Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1126 Pancreatic Cancer

■Genetic

■familial hereditary pancreatic cancer

■hereditary pancreatitis

■familial adenomatous polyposis syndrome

■familial atypical multiple mole melanoma

■HNPCC1 – hereditary nonpolyposis colon cancer syndrome

■Associated diseases with an increased risk of pancreatic cancer

■recent onset of diabetes present in >50% of patients afflicted with

pancreatic cancer

■chronic pancreatitis

■intraductal papillary mucinous tumor

Symptoms and Signs

■Abdominal or back pain

■Jaundice (often painless)

■Weight loss

■unexplained pancreatitis in an elderly patient > 50 yrs

tests

■endoscopic ultrasound (EUS) – may be the most sensitive (∼99%)

and can be used to obtain tissue at the time of examination

■high resolution spiral abdominal CT scan (sensitivity∼90%)

➣patients at high risk secondary to genetic causes should be

entered into a screening program using high resolution CT or

EUS.

■conventional CT scan (sensitivity∼75%)

■ERCP is also useful in detecting pancreatic cancer in specific cases

Blood Tests

■CA19-9 assays are often used but its sensitivity is poor and inade-

quate for screening purposes.

■serum amylase levels are not useful

■Abnormal liver function tests (bilirubin, alkaline phosphatase,

aminotransminases) are often seen with cancers in the pancreatic

head.

differential diagnosis

■Biliary tract disease must be considered in patients who are jaun-

diced or have liver function test abnormalities. Diseases should

include:

■choledocholithiasis

■cholangiocarcinoma