Stimulation With Bethanechol in Combination With Gemcitabine and Nab-paclitaxel in Pancreatic Adenocarcinoma

This trial tests whether adding bethanechol — a drug that stimulates nerve signaling in the digestive system — to standard chemotherapy (gemcitabine and nab-paclitaxel) before surgery can help treat pancreatic cancer more effectively. The idea is that nerve signals may fuel tumor growth. **You may be eligible if...** - You have been diagnosed with pancreatic ductal adenocarcinoma (a common type of pancreatic cancer) - You are planning to receive pre-surgery chemotherapy - Your cancer has not spread to distant organs - You can swallow pills and comply with study procedures **You may NOT be eligible if...** - Your cancer has already spread beyond the pancreas - You have bowel obstruction signs - You have a slow heart rate (below 55) or low blood pressure - You have hyperthyroidism, active heart disease, seizures, or stomach ulcers - You are currently taking acetylcholinesterase inhibitor medications Talk to your doctor to see if this trial is right for you.