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Pancreatic cancer management 1 - Clinical features and diagnosis

Learn about pancreatic cancer management, clinical features, and diagnosis in this informative video by Dr. Gunjan Desai from Lilavati Hospital. A must-watch for anyone interested in understanding this disease. Pancreatic cancer is a highly aggressive malignancy with a poor prognosis, often diagnosed at an advanced stage due to its subtle and nonspecific symptoms. In this video, we explore the clinical presentation of pancreatic cancer, the essential investigations required for diagnosis, and the critical role of endoscopic ultrasound and biopsy in confirming malignancy.

Clinical Presentation

Pancreatic cancer symptoms depend on the tumor's location within the pancreas. Tumors in the head of the pancreas often present with painless jaundice due to biliary obstruction, dark urine, pale stools, and pruritus. Patients may also experience weight loss, anorexia, early satiety, and vague abdominal or back pain. Tumors in the body or tail of the pancreas typically cause more insidious symptoms, such as progressive weight loss and deep-seated upper abdominal pain that radiates to the back. Other signs include new-onset diabetes mellitus, fatigue, and in some cases, signs of paraneoplastic syndromes like migratory thrombophlebitis (Trousseau’s sign).

Investigations for Pancreatic Cancer

Diagnosing pancreatic cancer involves a combination of imaging, laboratory tests, and histopathological confirmation. Blood tests include liver function tests to assess cholestasis, with elevated bilirubin and alkaline phosphatase suggesting biliary obstruction. Tumor markers like CA 19-9 are often elevated in pancreatic cancer, though they are not specific for diagnosis.

Imaging studies play a crucial role in detection and staging. Contrast-enhanced computed tomography (CT) of the abdomen is the initial modality of choice, providing detailed information on tumor size, location, and vascular invasion. Magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) is useful in evaluating the pancreatic duct and bile duct involvement. Positron emission tomography (PET) scans may be used to assess metastatic disease.

Endoscopic Ultrasound and the Role of Biopsy

Endoscopic ultrasound (EUS) is a highly sensitive modality for detecting small pancreatic tumors, assessing vascular involvement, and guiding tissue sampling. Using a high-frequency ultrasound probe mounted on an endoscope, EUS provides detailed images of the pancreas and surrounding structures, allowing for precise tumor localization. EUS is particularly valuable when CT or MRI findings are inconclusive.

EUS-guided fine-needle aspiration (EUS-FNA) or fine-needle biopsy (EUS-FNB) is the preferred method for obtaining tissue samples. EUS-FNA involves inserting a thin needle into the lesion under real-time ultrasound guidance, extracting cellular material for cytological analysis. EUS-FNB, on the other hand, provides larger tissue cores, allowing for histopathological examination and molecular profiling. These biopsies confirm malignancy, differentiate pancreatic cancer from other conditions like autoimmune pancreatitis, and help in molecular testing for targeted therapies.

In some cases, when percutaneous biopsy is considered unsafe or less feasible due to vascular involvement, EUS-guided sampling offers a safer and more effective alternative. Additionally, biopsy results aid in treatment planning, determining whether the tumor is resectable, borderline resectable, or unresectable.

This video provides an in-depth overview of pancreatic cancer’s clinical features, diagnostic approach, and the pivotal role of EUS and biopsy in confirming malignancy. Understanding these aspects is essential for early detection, accurate staging, and guiding treatment decisions. Stay tuned as we break down these topics with detailed explanations and expert insights.




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