free help matching trials: PanCAN Patient Services' case managers offer free one-to-one help and a Clinical Trial Finder, and "can provide a list of specialists in your area" — (310) 868-0083 (PanCAN Patient Services).

5. Stories from families who have been there

These are real people's own words. They are not a prediction of your mother's course.

  1. Patient's own story on the Let's Win Pancreatic Cancer foundation site (posted July 26, 2018) — Kayi Lewis
  2. What happened: her local doctor told her the cancer was "borderline resectable." Her husband and daughter researched options: "Everything kept leading us back to MD Anderson in Houston."
  3. Treatment: the MD Anderson team planned FOLFIRINOX to shrink the tumor, then radiation, and she was able to "have the chemotherapy at Hardin, back at home," her local hospital, starting in February 2017. Radiation in Houston was interrupted by Hurricane Harvey. On October 16, 2017 she had a Whipple: "my tumor was 99 percent dead and my margins were clear!"
  4. Outcome: a later editor's note says Kayi died seven and a half years after her cancer was found.
  5. Tone: grateful and family-driven, with a sad ending. Read her story
  6. Patient's own story on the Let's Win Pancreatic Cancer foundation site (posted April 10, 2017) — Shannon Magee
  7. Treatment: at MD Anderson in Houston, her team, led by Dr. Katz, made her "patient 1 in a new clinical trial." Her tumor was in the head of the pancreas, wrapped around the portal vein. The plan was eight weeks of FOLFIRINOX, then radiation with capecitabine pills, a Whipple on November 8, 2013, then four months of gemcitabine.
  8. What she says: she describes FOLFIRINOX as "the most difficult part" and the radiation as easier than expected.
  9. Outcome: the page is titled "A New Clinical Trial Leads to No Evidence of Disease," and she writes, "every day is a gift!" We do not know how she has done since 2017.
  10. Tone: hopeful and practical. Read her story
  11. Family fundraiser page written by a son in San Antonio (created February 25, 2026) — Brian Noriega, about his mother
  12. What happened: "For over a year, my mom was seeing a specialist for constant abdominal pain," told it was gastritis. He moved her to San Antonio: "I did everything I could to find better care and better options for her."
  13. Care so far: at Methodist Hospital of San Antonio, she had a biopsy and scans within a week. The page says stage 3 and "already spread significantly." The family is raising money for scans, medicines, rent and care.
  14. Outcome: no update on the page.
  15. Tone: urgent and loving, with real money worries. Read the page
  16. Hospital story (MD Anderson's own blog, February 11, 2026; reviewed by Dr. Katz) — Malinda, a San Antonio woman
  17. What happened: after an emergency-room visit near her home in San Antonio, her biopsy showed pancreatic ductal adenocarcinoma.
  18. Treatment: she chose MD Anderson, where Dr. Katz removed the tail of her pancreas and her spleen on May 30, 2025. Her cancer was found early, and the team did not recommend further treatment.
  19. Outcome: "more than nine months later" she showed no evidence of disease.
  20. Why it is less typical: it is the hospital's marketing, and her early-stage case is not the usual one. Read the story

What these have in common: each family moved fast to reach a team that sees many pancreatic cancers. Both of the long journeys combined chemotherapy before surgery with a carefully timed operation. Kayi's story also shows that chemotherapy can sometimes be given close to home under a plan from a high-volume center.

6. Ready-to-send messages

Email or online-form message to the specialist's office (copy, fill the brackets, send):

Subject: New patient request — pancreatic adenocarcinoma — before chemotherapy starts
Hello, I am writing about my mother, [name], age 63, who lives in San Antonio, Texas. She was recently found to have pancreatic adenocarcinoma and has not started treatment. Her local oncologist plans to start chemotherapy on about [date].
Dr. [Katz / Pant / Fleming / Zheng]'s experience with pancreatic cancer is why we are contacting your program. Could you tell us:
(1) whether Dr. [name] is seeing new patients with this condition, and how soon; (2) the current wait for a first visit, in person or by video;
(3) whether a referral is needed; and (4) how to send her pathology, scan images and blood tests for review before the visit?
We would also like to know whether her case can go to your tumor board, and whether she can be screened for clinical trials before any treatment starts.
Her insurance is Original Medicare with a [supplement company and plan letter]. Thank you, [your name, relationship, phone]

Email to a trial contact (for the trials in Section 4):

Subject: Question about [NCT number] — patient in San Antonio, not yet treated
Hello, my mother is 63, lives in San Antonio, and was recently found to have pancreatic adenocarcinoma. She has not started treatment. Her scans show [resectable / borderline / locally advanced / spread to ___ — or "staging not yet final"]. Her tumor gene results are [attached / pending / not done]. Could you tell us which Texas clinic is enrolling for [NCT number], who the study doctor is, what tests screening requires, and whether there is a deadline relative to starting chemotherapy? Thank you, [name, phone]

Phone script (what to say in the first 30 seconds): "Hi, I'm calling for my mother, who is 63 and was just found to have pancreatic adenocarcinoma. She hasn't started treatment yet; her oncologist in San Antonio wants to start chemo around [date]. Is Dr. [name] seeing new patients with pancreatic cancer? How soon is the first visit? Can it be by video? Do you need a referral, and how do we send her scans and biopsy report ahead of time? Can she be screened for trials before chemo starts?" Write down: the person's name, the date, the answer, the next step.

7. One-page summary to bring to the appointment

(Print this page and fill it in by hand.)

Name: ____________ Date of birth: ________ Phone: ____________ Family contact: ____________ Condition: Pancreatic adenocarcinoma. Treatment started? no / yes — what and when: ____________ How it was found: symptoms ____________ date ______ Biopsy: date ______ how (endoscopic ultrasound / CT-guided / other) ______ where ____________ Latest scans: CT / MRI / PET — date ______ — tumor location: head / body / tail · size ______ · touches blood vessels? yes / no / not sure · spread outside pancreas? yes (where: ______) / no / not sure Group my doctors used: resectable / borderline resectable / locally advanced / metastatic / not told yet Blood tests: CA 19-9 ______ bilirubin ______ (date ______) · stent placed for jaundice? yes / no Tumor gene (molecular) testing: ordered? yes / no — KRAS ______ (G12D? yes / no) · other results ______ Inherited (germline) gene testing: ordered? yes / no — results ______ · family history of pancreatic, breast, ovarian or colon cancer: ______ Other health conditions: ______________ (e.g., diabetes, heart, kidney) · weight lost in last 6 months: ______ Current medicines, supplements and allergies: ______________________________ Insurance: Medicare number ______ · supplement company & plan letter ______ · Part D plan ______ My 3 most important questions today:

  1. ______________________________________
  2. ______________________________________
  3. ______________________________________

What we want from this visit: (e.g., "the stage group in writing," "a yes/no on surgery now or later," "a list of trials she qualifies for, with deadlines") ________________

8. Questions to ask the specialist

  1. How many patients with pancreatic adenocarcinoma do you personally treat each year? And your team? For surgeons: how many pancreatic cancer resections (Whipple or distal) did your team do last year?
  2. What results do you see for patients like my mother — her age, her tumor's location and size, and whether it has spread?
  3. How long is the wait for a first visit, and can you review her scans and pathology before she comes in?
  4. Which group is her cancer in — resectable, borderline resectable, locally advanced or metastatic — and can you write that down for us? Who on your team made that call, and was it reviewed at a tumor board?
  5. Has her tumor had molecular testing, including KRAS G12D? Has she had inherited (germline) gene testing? If not, can both be ordered now, and how long do results take?
  6. Which trials in this report (or others you know of) might fit her, and does starting standard chemotherapy now close any of them? Some first-treatment trials accept only people with no treatment yet, or set a 6- to 12-week window.
  7. If surgery might become possible, would you give chemotherapy before surgery? Could that chemotherapy be given in San Antonio under your plan, with scans at your center?
  8. Which chemotherapy would you suggest for her, and what side effects should we expect? How would she be supported with nutrition, pancreatic enzymes and pain control from the start?
  9. What warning signs — such as yellow skin or eyes, fever with chills, dark urine, black stools, strong belly pain, or being unable to keep fluids down — should make us call you or go to the ER?

9. Your support after this report

This report is general information to help you find and talk to specialists. It is not medical advice, does not identify or confirm any condition, and does not recommend a treatment. Treatment decisions belong to you and your doctors. No doctor or hospital pays to be included in this report.

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