What is the Best Approach to Staging Pancreatic Cancer?

Due to the often late stage of diagnosis, pancreatic cancer remains a dreadful disease. Survival and treatment are directly related to the stage of the disease. Although direct laparotomy provides the best method of staging, noninvasive or minimally invasive imaging techniques are preferred. Computed tomography (CT) remains the most accepted first step in imaging to detect advanced disease. However, magnetic resonance imaging (MRI) should be considered equally specific and perhaps more sensitive. Detection of metastatic disease by CT precludes any need for local staging. If a CT or MRI suggests the absence of metastatic disease, endoscopic ultrasound (EUS) is the most accurate method for staging of the local extent of disease (Figures 32-1 and 32-2). Figure 32-1 Endoscopic ultrasound fine needle aspiration of a suspected early pancreatic cancer. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003523765/ec0150d1-34f7-4b4c-acbd-f9a0d6cf9a20/content/fig32_1.jpg” xmlns:xlink=“https://www.w3.org/1999/xlink”/> Figure 32-2 Cytology from endoscopic ultrasound fine needle aspiration showing adenocarcinoma. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003523765/ec0150d1-34f7-4b4c-acbd-f9a0d6cf9a20/content/fig32_2.jpg” xmlns:xlink=“https://www.w3.org/1999/xlink”/>.