gastrointestinal disorders
Pancreatic Cancer
Diagnosis of Pancreatic Cancer
CT or magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP), followed by endoscopic ultrasonography with fine-needle aspiration (EUS/FNA) biopsy CA 19-9 antigen to follow (not for screening) The preferred tests are an abdominal helical CT using pancreatic technique (triple-phase protocol, imaging slices ≤ 5 mm) or MRI/MRCP; these are followed by endoscopic ultrasonography with fine-needle aspiration (EUS/FNA) biopsy for tissue diagnosis and to assess surgical resectability. CT or MRI/MRCP is typically chosen based on local availability and expertise. Even if these imaging tests show apparent unresectable or metastatic disease, EUS/FNA or a percutaneous needle aspiration of an accessible lesion is done to obtain a tissue diagnosis. If CT shows a potentially resectable tumor or no tumor, MRI/MRCP or endoscopic ultrasonography may be used to stage disease or detect small tumors not visible with CT. Patients with obstructive jaundice may have Endoscopic retrograde cholangiopancreatography (ERCP) (ERCP) as the first diagnostic procedure. In ERCP, often a stent is placed to relieve the biliary obstruction and allow administration of any preoperative treatments. Routine laboratory tests should be done. Elevation of alkaline phosphatase and bilirubin indicate bile duct obstruction or liver metastases. Pancreas-associated antigen CA 19-9 may be used to monitor patients diagnosed with pancreatic carcinoma and to screen those at high risk (eg, those with hereditary pancreatitis; ≥ 2 first-degree family members with pancreatic cancer, Peutz-Jeghers Syndrome , or 