[Diagnosis and differential diagnosis of pancreatic carcinoma]

Despite improved imaging procedures for diagnosis, there is no improvement in prognosis of pancreatic carcinoma. This may be explained by the lack of early symptoms and the aggressiveness of the tumor with its tendency of early metastasis. However, in most cases imaging procedures enable an exact preoperative diagnosis and a reliable preoperative staging. Unnecessary laparotomies are avoided since resectability can be correctly predicted in more than 80%. Transabdominal sonography and computed tomography are mandatory in almost all cases. Endoscopic retrograde cholangiopancreatography has not lost its importance due to the possibilities of transpapillary biopsy or brush-cytology. A major role for ERCP is palliative therapy of cholestasis by stenting of malignant bile duct stenosis. At present endosonography can be regarded as most sensitive procedure to detect small pancreatic tumors and as a very reliable method for preoperative T-staging. Detection of mutations of the Ki-ras gene in shedded cells of pancreatic secretions may improve the still difficult differential diagnosis chronic pancreatitis versus pancreatic carcinoma.