Mandatory medical device diagnostics.
- Abdominal ultrasonography (ultrasound examination of abdominal organs; in this case: Pancreatic sonography/ultrasound examination of the pancreas) – for basic diagnosis [most common malignant (malignant) tumor of the pancreas: ductal adenocarcinoma; this shows up sonographically echo-poor, irregular and polycyclic limited; due topancreatic cyst see below].
- Endosonography (endoscopic ultrasound (EUS); ultrasound examination performed from the inside, i.e., the ultrasound probe is brought into direct contact with the internal surface (for example, the mucosa of the stomach/intestine) by means of an endoscope (optical instrument). ): detects potential lesions of the pancreas (pancreas) from the duodenum (duodenum) – for basic diagnostics.
- Computed tomography (CT) of the abdomen (abdominal CT) – to exclude metastases.
- Magnetic resonance imaging (abdominal MRI) – as a “one-stop store” to accurately determine the extent of the disease.
- X-ray of the thorax (X-ray thorax / chest), in two planes – to exclude metastases.
- Skeletal scintigraphy (nuclear medicine procedure that can represent functional changes in the skeletal system, in which regionally (locally) pathologically (pathologically) increased or decreased bone remodeling processes are present) – to exclude bone metastases.
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification.
- Magnetic resonance cholangiopancreaticography (MRCP; noninvasive (nonpenetrating into the body) imaging procedure to visualize the biliary and pancreatic ducts) – as a screening procedure.
- Positron emission tomography (PET; nuclear medicine procedure that allows the creation of cross-sectional images of living organisms by visualizing the distribution patterns of weak radioactive substances) – for early detection of the tumor.
- Gastrointestinal passage – to determine changes in the gastrointestinal tract.
- Celiacography – to determine vascular involvement in the area of the truncus coeliacus.
- Splenoportography – to determine vascular involvement in the area of the spleen and portal vein.
- Endoscopic retrograde cholangiopancreaticography (ERCP) if necessary with stent placement for bile drainage in cholangitis (inflammation of the bile ducts).
Pancreatic cancer screening
- Evidence report of the United States Preventive Services Task Force (USPSTF): in its current recommendation, the expert panel appointed by the US Department of Health and Human Services explicitly advises against screening because of the risks of false-positive results (D recommendation).
- In patients at increased risk (e.g., carriers of gene mutations; BRCA 1 and 2 and variants in the genes p16/CDKN2A, PALB2, STK11, ATM, PRSS1, and the genes for DNA mismatch repair proteins) and in elderly patients newly diagnosed with diabetes mellitus, early detection appears reasonable. In the latter risk group, the risk of pancreatic cancer is increased up to 8-fold.
Management of pancreatic cysts
Intraductal papillary mucinous neoplasia (IPMN; primarily intraductal (“located within a (glandular) duct”) growing epithelial pancreatic tumor (pancreatic tumor) composed of mucinous (“mucinous”) cells) and mucinous cystic neoplasia/neoplasm (MCN) are the only pancreatic lesions (pancreatic change) with potential for malignant transformation. The following warning signs are considered risk factors:
- Cyst ≥ 3 cm with thickened cyst wall.
- Dilatation of the main pancreatic duct to 5-9 mm.
- Non-contrast, mural nodules (small nodules).
- Abrupt pancreatic ductal changes with distal pancreatic atrophy.
In IPMN with main ductal dilation or with mural nodules, malignant transformation (malignant transformation) must be assumed in up to 90% of cases. There is a high risk in the presence of cystic pancreatic head lesions and occlusive icterus (jaundice (icterus) resulting from backwater of bile due to an obstruction of outflow), as well as when the main duct dilates to more than 10 mm. These patients require immediate surgery. Procedure: Initially, close monitoring intervals (6 months); if the situation is stable, annually if necessary.Note: Even small cysts change throughout life; cyst growth of more than 2 mm per year poses a high risk of malignancy;
