Investigation of abdominal pain to detect pancreatic cancer

doi:10.1136/bmj.39525.415521.AD

BMJ 2008;336:1067-1069 (10 May), doi:10.1136/bmj.39525.415521.AD

Practice

Rational Imaging

Investigation of abdominal pain to detect pancreatic cancer

J Ashley Guthrie, consultant radiologist , Maria B Sheridan, consultant radiologist

¹ Department of of Clinical Radiology, Lincoln Wing, St James’s University Hospital, Leeds LS9 7TF

Correspondence to: J A Guthrie ashley.guthrie@leedsth.nhs.uk

When a patient presents with abdominal pain, which investigationsshould clinicians use to establish whether the pain resultsfrom pancreatic cancer?

The first 150 words of the full text of this article appear below.

Learning points

Abdominal ultrasonography identifies aboutthree quarters of pancreatic cancers

Dedicated pancreatic computedtomography is the imaging method of choice both for diagnosisand staging of pancreatic pathology

Endoscopic retrograde cholangiopancreatographyshould be reserved for insertion of biliary endoprostheses inthose patients who develop jaundice

Brush cytology can be doneduring endoscopic retrograde cholangiopancreatography, withbrushings taken from duct strictures

Skilled endoscopic ultrasonographyis the most sensitive method of detecting small pancreatic tumoursand allows biopsy

The patient

A 76 year old woman with no important medical history presentedafter six months of intermittent epigastric discomfort and backpain. These symptoms were associated with 1 stone (6.4 kg) ofweight loss despite a good appetite. Immediately before referral,she had developed increased flatulence and loose stools. Physicalexamination was normal. Test results were normal for full bloodcount; glucose; urea and electrolytes; liver function; uppergastrointestinal endoscopy; and duodenal biopsy.

What is the next investigation?

The differential diagnosis . . . [Full text of this article]

Transabdominal ultrasonography
Computed tomography
Magnetic resonance imaging
Endoscopic retrograde cholangiopancreatography
Endoscopic ultrasonography