tailieunhanh - Chapter 089. Pancreatic Cancer (Part 3)

Carcinoma of the pancreas. A. Sonogram showing pancreatic carcinoma (P), dilated intrahepatic bile ducts (d), dilated portal vein (pv), and inferior vena cava (IVC). B. Computed tomography scan showing pancreatic carcinoma (dark arrows). C. Endoscopic retrograde showing abrupt c utoff of the duct of Wirsung (arrow). D. Magnetic resonance cholangiopancreatography showing obstruction (Obs) in the pancreatic duct (PD). The gallbladder (GB), hepatic duct (HD), and common bile duct (CBD) are labeled. Tissue Diagnosis and Cytology Patients with disease that is potentially curable by surgery, and in whom a highly suspicious lesion is seen on imaging, are often taken directly to. | Chapter 089. Pancreatic Cancer Part 3 Carcinoma of the pancreas. A. Sonogram showing pancreatic carcinoma P dilated intrahepatic bile ducts d dilated portal vein pv and inferior vena cava IVC . B. Computed tomography scan showing pancreatic carcinoma dark arrows . C. Endoscopic retrograde showing abrupt c utoff of the duct of Wirsung arrow . D. Magnetic resonance cholangiopancreatography showing obstruction Obs in the pancreatic duct PD . The gallbladder GB hepatic duct HD and common bile duct CBD are labeled. Tissue Diagnosis and Cytology Patients with disease that is potentially curable by surgery and in whom a highly suspicious lesion is seen on imaging are often taken directly to surgery without prior tissue confirmation of cancer. This is because of theoretical concerns that a percutaneous fine-needle aspiration may result in dissemination of cancer intraperitoneally or along the track of the biopsy needle. In addition negative cytology may not be sufficient evidence to avoid surgery particularly with small lesions. EUS-guided fine-needle aspiration is increasingly being used even in patients with potentially resectable disease as there is less risk of intraperitoneal spread of cancer. Other methods of obtaining specimens for cytological analysis include sampling of pancreatic juices or brushings of ductal lesions obtained by ERCP. Serum Markers The most widely used serum marker in pancreatic cancer is cancer-associated antigen 19-9 CA 19-9 . It has a reported sensitivity and specificity of about 80-90 and is suggestive rather than confirmatory of the diagnosis of pancreatic cancer. Serum levels of CA 19-9 can be elevated in patients with jaundice without pancreatic cancer present. The level of CA 19-9 may have prognostic implications with very high levels sometimes found in patients with inoperable disease. In advanced disease patients treated with chemotherapy who had high pretreatment levels of CA 19-9 have also been found to have a worse survival whereas .