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Families With Pancreatic Cancer

Background | Who is at Risk? | History & Physical Examination
Family History | Surveillance | Treatment | Outcome


Surveillance

Imaging modalities of the pancreas include endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP) and spiral CT. The first two tests appear to be quite useful, while the latter appears to be ineffective for surveillance. The endoscopic ultrasound findings can be subtle and require an experienced endoscopic ultrasonographer to interpret. The same abnormal EUS findings that are present in familial pancreatic cancer patients can also be seen in patients with chronic pancreatitis.

The next step in the work-up is to perform an ERCP (an examination of the pancreatic duct). Because of the risk of inducing pancreatitis, ERCP should be reserved for those patients who are symptomatic or have abnormal changes present at EUS. While some of the ERCP changes seen in association with histologic dysplasia are similar to those seen with chronic pancreatitis (main duct stricture), other features are often present that are unusual. These features include focal side branch duct irregularities, small sacculations, and grape-like clusters of saccules. It is essential to evaluate the endoscopic findings in the context of the patient’s symptoms and familial history.

In cases where the EUS is abnormal and the ERCP is normal, we generally repeat the EUS every 6-12 months based on the degree of abnormality at EUS and whether the patient is symptomatic or not. Patients who appear to be progressing symptomatically or on EUS (increase or extension of echogenic foci or nodules, and/or development of discrete masses) would require another ERCP.

The last step in the work-up is a spiral CT scan. Our experience with other patients with pancreatic precancer has indicated that the CT scan of pancreas is usually normal in appearance. The role of pancreatic biopsy performed at CT, endoscopy, or EUS has not been studied.

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