From the Guidelines
Evaluation of pancreatic cancer should start with a multiphase CT scan of the chest, abdomen, and pelvis to assess the extent of disease, as recommended by the American Society of Clinical Oncology 1. This approach is crucial in determining the stage of the disease, which in turn guides treatment options. The initial assessment should include:
- Contrast-enhanced CT scan of the abdomen and pelvis to detect tumors and assess local invasion and metastases
- Measurement of CA 19-9 tumor marker, though it's not specific enough for diagnosis alone
- Endoscopic ultrasound (EUS) with fine-needle aspiration for tissue diagnosis, particularly for smaller lesions that may not be visible on CT
- Laboratory tests, including liver function tests, complete blood count, and coagulation studies
- Additional staging with diagnostic laparoscopy if surgery is being considered to rule out peritoneal metastases not visible on imaging The European Society for Medical Oncology (ESMO) also recommends the use of EUS and MRI in the evaluation of pancreatic cancer 1. However, the most recent and highest quality study 1 prioritizes the use of multiphase CT scan as the initial imaging modality. It's essential to conduct the evaluation promptly, as pancreatic cancer is often diagnosed at advanced stages, and accurate staging determines treatment options, including surgery, chemotherapy, radiation, or palliative care 1. The goals of care, patient preferences, and support systems should also be discussed with every patient with metastatic pancreatic cancer and their caregivers 1. In terms of treatment, FOLFIRINOX is recommended for patients with ECOG PS 0 to 1, favorable comorbidity profile, and access to chemotherapy port and infusion pump management services 1. Gemcitabine plus NAB-paclitaxel is recommended for patients with ECOG PS 0 to 1 and relatively favorable comorbidity profile 1. The treatment approach should be individualized based on the patient's performance status, comorbidity profile, and preferences. Overall, the evaluation and treatment of pancreatic cancer require a multidisciplinary approach, and the most recent and highest quality evidence should guide clinical decision-making 1.
From the Research
Pancreatic Cancer Evaluation Methods
- Imaging examinations play a crucial role in the diagnosis and evaluation of pancreatic cancer, including tumor detection, staging, and surgical resectability evaluation 2.
- Commonly used imaging techniques for pancreatic cancer diagnosis include conventional ultrasound, endoscopic ultrasonography, PET-CT, multi-detector row CT (MDCT), and magnetic resonance imaging (MRI) 2.
- MDCT and MRI are the most widely used imaging techniques for pancreatic cancer diagnosis 2.
Comparison of Imaging Techniques
- A study comparing CT and MRI in the presurgical evaluation of pancreatic cancer found that both imaging modalities had similar performance in detecting tumors, evaluating vessel involvement, and assessing resectability 3.
- Another study found that CT scanning has a greater than 90% accuracy in staging patients with pancreatic cancer, and new imaging techniques such as spiral CT and gadolinium-enhanced MRI can further increase staging reliability 4.
Early Screening and Diagnosis
- Early diagnosis of pancreatic cancer is crucial for improving prognosis, and screening is often applied in high-risk individuals to achieve early diagnosis 5.
- Currently, there are no biomarkers with sufficient sensitivity and specificity for the diagnosis of pancreatic cancer, and carbohydrate antigen 19-9 (CA19-9) is not recommended for early screening due to its limited specificity 5.
- Novel serum biomarkers and liquid biopsy involving circulating tumor cells, circulating tumor DNA, microRNAs, and exosomes are being explored for the early diagnosis of pancreatic cancer 5.
Treatment and Prognosis
- Pancreatic adenocarcinoma is a devastating malignancy with a grim prognosis, and treatment options are limited to few agents such as 5-FU, irinotecan, oxaliplatin, gemcitabine, and nab-paclitaxel 6.
- Despite advances in first-line and second-line therapies, median overall survival remains short of a year, and collaborative efforts are needed to enroll patients in clinical trials and improve treatment outcomes 6.