RADIOLOGIC EVALUATION OF PANCREATIC DISEASE
Some of the radiological (x-ray) studies that may be performed to evaluate your disease are:
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 whether a tumor in the pancreas 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.
MRI utilized a different technology compared to CT to image the abdomen. In general MRI is less useful compared to a CT scan and is only recommended under very special circumstances.
This is a modified MRI where a radiologist utilizes specialized software packages to obtain a composite image of the pancreatic duct and the bile duct from the digital MRI images. This study provides similar information to an ERCP by providing images of the bile duct and the pancreatic duct. As a diagnostic study MRCP study is preferred to ERCP since this procedure is not invasive compared to an ERCP. MRCP is very useful for looking for stones in the bile duct.
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.
ERCP (Endoscopic Retrograde Cholangiopancreatogram)
In this study a gastroenterologist inserts a specialized fiber optic endoscope (a fiber optic tube with a light source and a video chip at its tip that transmits the image of your insides on a external TV video monitor) into the duodenum. The openings of the bile duct and pancreatic duct is identified and a small catheter (tube) is inserted into the bile duct and pancreatic duct for injection a dye so that an image of the bile duct and pancreatic duct is obtained. This study is performed to rule out diseases of the pancreas and the bile duct such as stricture (narrowing) of the ducts, chronic pancreatitis and cancer of the pancreas or bile duct. The gastroenterologist may also insert small tubes into the bile duct or the pancreatic duct if they are obstructed to relieve the obstruction
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 pancreatic 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.
We routinely perform laparoscopy to rule out the possibility of spread of the pancreatic 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.
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