Last reviewed: September 2018
Last updated: August  2018

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • jaundice
  • non-specific upper abdominal pain or discomfort
  • weight loss and anorexia

Other diagnostic factors

  • age: 65 to 75 years
  • steatorrhoea
  • thirst, polyuria, nocturia, and weight loss
  • nausea, vomiting, anorexia, and mid-epigastric pain
  • hepatomegaly
  • epigastric abdominal mass
  • positive Courvoisier's sign
  • petechiae, purpura, bruising
  • Trousseau's sign

Risk factors

  • smoking
  • family history of pancreatic cancer
  • other hereditary cancer syndromes
  • chronic sporadic pancreatitis
  • diabetes mellitus
  • obesity
  • dietary factors

Diagnostic investigations

1st investigations to order

  • abdominal ultrasound
  • pancreatic protocol CT
  • LFTs
Full details

Investigations to consider

  • prothrombin time (PT)
  • FBC
  • cancer antigen (CA)19-9 biomarker
  • positron emission tomography
  • endoscopic retrograde cholangiopancreatography (ERCP)
  • magnetic resonance cholangiopancreatography
  • endoscopic ultrasound
  • staging laparoscopy (with laparoscopic ultrasound)
  • biopsy
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

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 trial funding from Celgene and advisory board honorarium from Baxalta Inc.

Dr Hemant M. Kocher wishes to gratefully acknowledge Dr Fieke E.M. Froeling, a previous contributor to this topic. FEMF is an author of a reference cited in this topic.

Peer reviewers VIEW ALL

Consultant Pancreatic Surgeon

West of Scotland Pancreatic Unit

Glasgow Royal Infirmary

Glasgow

UK

Disclosures

Not disclosed.

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).

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