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 investigations should clinicians use to establish whether the pain results from pancreatic cancer?

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


Abdominal ultrasonography identifies about three quarters of pancreatic cancers
Dedicated pancreatic computed tomography is the imaging method of choice both for diagnosis and staging of pancreatic pathology
Endoscopic retrograde cholangiopancreatography should be reserved for insertion of biliary endoprostheses in those patients who develop jaundice
Brush cytology can be done during endoscopic retrograde cholangiopancreatography, with brushings taken from duct strictures
Skilled endoscopic ultrasonography is the most sensitive method of detecting small pancreatic tumours and allows biopsy


A 76 year old woman with no important medical history presented after six months of intermittent epigastric discomfort and back pain. These symptoms were associated with 1 stone (6.4 kg) of weight loss despite a good appetite. Immediately before referral, she had developed increased flatulence and loose stools. Physical examination was normal. Test results were normal for full blood count; glucose; urea and electrolytes; liver function; upper gastrointestinal endoscopy; and duodenal biopsy.

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


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Methods of enhancing visualisation of the pancreas with ultrasound
Anton E Joseph
bmj.com, 16 May 2008 [Full text]
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