[Pancreatic carcinoma: diagnosis]

Early detection, tumor diagnosis with histological proof and tumor-staging are the principle aims of diagnostic approaches in patients suffering from pancreatic cancer. Asymptomatic and small cancers are often missed since they produce no or no typical symptoms and no reliable screening methods are available. Symptomatic pancreatic cancers are often so advanced that only about 20-30% of patients qualify for curative treatment. The diagnosis of pancreatic cancer with histological characterization occurs by imaging techniques [sonography and CT-scan with guided fine needle punction, MRI, ERCP with biopsy or aspiration cytology, endoscopic sonography] and in some cases by laparoscopy or laparotomy. The combined use of tumor markers [CA 19-9, CEA, elastase-1] support the diagnosis of pancreatic cancer. The same methods used for diagnosis are also used for the preoperative tumor staging. Unfortunately the accuracy of these methods is smaller than 77%. The involvement of lymph nodes, encasement of large vessels and small liver metastases or a peritoneal spread of the tumor may be difficult to visualize and the real extent of the disease may only be observed during laparotomy.