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{{Pancreatic cancer}}
{{Pancreatic cancer}}
== Overview ==
== Overview ==
The diagnostic study of choice for [[pancreatic cancer]] is the dynamic spiral [[Computed tomography|CT scan]] with contrast media (oral and IV) enhancement. Findings on [[Computed tomography|CT scan]] that may be suggestive of [[pancreatic cancer]] include [[Morphology|morphological]] changes of the [[gland]], destruction of the peripancreatic fat and loss of the sharp margins with surrounding structures, involvement of the regional [[Lymph node|lymph nodes]] and adjacent [[Circulatory system|vasculature]], [[Pancreatic duct|pancreatic ductal]] [[Dilation|dilatation]], [[Pancreas|pancreatic]] atrophy and [[obstruction]] of the [[common bile duct]] . [[Computed tomography|CT scan]] is also used for the [[Cancer staging|staging]] of [[pancreatic cancer]].


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


=== Gold standard/Study of choice: ===
=== Gold standard/Study of choice: ===
* The dynamic spiral  [[Computed tomography|CT scan]] with contrast media(oral and IV) enhancement is the [[Gold standard (test)|gold standard test]] for the [[diagnosis]] and [[Cancer staging|staging]] of [[pancreatic cancer]].


* The following result of [[Computed tomography|CT scan]] is confirmatory of [[pancreatic cancer]]: <ref name="pmid19129613">{{cite journal| author=Horwhat JD, Gerke H, Acosta RD, Pavey DA, Jowell PS| title=Focal or diffuse "fullness" of the pancreas on CT. Usually benign, but EUS plus/minus FNA is warranted to identify malignancy. | journal=JOP | year= 2009 | volume= 10 | issue= 1 | pages= 37-42 | pmid=19129613 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19129613  }} </ref><ref name="pmid2827228">{{cite journal| author=Freeny PC, Marks WM, Ryan JA, Traverso LW| title=Pancreatic ductal adenocarcinoma: diagnosis and staging with dynamic CT. | journal=Radiology | year= 1988 | volume= 166 | issue= 1 Pt 1 | pages= 125-33 | pmid=2827228 | doi=10.1148/radiology.166.1.2827228 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2827228  }} </ref><ref name="pmid6867347">{{cite journal| author=Karasawa E, Goldberg HI, Moss AA, Federle MP, London SS| title=CT pancreatogram in carcinoma of the pancreas and chronic pancreatitis. | journal=Radiology | year= 1983 | volume= 148 | issue= 2 | pages= 489-93 | pmid=6867347 | doi=10.1148/radiology.148.2.6867347 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6867347  }} </ref><ref name="pmid9124153">{{cite journal| author=Raptopoulos V, Steer ML, Sheiman RG, Vrachliotis TG, Gougoutas CA, Movson JS| title=The use of helical CT and CT angiography to predict vascular involvement from pancreatic cancer: correlation with findings at surgery. | journal=AJR Am J Roentgenol | year= 1997 | volume= 168 | issue= 4 | pages= 971-7 | pmid=9124153 | doi=10.2214/ajr.168.4.9124153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9124153  }} </ref><ref name="pmid22699206">{{cite journal| author=Asagi A, Ohta K, Nasu J, Tanada M, Nadano S, Nishimura R et al.| title=Utility of contrast-enhanced FDG-PET/CT in the clinical management of pancreatic cancer: impact on diagnosis, staging, evaluation of treatment response, and detection of recurrence. | journal=Pancreas | year= 2013 | volume= 42 | issue= 1 | pages= 11-9 | pmid=22699206 | doi=10.1097/MPA.0b013e3182550d77 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22699206  }} </ref>


*[[Computed tomography|MDCT (Multi-detector row computed tomography]]) the [[imaging]] modality widely used in suspected [[pancreatic cancer]] patients as the pre-operative examination. <ref name="pmid24976723">{{cite journal| author=Lee ES, Lee JM| title=Imaging diagnosis of pancreatic cancer: a state-of-the-art review. | journal=World J Gastroenterol | year= 2014 | volume= 20 | issue= 24 | pages= 7864-77 | pmid=24976723 | doi=10.3748/wjg.v20.i24.7864 | pmc=4069314 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24976723  }} </ref>
*[[Computed tomography|MDCT]] is used as the primary [[imaging]] modality, and is used in conjunction with [[Positron emission tomography|PET]]/[[Computed tomography|CT]]. [[Computed tomography|MDCT]] helps in local and distant disease assessment in a single scan. <ref name="pmid18025509">{{cite journal| author=Brennan DD, Zamboni GA, Raptopoulos VD, Kruskal JB| title=Comprehensive preoperative assessment of pancreatic adenocarcinoma with 64-section volumetric CT. | journal=Radiographics | year= 2007 | volume= 27 | issue= 6 | pages= 1653-66 | pmid=18025509 | doi=10.1148/rg.276075034 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18025509  }} </ref>
*[[Computed tomography|MDCT]] is useful in the evaluation of [[vascular]] involvement, which helps in predicting the [[tumor]] resectability.<ref name="pmid24976723">{{cite journal| author=Lee ES, Lee JM| title=Imaging diagnosis of pancreatic cancer: a state-of-the-art review. | journal=World J Gastroenterol | year= 2014 | volume= 20 | issue= 24 | pages= 7864-77 | pmid=24976723 | doi=10.3748/wjg.v20.i24.7864 | pmc=4069314 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24976723  }} </ref> <ref name="pmid24976723">{{cite journal| author=Lee ES, Lee JM| title=Imaging diagnosis of pancreatic cancer: a state-of-the-art review. | journal=World J Gastroenterol | year= 2014 | volume= 20 | issue= 24 | pages= 7864-77 | pmid=24976723 | doi=10.3748/wjg.v20.i24.7864 | pmc=4069314 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24976723  }} </ref>
**
[[Image:CT_Pancreatic_cancer.png|thumb|350px|center|By Hellerhoff (Own work) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons]]
* The dynamic spiral  CT scan with contrast media(oral and IV) enhancement is the gold standard test for the diagnosis and staging of pancreatic cancer.
* The following result of CT scan is confirmatory of pancreatic cancer: <ref name="pmid19129613">{{cite journal| author=Horwhat JD, Gerke H, Acosta RD, Pavey DA, Jowell PS| title=Focal or diffuse "fullness" of the pancreas on CT. Usually benign, but EUS plus/minus FNA is warranted to identify malignancy. | journal=JOP | year= 2009 | volume= 10 | issue= 1 | pages= 37-42 | pmid=19129613 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19129613  }} </ref> <ref name="pmid2827228">{{cite journal| author=Freeny PC, Marks WM, Ryan JA, Traverso LW| title=Pancreatic ductal adenocarcinoma: diagnosis and staging with dynamic CT. | journal=Radiology | year= 1988 | volume= 166 | issue= 1 Pt 1 | pages= 125-33 | pmid=2827228 | doi=10.1148/radiology.166.1.2827228 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2827228  }} </ref><ref name="pmid6867347">{{cite journal| author=Karasawa E, Goldberg HI, Moss AA, Federle MP, London SS| title=CT pancreatogram in carcinoma of the pancreas and chronic pancreatitis. | journal=Radiology | year= 1983 | volume= 148 | issue= 2 | pages= 489-93 | pmid=6867347 | doi=10.1148/radiology.148.2.6867347 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6867347  }} </ref><ref name="pmid9124153">{{cite journal| author=Raptopoulos V, Steer ML, Sheiman RG, Vrachliotis TG, Gougoutas CA, Movson JS| title=The use of helical CT and CT angiography to predict vascular involvement from pancreatic cancer: correlation with findings at surgery. | journal=AJR Am J Roentgenol | year= 1997 | volume= 168 | issue= 4 | pages= 971-7 | pmid=9124153 | doi=10.2214/ajr.168.4.9124153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9124153  }} </ref><ref name="pmid22699206">{{cite journal| author=Asagi A, Ohta K, Nasu J, Tanada M, Nadano S, Nishimura R et al.| title=Utility of contrast-enhanced FDG-PET/CT in the clinical management of pancreatic cancer: impact on diagnosis, staging, evaluation of treatment response, and detection of recurrence. | journal=Pancreas | year= 2013 | volume= 42 | issue= 1 | pages= 11-9 | pmid=22699206 | doi=10.1097/MPA.0b013e3182550d77 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22699206  }} </ref>
**[[Morphology|Morphological]] changes of the [[gland]]  
**[[Morphology|Morphological]] changes of the [[gland]]  
**Destruction of the peripancreatic fat and loss of the sharp margins with surrounding structures
**Destruction of the peripancreatic fat and loss of the sharp margins with surrounding structures
**Involvement of the regional [[Lymph node|lymph nodes]] and adjacent [[Circulatory system|vasculature]]
**Involvement of the regional [[Lymph node|lymph nodes]] and adjacent [[Circulatory system|vasculature]]
**[[Pancreatic duct|Pancreatic ductal]] [[Dilation|dilatation]]
**[[Pancreatic duct|Pancreatic ductal]] [[Dilation|dilatation]]
**[[Pancreas|Pancreatic]] atrophy
**[[Pancreas|Pancreatic]] [[atrophy]]
**[[Obstruction]] of the [[Common bile duct|common bile duct (CBD)]]
**[[Obstruction]] of the [[Common bile duct|common bile duct (CBD)]]  
**
**[[Computed tomography|MDCT (Multi-detector row computed tomography]]) the [[imaging]] modality widely used in suspected [[pancreatic cancer]] patients as the pre-operative examination. <ref name="pmid24976723">{{cite journal| author=Lee ES, Lee JM| title=Imaging diagnosis of pancreatic cancer: a state-of-the-art review. | journal=World J Gastroenterol | year= 2014 | volume= 20 | issue= 24 | pages= 7864-77 | pmid=24976723 | doi=10.3748/wjg.v20.i24.7864 | pmc=4069314 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24976723  }} </ref>
=== Diagnostic Criteria ===
**[[Computed tomography|MDCT]] is used as the primary [[imaging]] modality, and is used in conjunction with [[Positron emission tomography|PET]]/[[Computed tomography|CT]]. [[Computed tomography|MDCT]] helps in local and distant disease assessment in a single scan. <ref name="pmid18025509">{{cite journal| author=Brennan DD, Zamboni GA, Raptopoulos VD, Kruskal JB| title=Comprehensive preoperative assessment of pancreatic adenocarcinoma with 64-section volumetric CT. | journal=Radiographics | year= 2007 | volume= 27 | issue= 6 | pages= 1653-66 | pmid=18025509 | doi=10.1148/rg.276075034 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18025509  }} </ref>
* Here you should describe the details of the diagnostic criteria.
**[[Computed tomography|MDCT]] is useful in the evaluation of [[vascular]] involvement, which helps in predicting the [[tumor]] resectability.<ref name="pmid24976723" />
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].


* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
[[Image:CT_Pancreatic_cancer.png|thumb|350px|center|By Hellerhoff (Own work) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons]]
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
** Criteria 1
** Criteria 2
** Criteria 3
 
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].


==References==
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 23:32, 29 July 2020


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

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Overview

The diagnostic study of choice for pancreatic cancer is the dynamic spiral CT scan with contrast media (oral and IV) enhancement. Findings on CT scan that may be suggestive of pancreatic cancer include morphological changes of the gland, destruction of the peripancreatic fat and loss of the sharp margins with surrounding structures, involvement of the regional lymph nodes and adjacent vasculature, pancreatic ductal dilatation, pancreatic atrophy and obstruction of the common bile duct . CT scan is also used for the staging of pancreatic cancer.

Diagnostic Study of Choice

Gold standard/Study of choice:

By Hellerhoff (Own work) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

References

  1. ↑ Horwhat JD, Gerke H, Acosta RD, Pavey DA, Jowell PS (2009). "Focal or diffuse "fullness" of the pancreas on CT. Usually benign, but EUS plus/minus FNA is warranted to identify malignancy". JOP. 10 (1): 37–42. PMID 19129613.
  2. ↑ Freeny PC, Marks WM, Ryan JA, Traverso LW (1988). "Pancreatic ductal adenocarcinoma: diagnosis and staging with dynamic CT". Radiology. 166 (1 Pt 1): 125–33. doi:10.1148/radiology.166.1.2827228. PMID 2827228.
  3. ↑ Karasawa E, Goldberg HI, Moss AA, Federle MP, London SS (1983). "CT pancreatogram in carcinoma of the pancreas and chronic pancreatitis". Radiology. 148 (2): 489–93. doi:10.1148/radiology.148.2.6867347. PMID 6867347.
  4. ↑ Raptopoulos V, Steer ML, Sheiman RG, Vrachliotis TG, Gougoutas CA, Movson JS (1997). "The use of helical CT and CT angiography to predict vascular involvement from pancreatic cancer: correlation with findings at surgery". AJR Am J Roentgenol. 168 (4): 971–7. doi:10.2214/ajr.168.4.9124153. PMID 9124153.
  5. ↑ Asagi A, Ohta K, Nasu J, Tanada M, Nadano S, Nishimura R; et al. (2013). "Utility of contrast-enhanced FDG-PET/CT in the clinical management of pancreatic cancer: impact on diagnosis, staging, evaluation of treatment response, and detection of recurrence". Pancreas. 42 (1): 11–9. doi:10.1097/MPA.0b013e3182550d77. PMID 22699206.
  6. ↑ 6.0 6.1 Lee ES, Lee JM (2014). "Imaging diagnosis of pancreatic cancer: a state-of-the-art review". World J Gastroenterol. 20 (24): 7864–77. doi:10.3748/wjg.v20.i24.7864. PMC 4069314. PMID 24976723.
  7. ↑ Brennan DD, Zamboni GA, Raptopoulos VD, Kruskal JB (2007). "Comprehensive preoperative assessment of pancreatic adenocarcinoma with 64-section volumetric CT". Radiographics. 27 (6): 1653–66. doi:10.1148/rg.276075034. PMID 18025509.

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