A diagnostic approach to pancreatic cancer

The diagnostic and staging evaluation for patients suspected of having pancreatic cancer has not been standardized. This review describes a practical algorithm for the workup of affected individuals. Computed tomography as an initial test can usually provide the most information when clinical features or biochemical or serological (CA19-9) test results suggest the presence of a neoplasm. Endoscopic retrograde cholangiopancreatography is appropriate when scans are equivocal or clearly abnormal especially in jaundiced patients. A cytological diagnosis is possible and biliary decompression can be accomplished with this procedure. Laparoscopy followed by angiography is useful for staging surgical candidates.