Editing Pancreatic cancer (section)

== '''Evaluation''' ==

* Bloods
** LFTs and coags
** Ca 19-9 - most sensitive (82%)
*** Can get false elevation from biliary obstruction
*** Normalisation after neoadjuvant therapy is an important prognostic marker

'''Preoperative CA 19-9 levels and tumor resectabilty and survival rates in pancreatic cancer'''
{| class="wikitable"
|'''CA 19-9 (U/mL)'''
|'''Number of patients'''
|'''Resectability (%)'''
|'''R0 resection (%)'''
|'''Survival after resection'''
|
|'''Survival if unresectable'''
|-
|
|
|
|
|'''5-year (%)'''
|'''Median (months)'''
|'''Median (months)'''
|-
|<5
|99
|73.7
|48.6
|21.9
|26.8
|10.1
|-
|5 to <37
|281
|79.7
|52.7
|27.2
|28.5
|9.1
|-
|37 to <100
|216
|83.3
|46.9
|19.1
|26.9
|8.6
|-
|100 to <250
|247
|82.2
|42.1
|16.8
|22.5
|5.4
|-
|250 to <500
|204
|72.1
|37.0
|8.3
|20.1
|9.2
|-
|500 to <1000
|184
|67.4
|44.7
|7.0
|15.4
|8.9
|-
|1000 to <2000
|126
|61.1
|32.5
|0.0
|12.0
|6.8
|-
|2000 to <4000
|92
|45.7
|31.0
|0.0
|12.3
|6.2
|-
|≥4000
|94
|38.3
|27.8
|0.0
|14.4
|7.2
|-
|
|
|''p''<0.0001
|''p'' = 0.0009
|
|''p''<0.0001
|''p'' = 0.065
|}

* CEA
* AFP

* CT pancreas protocol (non-con, arterial, PV, with 3mm slices, and 3D reconstruction)
** Hypoattenuating lesion in PV phase
** Ability to accurately predict resectability is about 85%. Mistakes are generally due to small liver or peritoneal mets.
** Look at level of biliary obstruction, relationship to vascular structures, and presence of regional or metastatic disease
* ERCP
** Good for biopsy, but controversial role of stenting
** Indications for stenting:
*** Active treatment:
**** Acute cholangitis
**** Debilitating symptoms (e.g. pruritus)
**** Expected delay in surgical intervention >2 weeks (neoadjuvant therapy)
*** Palliative
**** Relieve symptoms of jaundice or pruritus
**** Cholangitis
**** Optimise medical status prior to CRT
* EUS
** Sensitivity and specificity far higher than brush cytology
** Diagnostic accuracy 92-95%
** May have another role in the delineation of suspicious lesions <2cm
* MRCP
** When detailed assessment of luminal anatomy is necessary
* FDG-PET
** Can differentiate between benign and malignant pancreatic tumours
** Not routinely used