Summary
Definition
History and exam
Key diagnostic factors
- jaundice
- nonspecific upper abdominal pain or discomfort
- weight loss and anorexia
- back pain
Other diagnostic factors
- age 65-74 years
- steatorrhea
- thirst, polyuria, nocturia, and weight loss
- nausea, vomiting, and early satiety
- unexplained acute pancreatitis
- hepatomegaly
- epigastric abdominal mass
- positive Courvoisier sign
- petechiae, purpura, bruising
- Trousseau sign (migratory thrombophlebitis)
Risk factors
- smoking
- family history of pancreatic cancer
- other hereditary cancer syndromes
- chronic sporadic pancreatitis
- diabetes mellitus
- obesity
- dietary factors
Diagnostic tests
1st tests to order
- pancreatic protocol CT
- abdominal ultrasound
- LFTs
Tests to consider
- prothrombin time (PT)
- CBC
- cancer antigen (CA)19-9 biomarker
- positron emission tomography
- endoscopic retrograde cholangiopancreatography (ERCP)
- MRI
- magnetic resonance cholangiopancreatography
- endoscopic ultrasound
- staging laparoscopy (with laparoscopic ultrasound)
- biopsy
Emerging tests
- genomic testing
Treatment algorithm
resectable (stages 1 and 2)
locally advanced unresectable (stage 3)
metastatic (stage 4)
Contributors
Authors
Hemant M. Kocher, MBBS, MS, MD, FRCS
Professor of Liver and Pancreas Surgery
Barts Cancer Institute
Barts and The London School of Medicine and Dentistry
London
UK
Disclosures
HMK is an author of a number of references cited in this topic. HMK has received research grants from Bristol-Myers-Squibb (formerly Celgene) for investigator-initiated clinical trials. HMK has unrestricted educational grants from Meril, Mylan, Medtronics, and Ethicon.
Acknowledgements
Dr Hemant M. Kocher wishes to gratefully acknowledge Dr Fieke E.M. Froeling, a previous contributor to this topic.
Disclosures
FEMF is an author of a reference cited in this topic.
Peer reviewers
Ross Carter, FRCS
Consultant Pancreatic Surgeon
West of Scotland Pancreatic Unit
Glasgow Royal Infirmary
Glasgow
UK
Disclosures
Not disclosed.
Nikhil I. Khushalani, MD
Assistant Professor of Oncology
Roswell Park Cancer Institute
Buffalo
NY
Disclosures
NIK has received funding for the conduction of clinical trials and associated translational studies from Merck, Pfizer, and Astra-Zeneca. NIK has a grant from the National Comprehensive Cancer Network (from research support by Roche).
References
Key articles
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: pancreatic adenocarcinoma [internet publication].Full text
Conroy T, Pfeiffer P, Vilgrain V, et al. Pancreatic cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2023 Nov;34(11):987-1002.Full text Abstract
Sohal DPS, Kennedy EB, Cinar P, et al. Metastatic pancreatic cancer: ASCO guideline update. J Clin Oncol. 2020 Aug 5:JCO2001364.Full text Abstract
Von Hoff DD, Ervin T, Arena FP, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013 Oct 31;369(18):1691-703.Full text Abstract
Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011 May 12;364(19):1817-25.Full text Abstract
Balaban EP, Mangu PB, Khorana AA, et al. Locally advanced, unresectable pancreatic cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2016 Aug 1;34(22):2654-68.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Chronic pancreatitis
- Bile duct stones
- Ampullary carcinoma
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: pancreatic adenocarcinoma
- ERCP-related adverse events
More GuidelinesPatient information
Pancreatic cancer
Pancreas cancer: questions to ask your doctor
More Patient information
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer