Diagnosis of carcinoma of the pancreas

The emergence of new diagnostic techniques has been of great value in pancreatic carcinoma. These techniques include ultrasonography, computerized axial tomography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography and fine-needle aspiration biopsy. In spite of these advances in diagnosis, the prognosis of the disease remains poor and most patients still present at a late stage. Used intelligently, these technologic advances can reduce the number of investigations for pancreatic malignant lesions and yet maintain a high degree of diagnostic accuracy. A schema of investigations based on clinical symptoms and a patient's ability to undergo surgery is presented. The author believes this approach obviates the need for diagnostic laparotomy in many and palliative surgery for obstructive jaundice in some.