Staging of pancreatic cancer
Appropriate staging is very important in pancreatic cancer to avoid unnecessary exploratory surgery. At the same time with proper staging, surgical treatment can be pursued under appropriate circumstances in patients who are thought to have removal tumors. Prior to availability of modern imaging (X-ray) studies, approximately 80% of patients who underwent an exploratory surgery were closed because the tumor was found to be unresectable. Today this number can be reduced to less than 10% so that in the majority of the patients who undergo surgery, the tumor is removed.
The two reasons that pancreatic cancer is usually surgically inoperable are:
All patients with potentially removable pancreatic tumors should be evaluated by an experienced pancreatic surgeon.
Specialized studies performed at USC to stage pancreatic cancer
Volume rendering CT scans
Third generation CT scans provides detailed images of the cancer and its relationship to the surrounding structures such as the major blood vessels around the pancreas. This information is crucial to make the determination that the tumor is removable.
The most recent advance in CT technology is called volume rendering with a multi detector CT scan. Only a few centers in Southern California have this technology available. At both the USC University Hospital and the Norris Cancer Center at USC we use this technology to stage patients with pancreatic cancer.
This type of CT scan allow for rapid scanning of the pancreas and very sections of 1 mm of the pancreas are obtained. A three dimensional image of the cancer and the surrounding blood vessels is then created by a sophisticated software program to determine whether the tumor is resectable. Our experience has demonstrated that this technique is far superior to the old double spiral CT scans that were previously utilized.
This is a technique whereby the gastroenterologist inserts a fiber optic endoscope into the stomach and duodenum. The scope has a small ultrasound probe at its tip and the ultrasound probe allows direct scanning of the pancreas and the surrounding blood vessels.
We routinely perform laparoscopy to rule out the possibility of spread of the cancer outside of the pancreas prior to performing an extensive open surgical incision. In our experience 10 to 20% of patients will have spread of the cancer outside of their pancreas even when the CT scan and the other imaging studies suggest that the tumor is localized to the pancreas.
Tumor markers are often obtained to assess the probability of a cancer in a patient who has a mass lesion in the pancreas. The tumor markers that are commonly ordered include CA 19-9 and CEA. While high tumor markers are suspicious for cancer they do not absolutely predict the presence of cancer since non-cancerous or benign conditions of the pancreas and liver can falsely elevate these tumor markers.
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