Introduction

Pancreatic cancer affects approximately 6000 people in the United Kingdom every year and is one of the 10 most common causes of cancer death in the western hemisphere.1 2 There is a slight male preponderance in the incidence of the disease, with peak incidence in the seventh and eighth decades (box 1).1 The vast majority of patients with pancreatic cancer die within one year of diagnosis,^w1 and the overall five year survival rate ranges from 0.4% to 4%, the lowest for any cancer.2 Currently, surgical resection offers the best chance of cure; however, more than 80% of patients present with advanced and unresectable disease,3 which accounts for the low rates of resection and survival. The key to increased resection rates lies with early diagnosis. In this article we describe the clinical features of pancreatic cancer and the various modalities used to diagnose this debilitating disease.

Sources and selection criteria

We did an internet based search of the Medline and Science Citation Index databases by using the keywords “pancreatic cancer,” “diagnosis,” and “pancreatic imaging.” We included reviews and evidence based studies in major journals from surgery, gastroenterology, and radiology published from January 1999 to June 2004, as well as key early papers.

Symptoms and signs

Box 2 summarises the signs and symptoms of pancreatic cancer. The early symptoms of pancreatic cancer are usually non-specific and are often ignored by the patient and doctor. These include epigastric bloating, flatulence, general malaise, diarrhoea, vomiting, and constipation. As the disease progresses, patients present with painless jaundice and weight loss. The prevalence of symptoms varies with the site and extent of the tumour. The presence of jaundice with a tumour in the body or tail of the pancreas is invariably associated with late presentation as well as inoperability due to hepatic or hilar nodal metastases.

Abdominal pain …