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Work-up
The diagnosis of pancreatic cancer is based on imaging studies and histologic confirmation performed by fine-needle aspiration by endoscopic ultrasonography (EUS), biopsy under CT or US guidance, or during laparotomy
History and physical examination
CBC and differential, serum electrolytes, creatinine, LFTs, PT, PTT, CA19-9
Imaging:
Spiral CT: Spiral or a helical CT of the abdomen according to a defined pancreatic protocol is essential. CT provides localization, size of the primary tumor, and evidence of metastasis and evaluates major vessels adjacent to the pancreas for neoplastic invasion or thrombosis. CT is almost 100% accurate in predicting unresectable disease. However, the positive predictive value of the test is low and approximately 25–50% of patients predicted to have resectable disease on CT turn out to have unresectable lesions at laparotomy
Endoscopic retrograde cholangiopancreatography (ERCP) can also be useful in patients whom a CT scan is equivocal, because fewer than 3% of patients with pancreatic carcinoma have normal pancreatograms
EUS is a relatively new technique and provides useful information. However, EUS needs to be performed in centers with experience in this procedure. EUS is useful for characterizing cystic lesions and assessment of vascular invasion by tumor. In addition, an aspirate can be done for histologic diagnosis. A celiac plexus block can be done via EUS for relief of abdominal pain
Agawam B. Am J Gastroenterol 2004;99:844–850
Tamm EP et al. Radiographic Imaging: Daniel D. Von Hoff, Douglas B. Evans, Ralph H. Hruban, eds. Pancreatic Cancer, 1st ed. Jones & Bartlett Publishers, 2005:165–180
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