[Staging of exocrine pancreatic cancer]

The aim of this review is to report results of investigations used in the staging of pancreatic cancer and draw a practical approach in the treatment of this cancer. For the diagnosis of pancreatic mass and the diagnosis of malignancy, ultrasonography and helical-CT seem to be the best methods. In cases of non evident malignancy, diagnosis of pancreatic cancer can be done by endoscopic retrograde cholangiopancreatography and confirmed by transcutaneous biopsy, under CT locating. The diagnosis of vascular involvement is usually done by helical-CT, while endoscopic ultrasonography gives best results in the diagnosis of lymph node involvement. The diagnosis of hepatic and peritoneal metastasis can be difficult, specially in case of small peritoneal deposits, but accuracy of helical-CT remains high. Grading of these investigations depends on the situation after performing ultrasonography and CT scan. When a pancreatic resection seems to be possible, a surgical treatment can be directly proposed or preceding by endoscopic ultrasonography for lymph node diagnosis, and/or laparoscopy for detection of small peritoneal deposits.