Pancreatic Cancer: Diagnosis and Treatment

Diagnosis

Abdominal CT scan is the most common diagnostic test for pancreatic cancer. It will reveal the extent of the disease and may identify metastases.

Biopsy is necessary for a definitive diagnosis.

MRI (with or without angiography) or laparoscopy may determine resectability.

Ultrasound, endoscopic ultrasound, and endoscopic retrograde cholangiopancreatography (ERCP) are used for tumor staging.

Laboratory analysis should include a complete blood count, liver function tests, amylase, lipase, and tumor–associated antigens such as carcinoembryonic antigens (CEA) and cancer antigen (CA) 19–9. Levels of alkaline phosphatase and bilirubin will be elevated if the bile duct is obstructed or if liver metastases are present.

Treatment

Despite advances in therapies, prognosis for pancreatic cancer remains poor, and surgical resection is the only curative treatment. However, curative operations are only possible in 10% to 15% of patients. Common surgical procedures include:

Pancreaticoduodenectomy (Whipple procedure), which involves removal of the duodenum, head of the pancreas, and gallbladder.

Total pancreatectomy.

Distal pancreatectomy.

If the tumor is unresectable, palliation may be attempted via radiation, chemotherapy, or surgical intervention to relieve bile duct and GI tract obstructions.

Allow for liberal use of narcotic analgesics for pain control.