[Early diagnosis and staging of pancreatic cancer]

Case of pancreatic cancer have increased in number, and the number of deaths from that disease has reached 20,000 in recent years in Japan. Only a few patients with pancreatic cancer can be cured. However, the prognosis in small pancreatic cancer such as TS1 less than 2 cm is relatively good if radical surgical resection is performed. Therefore early diagnosis of pancreatic cancer is important to improve the dismal prognosis. Although clinical symptoms are not reliable for the diagnosis of pancreatic cancer, 30% of TS1 patients have abdominal or back pain. Recent epidemiologic studies have shown that familial history of pancreatic cancer, chronic pancreatitis, diabetes, obesity, and smoking are possible high-risk factors for pancreatic cancer. Serum pancreatic enzyme and tumor markers in terms of CA19-9 and CEA are measured first. Ultrasonography (US) should be performed as soon as possible. Not only tumors but also slightly dilated main pancreatic ducts and/or small simple cysts that may represent indirect changes due to pancreatic cancer can be detected with US. Enhanced computed tomography, magnetic resonance cholangiopancreatography and endoscopic US are also useful. Endoscopic retrograde cholangiopancreatography yields more detailed images of branch ducts, and the cytology of pancreatic juice can be determined following examination. Unfortunately, position-emission tomography is not a reliable method for the diagnosis of small tumors in the pancreas. Finally, TNM staging of pancreatic cancer is performed based on the results of these imaging examinations.