Pancreatic Cancer (cont.)
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Pancreatic Cancer Diagnosis and Treatment
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On physical exam, the doctor may feel a mass in the center of the abdomen. However, pancreatic cancer is seldom diagnosed using a physical exam, and the absence of any abnormalities should not dissuade the doctor from obtaining an imaging test if the symptoms of pancreatic cancer are present and persistent. The main imaging tests used to help detect pancreatic cancer are as follows:
If a tumor is seen in the pancreas, the doctor may want to perform a biopsy so that a pathologist can confirm that the mass is cancer. A biopsy can be performed in the following ways:
If a tumor is seen in the pancreas and little doubt exists that the tumor is cancer, a surgeon may choose to attempt to remove the cancer completely without first obtaining a biopsy.
Once the diagnosis of pancreatic cancer is confirmed, routine blood studies are also performed to assess overall liver and kidney function.
In addition, a blood test called CA 19-9 is obtained. CA 19-9 is often produced by pancreatic cancers, and its level is elevated in 80% of pancreatic cancer cases. The CA19-9 can not be used to establish a diagnosis of pancreatic cancer by itself. Checking the CA 19-9 levels can be a useful gauge of how the treatment is working. After treatment, the doctor may check the CA 19-9 levels regularly in patients in whom the test was originally elevated, then fell, as one indicator of whether the cancer has returned after surgery or progressed on prior treatment. However, CA 19-9 is not an absolute test for pancreatic cancers, and other conditions may cause a rise in the CA 19-9 levels. Likewise, a normal or unchanged CA 19-9 level is not a guarantee that the cancer has not returned or progressed.
New research findings released in 2016 may change aspects of pancreatic cancer. Researchers reported genomic analysis of 456 pancreatic ductal adenocarcinomas. Subsequent genetic expression analysis of these adenocarcinomas allowed them to be defined into four subtypes. These subtypes have not been previously discerned. The following is a list of these four new subtypes:
These findings may allow future pancreatic cancer patients to be treated more specifically and, hopefully, more effectively. For example, the people with the immunogenic subtype could possibly respond to therapy where the immune system is re-engineered to attack this particular type of pancreatic cancer cell.
Pancreatic Cancer Treatment
The optimal treatment of pancreatic adenocarcinoma depends on the extent of the disease. The extent of cancer can be divided into the following three categories:
Medically Reviewed by a Doctor on 11/17/2017
Timothy Kuo, MD
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