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
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
Treatment algorithm
Contributors
Authors
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, advisory board honorarium from Baxalta Inc., and educational grants from Mylan, Celgene, Ethicon, and Medtronic.
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
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).
Use of this content is subject to our disclaimer