[Gastroenterology diagnosis of pancreatic carcinoma]

Abdominal ultrasound is the primary imaging study for patients with suspected pancreatic carcinoma. Unless the tumor is large, this test might not be abnormal. The next appropriate test in the diagnostic work-up is the EUS. If this technique is not available, dual-phase spiral CT might be ordered instead. In cases which remain unclear or require palliative relief of biliary obstruction. It has been proposed that diagnosis and staging of a pancreatic carcinoma can be afforded by an all-in-one investigation using MRI, MRCP and MR-angiography. But at present, the superiority of MRI for diagnosing pancreatic cancer is insufficiently established. Conventional angiography does no longer play a role in the staging process. Fine-needle aspiration of focal pancreatic lesions is only recommended in patients who have unresectable lesions or who are more likely to have a focal inflammatory lesion in chronic pancreatitis. Laparoscopy is indicated if there is a high likelihood of unrecognized peritoneal or hepatic micrometastases in patients who are otherwise candidates for a surgical cure. Furthermore, laparoscopy should only be performed if the proof of metastases precludes further surgery or if palliative surgery is not necessary. Tumor markers and genetic markers might help to detect pancreatic cancer. However, the optimal screening method for the diagnosis of early and potentially curable pancreatic cancer is not in sight as yet.