The diagnosis of pancreatic cancer

Despite increasing interest and research on pancreatic cancer, patients with this devastating disease have a very poor prognosis. The principal reason for this grim prognosis is the inability to diagnose the disease at an early, localized, and curable stage. This review is intended to present an overview of our current status on the diagnosis of pancreatic cancer and emphasize recent advances in imaging and tumor markers that are attempting to overcome the challenges of this dreaded disease. Clinical presentation and risk factors for pancreatic cancer are reviewed. Various imaging modalities-including endoscopic and transabdominal ultrasound, ERCP, CT, MRI and PET-are described, with emphasis on their limitations for diagnosing pancreatic cancer at a size that has a significant impact on survival rates. The most promising approach for the early diagnosis of pancreatic adenocarcinoma utilizes tumor markers. Many of the tumor markers investigated over the past 20 years as well as some promising markers under current investigation are reviewed. The combination of serum markers may improve sensitivity and specificity in making the diagnosis of pancreatic adenocarcinoma. We conclude that the current status of imaging and tumor markers does not permit the early diagnosis of an adenocarcinoma of the pancreas. The development of improved early detection methods for pancreatic cancer is essential; however, at the present time it should be limited to high-risk individuals to allow for a better opportunity for success.