Pancreatic Adenocarcinoma on CT

Pancreatic adenocarcinoma is the most common cancer of the pancreas having a very poor prognosis. Pancreatic cancer is most commonly diagnosed when a patient gets a CT scan for abdominal pain. Sometimes symptoms like jaundice or new onset diabetes is seen. Some risk factors include smoking, diabetes and chronic pancreatitis. The radiologist in many cases will be able to make the diagnosis, especially when the disease is more advanced. Smaller tumors are more difficult with just CT.

In my experience, pancreatic cancer is often diagnosed when advanced. That is, a cure can not be attempted. Pancreatic adenocarcinoma often looks like a low density (darker then the normal pancreas) infiltrative mass. That means that the borders are irregular and sometimes not well seen. The tumor often extends beyond the pancreas. It can wrap around critical blood vessels which then prevents an attempt at a surgical cure with a Whipple operation.

When the tumor occurs in the head of the pancreas, or that portion closest to the duodenum, the bile duct can become obstructed. This causes jaundice or yellowing of the skin. A stent or tube will need to be placed to allow the flow of bile from the liver to the intestine.

I also see blood vessels around the pancreas become blocked, especially the portal and splenic veins. Often the tissue next to the tumor becomes atrophic or shrunken. Metastasis or spread of the tumor is also common. This is most common to the liver although the spleen is also common especially when the tumor is in the tail of the pancreas. I also see spread to other areas like the lungs commonly.

The prognosis is dismal even with surgery. If the tumor wraps around vessels near it or spreads to other organs then cure is not possible. The CT scan is very important for both diagnosis and staging of the tumor, that is telling the ordering doctor if it’s localized to the pancreas or has spread. A biopsy will be needed for definitive diagnosis.

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