Publications

Abstract

Pancreatic cancer (PC) is the fourth most common cause of cancer death in adult Australians. It is an aggressive tumour with an overall 5-year survival rate of less than 5%. Surgical resection offers the only possibility of cure and long-term survival for patients with PC, but unfortunately only less than 20% of patients with PC have disease amendable to surgical resection. Therefore it is important to accurately diagnose and stage these patients for optimal treatment. The imaging modalities involved in the diagnosis and staging of PC include multi-detector computer tomography (CT), endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreaticography (ERCP) and magnetic resonance imaging (MRI). The roles and relative importance of these imaging modalities have changed over the last few decades and continue to change due to the rapid technological advances in medical imaging, but these investigations continue to be complementary. EUS was first introduced in the mid-1980s in Japan and Germany and has quickly gained acceptance. Its widespread use in the last decade has revolutionized the management of pancreatic disease as it simultaneously provides primary diagnostic, and staging information and enabling tissue biopsy. This article discusses the potential benefits and drawbacks of EUS in the primary diagnosis, staging and assessment of resectability, and EUS-guided FNA in PC. Difficult diagnostic scenarios and pitfalls are also discussed. A suggested management algorithm for patients with suspected PC is also presented.