Newly Diagnosed?
We Can Help Getting the correct diagnosis and the most appropriate treatment from the start is crucial 
|
|
|
Nationally, only about 20 percent of pancreatic cancers are diagnosed while the tumor is confined entirely within the pancreas. Research is under way at Memorial Sloan-Kettering on ways to diagnose cancer of the pancreas earlier in the course of the illness, while the tumor is still limited to the pancreas and may be treatable by surgery. A better understanding of risk factors for pancreatic cancer and the molecular genetics of the disease may lead to earlier evaluation and treatment, particularly in high-risk individuals.
Imaging Studies
When a patient with pancreatic cancer comes to Memorial Sloan-Kettering, the extent of disease is carefully determined through advanced computed tomographic (CT) scanning and laparoscopy, a minimally invasive procedure. This evaluation allows for precise determination of the extent of the disease, facilitating appropriate, individualized therapy and avoiding unnecessarily extensive surgery. Patients are then treated with surgery, chemotherapy, radiation therapy, or immunotherapy, alone or in combination.
Advances in imaging technologies have been key to improving the detection and treatment of pancreatic cancer. An accurate and cost-effective method of diagnosing pancreatic cancer is to perform CT as the first test. Memorial Sloan-Kettering physicians have developed a contrast-enhanced, thin-cut, dynamic technique for scanning the pancreas that is highly accurate and easy to repeat. This scanning technique reduces the amount of radiation required while improving diagnostic accuracy to levels approaching those of invasive procedures (such as angiography).
Magnetic Resonance Imaging
For selected patients, particularly those in whom major blood vessels are compressed or invaded by cancer, a magnetic resonance imaging (MRI) scan may be indicated. A special type of MRI allows the physician to get a picture of the pancreatic ducts, the internal channels of the pancreas that are a prime target of tumors. Memorial Sloan-Kettering is a leading center of experience and innovation in these advanced imaging techniques.
Other imaging studies used in the diagnosis of pancreatic cancer include endoscopic ultrasonography; endoscopic retrograde cholangiopancreatography (an x-ray of the pancreatic duct and bile ducts); and percutaneous transhepatic cholangiography (an x-ray of the bile duct).
Biopsy
To confirm suspected pancreatic cancer after a physical examination and imaging tests, in selected cases a tissue sample will be obtained for microscopic examination by a pathologist. The sample is often initially obtained by fine-needle aspiration, usually guided by CT or MRI.
To an experienced pathologist, each of the approximately 20 types of pancreatic tumors has a different appearance under the microscope. Expert microscopic evaluation remains the "gold standard" for diagnosing pancreatic cancer. Many of these tumors require different treatments, and vary in their response to therapy.
The molecular genetics of pancreatic cancer, and in particular of the genes targeted in various forms of the disease, are under study at Memorial Sloan-Kettering and other centers with the hope of improving the ability to diagnose pancreatic cancer in high-risk individuals.
Laparoscopic Staging
Traditionally, patients with pancreatic cancer have also needed exploratory surgery to determine whether surgical removal would be appropriate for their disease. But because pancreatic cancer is especially aggressive, many patients were found to have had advanced disease that would not benefit from surgical treatment. Patients would need to recover for six weeks after this exploratory surgery before beginning chemotherapy -- an alternative treatment to surgery.
Surgeons at Memorial Sloan-Kettering have pioneered a less invasive approach to exploratory surgery for pancreatic cancer patients. Surgeons insert a laparoscope -- a specialized telescope with a camera attached -- into the patient's abdomen and then view the pancreas and surrounding organs to determine the extent of the disease. With laparoscopy, patients who are not candidates for surgery can begin chemotherapy without delay. Those patients deemed to have surgically removable tumors can go on to a conventional operation immediately. Laparoscopy allows physicians to stage pancreatic cancer accurately and direct patients to the appropriate treatment regimen immediately. Currently, the great majority of pancreatic cancer patients who undergo an open operation at Memorial Sloan-Kettering actually receive a resection to remove all or part of a tumor.
