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Work-up
General and tumor markers
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. In some clinical situations, relying on fine needle aspiration alone is not recommended.
History and physical examination
CBC and differential, serum electrolytes, creatinine, LFTs, PT, PTT, CA19–9
Measure CA19–9, CEA, and CA125 at baseline. While CA19–9 is often elevated in pancreatic cancer, the other serum tumor markers should be measured at baseline, as 8% of patients carry genetic variants in the Fucosyltransferase 3 gene, which results in a negative test for CA19–9 (the Lewis antigen). In PDAC, CEA or CA125 have a sensitivity of 63.8 and 51.1%, respectively. These markers may be valuable if elevated
Luo G et al. Ann Surg 2017;265:800–805
Vestergaard EM et al. Clin Chem 1999;45:54–61
Imaging
Spiral CT: spiral or helical CT of the abdomen according to a defined triple-phase pancreas 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 ...