Overview
How common is pancreatic cancer?
What are the signs and symptoms of pancreatic cancer?
What is the role of lab testing in the diagnosis of pancreatic cancer?
Which imaging studies are performed in the workup of pancreatic cancer?
How is pancreatic cancer treated?
Which surgical interventions are used in the treatment of pancreatic cancer?
Which chemotherapy agents are used in the treatment of pancreatic cancer?
Which neoadjuvant therapy regimens are used in the treatment of pancreatic cancer?
Which medications are used in maintenance therapy for pancreatic cancer?
What is the role of palliative therapy in the treatment of pancreatic cancer?
What are the life-time risk and survival rates for pancreatic cancer?
What are the types of pancreatic cancer?
What is the pathophysiology of pancreatic cancer?
What causes pancreatic cancer?
What is the role of smoking in the etiology of pancreatic cancer?
What is the role of obesity in the etiology of pancreatic cancer?
What is the role of diet in the etiology of pancreatic cancer?
What is the risk of diabetes mellitus (DM) in the etiology of pancreatic cancer?
What is the role of chronic pancreatitis in the etiology of pancreatic cancer?
What is the role of genetics in the etiology of pancreatic cancer?
Which patient groups are at highest risk for pancreatic cancer?
What is the incidence of pancreatic cancer in the US?
What is the global incidence of pancreatic cancer?
What is the racial predilection of pancreatic cancer?
Which age groups have the highest prevalence of pancreatic cancer by age?
What are the mortality rates for pancreatic cancer?
What is the prognosis of pancreatic cancer?
What is included in patient education about pancreatic cancer?
Presentation
Which clinical history findings are characteristic of pancreatic cancer?
What are the signs and symptoms of pancreatic cancer?
Which physical findings are characteristic of pancreatic cancer?
DDX
In which patients should a diagnosis of pancreatic cancer be considered?
How prevalent is regional spread or distant disease at diagnosis of pancreatic cancer?
Which disorders should be considered in the differential diagnoses of pancreatic cancer?
What are the differential diagnoses for Pancreatic Cancer?
Workup
Which tests are performed in the workup of pancreatic cancer?
How is chronic pancreatitis differentiated from pancreatic cancer?
What is the role of lab testing in the workup of pancreatic cancer?
What is the role of carbohydrate antigen 19-9 testing in the evaluation of pancreatic cancer?
What is the role of carcinoembryonic antigen testing in the evaluation of pancreatic cancer?
What is the role of tumor markers in the diagnosis of pancreatic cancer?
What is the role of CT scanning in the workup of pancreatic cancer?
What is the role of transcutaneous ultrasonography (TUS) in the workup of pancreatic cancer?
What is the role of endoscopic ultrasonography (EUS) in the workup of pancreatic cancer?
What is the role of MRI in the workup of pancreatic cancer?
What is the role of PET scanning in the workup of pancreatic cancer?
What is the role of fine needle aspiration (FNA) in the workup of pancreatic cancer?
Which morphologic characteristics are associated with pancreatic cancer?
Which histologic findings are characteristic of pancreatic cancer?
What is the role of germline testing in the diagnosis of pancreatic cancer?
What is the role of molecular profiling in the diagnosis of pancreatic cancer?
How are pancreatic masses characterized by surgeons?
How is pancreatic cancer staged?
Which imaging studies are used for staging of pancreatic cancer?
What is the role of preoperative staging laparoscopy in the management of pancreatic cancer?
What are the indications of staging laparoscopy in the management of pancreatic cancer?
What is the evaluation and treatment algorithm for pancreatic cancer?
Treatment
How is pancreatic cancer treated?
What are the NCCN guidelines for treatment selection in pancreatic cancer?
What are the ESMO treatment guidelines for pancreatic cancer?
What is the role of local ablation in the treatment of pancreatic cancer?
What is the role of molecular markers in the treatment of pancreatic cancer?
What is the role of neoadjuvant therapy in the treatment of pancreatic cancer?
What are the NCCN guidelines for neoadjuvant therapy for pancreatic cancer?
What is the efficacy of neoadjuvant therapy for the treatment of pancreatic cancer?
What is the role of distal pancreatectomy in the treatment of pancreatic cancer?
What is the role of total pancreatectomy in the treatment of pancreatic cancer?
What is the role of adjuvant therapy in the treatment of pancreatic cancer?
What is the role of chemotherapy in the treatment of pancreatic cancer?
How is pain managed in pancreatic cancer?
How is jaundice treated in pancreatic cancer?
How is duodenal obstruction treated in pancreatic cancer?
Which dietary modifications are used in the treatment of pancreatic cancer?
Which specialist consultations are beneficial to patients with pancreatic cancer?
Guidelines
Which organizations provide guidelines on pancreatic cancer screening?
What are the USPSTF and AAFP guidelines for pancreatic cancer screening?
What are international CAPS consortium guidelines for pancreatic cancer screening?
What are the guidelines for the use of tumor markers in pancreatic cancer?
What are the AGA guidelines for pancreatic cancer screening?
What are the ESMO diagnostic guidelines for pancreatic cancer?
What are the NCCN diagnostic guidelines for pancreatic cancer?
What are the NCCN guidelines for staging laparoscopy in patients with pancreatic cancer?
What are the NCCN guidelines for germline testing in patients with pancreatic cancer?
What are the ASCO guidelines for initial assessment of metastatic pancreatic cancer?
What are the criteria for defining resectability status in pancreatic cancer?
What are the criteria for borderline resectable tumors in pancreatic cancer?
What are the ASCO recommendations for primary surgical resection in pancreatic cancer?
What are ASCO treatment guidelines for potentially curable pancreatic cancer?
What are the ASCO criteria for preoperative therapy of pancreatic cancer?
What are the ASCO guidelines for postoperative treatment of pancreatic cancer?
What are the ESMO treatment guidelines for pancreatic cancer?
What are the ESMO treatment guidelines for resectable pancreatic cancer?
What are the NCCN treatment guidelines for localized pancreatic cancer?
What are the NCCN guidelines for neoadjuvant therapy for pancreatic cancer?
What are the NCCN recommended neoadjuvant regimens for pancreatic cancer?
What are the ASCO treatment guidelines for locally advanced, unresectable pancreatic cancer?
What are the ESMO recommendations for treatment of locally advanced pancreatic cancer?
What are the NCCN treatment guidelines for locally advanced pancreatic cancer?
What are the ASCO guidelines on first-line treatment of metastatic pancreatic cancer?
What are the ASCO guidelines for second-line treatment of metastatic pancreatic cancer?
What are the ESMO treatment guidelines for metastatic pancreatic cancer?
What are the NCCN treatment guidelines for metastatic pancreatic cancer?
What are the ASCO guidelines for follow-up and surveillance of metastatic pancreatic cancer?
What are the NCCN and ESMO guidelines for the palliative care in pancreatic cancer?
Medications
Which medications are the most active against pancreatic cancer?
What is the role of olaparib in the treatment of pancreatic cancer?
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Pancreatic cancer. Gross section of an adenocarcinoma of the pancreas measuring 5 X 6 cm resected from the pancreatic body and tail. Although the tumor was considered to have been fully resected and had not spread to any nodes, the patient died of recurrent cancer within 1 year.
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Pancreatic cancer. Hematoxylin and eosin stain of a pancreatic carcinoma. Note the intense desmoplastic response around the neoplastic cells. The large amount of fibrotic reaction in these tumors can make obtaining adequate tissue by fine-needle aspiration difficult.
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Pancreatic cancer. T staging for pancreatic carcinoma. T1 and T2 stages are confined to the pancreatic parenchyma. T3 lesions invade local structures such as the duodenum, bile duct, and/or major peripancreatic veins, and T4 lesions invade surrounding organs (eg, stomach, colon, liver) or invade major arteries such as the superior mesenteric or celiac arteries.
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Pancreatic cancer. Computerized tomographic scan showing a pancreatic adenocarcinoma of the pancreatic head. The gallbladder (gb) is distended because of biliary obstruction. The superior mesenteric artery (sma) is surrounded by tumor, making this an unresectable T4 lesion.
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Pancreatic cancer. Abdominal CT scan of a small, vaguely seen, 2-cm pancreatic adenocarcinoma (mass) causing obstruction of both the common bile duct (cbd) and pancreatic duct (pd).
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Pancreatic cancer. Endoscopic ultrasound of a 2.2-cm pancreatic adenocarcinoma of the head of the pancreas obstructing the common bile duct (CBD) but not invading the portal vein (PV) or superior mesenteric vein (SMV). Findings from endoscopic ultrasound–guided fine-needle aspiration revealed a moderately to poorly differentiated adenocarcinoma. Abdominal CT findings did not show this mass, and an attempt at endoscopic retrograde cholangiopancreatography at another institution was unsuccessful.
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Algorithm for evaluation of a patient with suspected pancreatic cancer. CT scanning for definitive diagnosis and staging must be with thin-cut, multidetector, spiral CT scanning using dual-phase contrast imaging to allow for maximal information. This schema varies among institutions depending on local expertise, research interest, and therapeutic protocols for pancreatic carcinoma.
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Pancreatic cancer. Tip of linear array echoendoscope (Pentax FG 36UX) with 22-gauge aspiration needle exiting from biopsy channel. Insert shows magnification of aspiration needle tip. Note that the needle exits from the biopsy channel such that it appears continuously in the view of the ultrasonic transducer on the tip of the echoendoscope.
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Pancreatic cancer. Cytologic samples from fine-needle aspirations (rapid Papanicolaou stain) of pancreatic adenocarcinomas. (A) Well differentiated, (B) moderately differentiated, (C) moderate to poorly differentiated, (D) poorly differentiated tumor.
Tables
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- Overview
- Presentation
- DDx
- Workup
- Approach Considerations
- Laboratory Findings
- Tumor Markers
- Computed Tomography
- Transcutaneous Ultrasonography
- Endoscopic Ultrasonography
- Endoscopic Retrograde Cholangiopancreatography
- Magnetic Resonance Imaging
- PET Scanning
- Needle Aspiration
- Histologic Findings
- Germline Testing and Molecular Analysis
- Staging
- Evaluation Algorithm
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- Treatment
- Guidelines
- Medication
- Questions & Answers
- Media Gallery
- References