Key practice points: pancreatic cancer

Pancreatic cancer often presents as advanced disease due to lack of symptoms in early disease. Symptoms include abdominal pain radiating to the back, unintentional weight loss, and jaundice.
CT scan should be performed for staging to evaluate for metastatic disease.
If the tumor appears to be resectable but there appears to be possible vascular involvement, EUS should be performed for local staging.
EUS-guided fine needle aspiration is the optimal modality for obtaining tissue diagnosis if indicated.
Placement of a metal biliary stent should be considered for patients with unresectable tumors causing biliary obstruction.

Other Malignant and Premalignant Diseases of the Pancreas

Cystic neoplasms

Cystic neoplasms of the pancreas may be benign or malignant. These lesions must be differentiated from the pseudocysts that often complicate the course of acute and chronic pancreatitis. Cystadenomas are classified as mucinous, also termed macrocystic adenomas, and serous, also termed microcystic adenomas. The distinction is critical because serous cystadenomas have almost no malignant potential whereas mucinous cystadenomas have a high incidence of progression to cystadenocarcinoma. Both lesions occur more commonly in women; serous lesions usually are diagnosed in elderly patients, and mucinous lesions usually are diagnosed in middle-aged patients. Because mucinous lesions are larger, abdominal pain, weight loss, and vomiting are common presenting symptoms. Serous lesions are usually smaller than 4–6 cm and contain many small cysts smaller than 1–2 cm in diameter. One-third of serous lesions exhibit a characteristic stellate “sunburst” calcification, sometimes evident on abdominal radiography. In contrast, mucinous cystadenomas contain a few large cysts, and a curvilinear calcification of the cyst capsule may occur.

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