"King of Cancer" - diagnosis and treatment of pancreatic cancer

The previous article introduced incidence of pancreatic cancer and its associated symptoms, here we continue to introduce diagnosis and treatment of pancreatic cancer!

"King of Cancer" - diagnosis and treatment of pancreatic cancer
diagnostic CT

Computed tomography is most important diagnostic and diagnostic tool.

  • It can detect tumors as small as 2 cm and determine if tumor can be operated on. In this case, it has a sensitivity of 95%.
  • Metastases in liver
  • Swollen lymph nodes
  • Perivascular invasion (SMA and superior mesenteric portal vein (SMV)). Sensitivity: 88%~97%.
  • Relationship between tumor and abdominal axis
  • Dilation of pancreatic duct and site of obstruction
  • "King of Cancer" - diagnosis and treatment of pancreatic cancer
Ultrasound Echography

    It is more accurate than CT in distinguishing between obstructive and non-obstructive jaundice. Compared to CT, its effectiveness decreases with obesity and excess gas in intestines.


    Although endoscopic retrograde cholangiopancreatography and fine needle aspiration biopsy are invasive procedures, they have certain advantages. Endoscopic retrograde cholangiopancreatography (ERCP) has a high diagnostic sensitivity (94%) in pancreatic cancer [28]. It can detect tumors and locate blocked ducts. In addition, endoscopic retrograde cholangiopancreatography allows for a cytological study of aspiration of pancreatic secretions. Bile entry can also determine other cancer-causing factors such as K-ras oncogene. According to a group report [29], false-negative rate of ERCP is only 3%. Microscopic retrograde cholangiopancreatography, but fine needle aspiration biopsy with a sensitivity of 86% [30] allows for a histological diagnosis.

  • Sensitivity: 94%
  • Define blocking locations
  • Cytology
  • fine needle aspiration biopsy
  • Sensitivity: 86%
  • Histological diagnosis
  • "King of Cancer" - diagnosis and treatment of pancreatic cancer
Oncomarker CEA
  • Sensitivity: 40%
  • Elevated in pancreatitis, other benign and malignant tumors.
  • SA 19-9
  • Sensitivity: 70%
  • Levels increase at more advanced stages.
  • Early detection is less sensitive
  • Chronic pancreatitis, elevated gastrointestinal cancer
  • Tumor markers such as CEA and CA19-9 are of low specificity but may help in making a diagnosis when clinical manifestations are unclear.

    Without pathological data, diagnosis of pancreatic cancer is impossible. This must be taken prior to surgery. Thanks to advances in diagnostics such as endoscopic ultrasonography and CT-guided biopsy, there is no need to perform exploratory laparoscopy except in very rare cases. Endoscopy (ERCP) also allows cytology (because most cancers originate in the ducts).

    "King of Cancer" - diagnosis and treatment of pancreatic cancer
  • Adenocarcinoma of pancreas: arises from ductal cells and occurs in most cases. Diagnosis is based on ductal cell nuclei, cellular pleomorphism, discontinuity of ductal epithelium, and vascular and lymphatic invasion.
  • Other rare types include acinar cell carcinoma and cystadenocarcinoma.
  • Must be clearly differentiated from islet cell tumors with a good prognosis. They have a different histological appearance and stain positively for chromogranin.

    Staging and prognostic factors Adrenal tumor staging
  • TNM staging system for pancreatic cancer
  • It is important to note that TNM classification has no clinical value beyond classification of operable and non-resectable diseases. According to TNM system, operable disease was defined as T1N0M0 and T2N0M0.

    Prognostic factors (risk factors for relapse)

    The two main predictors of adrenal cancer are:

  • Total resection
  • Phase
  • "King of Cancer" - diagnosis and treatment of pancreatic cancer

    Only surgery can provide radical treatment for patients with operable disease. This refers to tumors of head that have not spread to adjacent structures such as celiac plexus or superior mesenteric artery. Adjuvant chemoradiotherapy is not standard and is used by many centers. In locally advanced disease, combination chemotherapy and radiation therapy may be helpful.

    1. Operable cases

    Determining stage and resectability is of great prognostic value. Tools for assessing resectability include CT, MRI, angiography, and laparoscopic "surgical confirmation". Determination of surgical resectability includes careful examination of liver, hilum, portal vein, and superior mesenteric vessels. The head of pancreas and uncinate process are assessed using a wide Kocher test. The SMA was palpated and assessed for its association with tumor. Check hepatic artery and celiac trunk to make sure there are no vascular wraps.

    Operable cases show none of following:

  • There is no local spread of tumor to neighboring organs.
  • No lymphadenopathy
  • No invasion of mesenteric vessels
  • No celiac plexus invasion.
  • Operation Whipple

    Pancreatoduodenal resection (Whipple operation and its variants) is method of choice. Variants of Whipple procedure include pylorus-sparing surgery to reduce postgastrectomy syndrome and extended Whipple procedure commonly used in Japan.


    The overall 5-year survival rate for resected tumors less than 2 cm is approximately 18%.

    Surgical mortality

    Surgical mortality rates range from 5% to 20%. Serious complications accounted for 30%, including sepsis, abscess formation, hemorrhage, and fistula formation.

    Complementary Therapy

    The Small Gastrointestinal Tumor Study (GITSG) found that patients with pancreatic cancer who received radiotherapy in combination with 5-Fu chemotherapy had a significantly higher survival rate (median survival, 11 to 20 months). The long-term cure rate also improved in radiotherapy group.

    "King of Cancer" - diagnosis and treatment of pancreatic cancer
2. Locally advanced cases in combination with chemotherapy.

    Several studies conducted at same institution evaluated role of preoperative radiotherapy in combination with chemotherapy with fluorouracil (5-Fu) and gemcitabine (gemcitabine). In these studies, 60-80% of lesions were completely removed 1.0-1.5 months after completion of chemotherapy. Median survival is 16 to 25 months.

    Intraoperative electron beam therapy

    Intraoperative electron beam therapy is closely associated with good local control.

    3. Metastatic cases Chemotherapy

    In cases of spread beyond pancreas to lymph nodes or liver, chemotherapy may provide temporary relief.


    The five-year survival rate for patients with stage IV tumors is less than 2%, and median survival time is usually less than 6 months.