This test is a CT scan focused on the pancreas and liver. The study gives essential information about the location of the tumor and it’s relationship with important blood vessels and other tissues in the area. The study is also important to evaluate for the presence of spread (metastases). The findings on CT (or MRI is used at some institutions) help direct further evaluation and the appropriateness of surgery.
EUS has several benefits in the evaluation of patients with pancreatic tumors. EUS is very accurate at evaluating blood vessel involvement and it allows a safe method for biopsy of the tumor and lymph nodes. This is a critical test in determining the diagnosis and stage of the cancer as well as the feasibility of surgery.
Biospy refers to obtaining a sample of a tumor. Biospies can be safely performed on most organs in the body. Pancreatic cancer can spread to the liver, the lining surface of the abdomen (the peritoneum), abdominal lymph nodes, the lungs and to other sites. Radiologists can biopsy the liver and lungs safely and can usually obtain fluid from the abdomen using CT or ultrasound imaging. The pancreas itself, and any lymph nodes are accessed by endoscopic ultrasound.
Positron emission tomography is a metabolic test. Patinets are injected with radioactive glucose. This agent is taken up by metabolically active tissues (cells that are growing and dividing rapidly) like many cancers. The role of PET in pancreatic cancer is evolving. The test has not been fully validated in pancreatic cancer and some insurance companies do not cover the test. We use PET with caution as we commonly obtain the best information from the other tests listed here.
EUS can also be performed to deliver a celiac axis block to relieve pain caused by tumor invasion and inflammation.
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The main purpose of ERCP and stent placement in pancreatic cancer is to relieve blockage of the bile duct caused by a tumor. A stent is a tube (either plastic or metal) that is used to relieve blockages of the bile duct caused by a tumor. Placement of a stent is not essential to do before surgery, but it may be necessary to improve the symptoms of the blockage (i.e. itching or poor digestion). Plastic stents are temporary and are removed at surgery. For patients who prove not to be candidates for surgery a metal stent is often placed as metal stents stay open longer and tend to function better. Metal stents can also be removed at an operation, so they do not prevent surgery.
This new technology available at only a few centers in the country allows our gastroenterologists to visually exam and biopsy in inside of the bile duct and pancreatic duct. This powerful technique assists in making difficult diagnoses and documenting the extension of certain tumors (especially pre-malignant tumors like IPMN) – making clear the extent of surgery needed to remove a tumor.
The last diagnostic test is often laparoscopy. Laparoscopy is “keyhole” surgery that allows the surgeons to examine the entire abdomen through 5 to 10 mm puncture sites, without making a large incision. We use this approach to identify metastases that are too small to be detected by other tests. If metastatic disease is proven, the operation is completed and the patient is ready to start chemotherapy without delay. If no metastases are seen the resection proceeds.
We are now performing many resections, including Whipple operations, using minimally invasive techniques.
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