Healthcare Professionals

Clinical Evaluation

Most of the patients with pancreatic cancer present with jaundice. It is usually accompanied by abdominal pain, dark urine, light or clay coloured stools, weight loss, pruritus, weakness and anorexia. Some of the clinical features are:

• Patients may have epigastric or back pain
• Patients with jaundice show cutaneous signs of scratching due to pruritus
• About 10% of patients develop new onset diabetes mellitus
• Nausea and vomiting due to the mechanical duodenal obstruction
• Acute pancreatitis may be the first symptoms of pancreatic cancer in some patients
• Hepatomegaly, temporal wasting and a palpable gall bladder
• In patients with advanced pancreatic cancer, palpable hepatic metastases, left supraclavicular lymphadenopathy, adenopathy, periumbilical lymphadenopathy and drop metastases in the pelvis encircling the perirectal region can be seen.

• Laboratory findings



• Patients with cancer of the right side of the pancreas show elevated serum bilirubin, alkaline phosphatase and γ-glutamyl transpeptidase with slightly elevated hepatic aminotransferases (i.e. SGOT and SGPT).
• Occasionally, patients with ductal carcinoma have hyperamylasemia or hyperlipasemia.
• Deeply jaundiced patients show prolongation of prothrombin time due to malabsorption of fat soluble vitamins.
• Diagnostic imaging



• Multidetector CT (MDCT) is commonly used and is preferred for diagnosis and staging of pancreatic cancer.
• MRI is less often used for diagnosis and staging. High resolution imaging, fast and functional imaging, volume acquisitions and MR cholangiopancreatography (MRCP) is now possible and sometimes useful.
• EUS-FNA is highly sensitive and is useful for tissue diagnosis of pancreatic cancer when diagnosis is required before surgical treatment.
• Recently, positron emission tomography (PET) with fluorodeoxyglucose (FDG) has also been shown to be sensitive in evaluating pancreatic cancer. It is especially useful in detection of metastases in otherwise localised pancreatic cancer. However there remains concern about sensitivity (in hyperglycemic patients) and specificity (in patients with pancreatitis).
• Histopathologic diagnosis

Although percutaneous biopsy is commonly used, it may give rise to serious complications like haemorrhage, pancreatitis, fistula, and even abscess. Tumor dissemination due to capsular disruption of the neoplasm is also well documented. Therefore it is advisable to use a relatively safe technique like EUS-FNA. Percutaneous biopsy should be avoided in all potentially resectable cases.

• Laparoscopy

Staging laparoscopy in pancreatic cancer is useful. It has been well documented that such an approach can detect metastatic disease undetected by pre-operative imaging. However its routine use is debatable especially in pancreatic head lesions since operative palliation is a good action. In case of left sided tumors (more often locally advanced/ metastatic), staging laparoscopy might prevent unnecessary laprotomy. In case of patients with right-sided tumors, and signs of obstructive jaundice, vague symptoms of gastric obstruction and tumor it may be unnecessary to proceed for laparoscopy.

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