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Pancreatic cancer

Last reviewed: 30 Sep 2024
Last updated: 05 Oct 2023

Summary

Definition

History and exam

Key diagnostic factors

  • jaundice
  • nonspecific upper abdominal pain or discomfort
  • weight loss and anorexia
  • back pain
Full details

Other diagnostic factors

  • age 65-75 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)
Full details

Risk factors

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

Diagnostic tests

1st tests to order

  • pancreatic protocol CT
  • abdominal ultrasound
  • LFTs
Full details

Tests to consider

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

Emerging tests

  • genomic testing

Treatment algorithm

ACUTE

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 trial funding from Celgene and Bristol-Myers Squibb, advisory board honorarium from Baxalta Inc., and educational grants from Mylan, Celgene, Ethicon, and Medtronic.

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).

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