This is the most common pancreatic malignancy, accounting for 90% of pancreatic cancers. Risk factors include chronic pancreatitis and smo...
This is the most common pancreatic malignancy, accounting for 90% of pancreatic cancers. Risk factors include chronic pancreatitis and smoking. These are aggressive tumours that invade adjacent vessels, nerves and lymphatics. Tumours metastasise to lymph nodes, liver and peritoneum. Associated tumour markers are Ca19-9, Ca242 and carcinoembryonic antigen (CEA). About 10% can be resected at diagnosis (Whipple procedure); 5-year survival is up to 3%.
US
• Hypoechoic mass.
• Pancreatic head tumours cause biliary obstruction early on.
• EUS also useful for diagnosis and T-staging.
CT
• Arterial (assess pancreas) and portal venous phases (assess liver).
• Look for a hypovascular, hypoattenuating mass post-contrast.
• The portovenous confluence is often invaded—look for venous collaterals.
• Check for local lymph node enlargement then coeliac, common hepatic, mesenteric and para-aortic.
Note that nodes may be involved without being enlarged.
• Peritoneal nodules may be too small to be detected—ascites implies peritoneal disease.
MRI
• Pancreatic tumours are typically seen as low-signal abnormalities on Tl-weighted fat saturated MRI.
NUCLEAR MEDICINE
• PET is useful for assessing local disease recurrence.
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