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Diagnosis of Carcinoma of the Pancreas: For detection of small carcinoma K. Takagi 1 , F. Kasumi 1 , T. Ohta 1 , I. Ohashi 1 , T. Takekoshi 2 , K. Ohashi 2 , K. Maruyama 2 , Y. Kato 3 , K. Nakamura 3 1Department of Surgery, Cancer Institute Hospital 2Department of Internal Medicine, Cancer Institute Hospital 3Department of Pathology, Cancer Institute Hospital pp.595-610
Published Date 1980/6/25
DOI https://doi.org/10.11477/mf.1403106901
  • Abstract
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 Progress in various diagnostic procedures of pancreatic diseases has made it possible to diagnose relatively easily cancer of the pancreas hitherto diflicult to confirm as such. In fact, ERCP and angiography could reveal pancreatic cancer less than 2 cm in diameter. However, this possibility is not directly linked up at present with the discovery of small cancer of this organ. In other words, screening methods which leadings to through examination with the use of ERCP and angiography are of great importance in attaining the detection of pancreatic abnormality. For this purpose, we have studied 25 cases of pancreatic cancer encountered during the two years 1978~1979. The re-sectability hitherto published ranged from 10 to 20 per cent and the subjects were all of advanced carcinoma. In our hospital as well, the resectability was 20 per cent in the year from 1946 to 1977. In the last two year (1978~1979), we were able to resect 14 out of 25 cases of pancreatic carcinoma. Thus, the resectability became as high as 56 per cent. This increase is due to the following fact: we were able to detect two cases of small cancer measuring 2cm in diameter; in three cases we actively resected the portal vein; and we organized groups of doctors for the detection of cancer of the pancreas and choleclochus, especially close tie-up of internists and surgeons for diagnosis and treatment. We were also engaged in daily consutation, always bearing in mind how to detect pancreatic cancer.

 The clues that led to the diagnosis of pancreatic cancer in 25 cases encounted for the last 2 years were jaundice in 6 cases, displacement of the stomach found in examination in 6, ERCP in 6, upper GI series in 4, elevation of serum and urinary amylase level in 2 and 1 each of ultrasonic examination and laparotomy. In cancer of the tail of the pancreas, displacement of the stomach by external factors was seen in 6 out of 8 cases during the examination of the stomach. Suspicion of cancer was confirmed in all cases as such by ERCP. Displacement of the stomach by pancreatic cancer is usually seen on both the lesser and greater curvatures of the body, but it is often overlooked. This finding is especially important in detecting cancer of the body of the pancreas because it is believed so diflicult to diagnose.

 Of two Cases (Case 2 and 25) in which elevated levels of urinary and serum amylase led to the correct diagnosis, Case 2 was cancer of the head of the pancreas measuring 2 cm in diameter. The chief complaint was pain in the upper abdomen, and transitory elevation of urinary amylase level gave us a clue to possible presence of cancer, and ERCP revealed narrowing of the pancreatic duct. Curative resection was thus possible. This experience led us to detection of another case of cancer (Case 25) as we checked the level of urinary and serum amylase level in patients complaining of pain in the upper abdomen. Curative resection cancer of the head of the pancreas. was done in this patient. In both cases jaundice was not seen. Elevated level of urinary and serum amylase level was caused by the narrowing of the main duct in an early stage of pancreatic cancer. Not only this fact but also dilatation of the main duct distal to the narrowing and appearance of accompanying pancreatitis should be suspected by checking the level of urinary and serum amylase level and taking into account symptoms in the upper abdomen. ERCP should be done at the first check for the detection of any lesion in the pancreas. Discussion and study on accurate diagnosis and resectability further made possible by angiography can, we believe, lead to early discovery of pancreatic cancer.

 This study was supported by the grant of Japan IBM Co.


Copyright © 1980, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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