Chapter 13 CANCER OF THE PANCREAS AND PANCREATIC CYSTIC LESIONS
PANCREATIC CANCER
Clinical features
Clinical signs include evidence of weight loss, jaundice, hepatomegaly, a palpable gall bladder, Troisier’s sign (enlarged left supraclavicular lymph nodes), an abdominal mass and ascites. In patients suspected of having a pancreatic malignancy, weight loss, hyperbilirubinaemia and an increased CA 19-9 may be highly predictive of pancreatic malignancy. Surgical exploration should be considered in these patients even in the absence of a preoperative diagnosis.
Diagnostic methods
Imaging
Magnetic resonance imaging (MRI)
Results in the same efficacy as CE-CT and is used if patients cannot tolerate intravenous contrast.
Laparoscopy
Laparoscopy allows for direct observation of the pancreas and for biopsies and cytological washings to be taken. This is particularly important in cases where the other modalities are equivocal. It may also preclude unnecessary laparotomies. Laparoscopic ultrasound (LUS) is useful for liver and pancreas scanning.