The Role of Positron Emission Tomography in the Management of Pancreatic Cancer

https://doi.org/10.1053/j.semnuclmed.2006.03.005Get rights and content

The role of positron emission tomography (PET) and PET/computed tomography (CT) in the assessment of a patient presenting with cancer of the pancreas is discussed in the overall context of the management of this condition. The clinical limitations persist, with many patients presenting late with unresectable disease and poor prospects for novel drug therapies. PET and PET/CT are best at diagnosing and staging but are relatively inefficient in the detection of nodal disease. The detection of late disease manifestations such as metastatic spread is often of little clinical consequence. PET/CT may be considered as a first-line imaging investigation but evidence for this approach needs to accrue. Overall detection sensitivity at diagnosis varies between 90% and 95% and specificity from 82% to 100%, whereas for staging, sensitivity data vary from 61% to 100% and specificity data from 67% to 100%.

Section snippets

Clinical Features

Symptoms of pancreatic malignancy often are nonspecific and tend to be ignored by both patient and doctor. Consequently, patients usually present with late-stage disease. Painless jaundice with an associated weight loss is the principal clinical feature that prompts further investigation. In more than 80% of patients, abdominal pain is a late presenting symptom, which is commonly epigastric and diffuse.4

Physical signs of pancreatic cancer include abdominal mass, palpable gall bladder

Hematological and Biochemical Parameters

Laboratory findings in pancreatic cancer are nonspecific. Anemia and hypoalbuminemia represent the chronic nature of the condition, and a global derangement of liver enzymes commonly is observed with obstructive jaundice. Malabsorbtion of fat-soluble vitamins because of prolonged biliary obstruction also results in abnormalities of vitamin K-dependent clotting factors. Pancreatic duct obstruction may result in pancreatic atrophy and subsequent impaired glucose tolerance or frank diabetes in as

Positron Emission Tomography (PET)

Anatomical imaging modalities outlined in previous sections, have formed the corner stone of diagnosis and staging of pancreatic cancer. However, many challenges still remain, which include the definitive diagnosis of small tumors and differentiating malignant and benign inflammatory lesions (eg, caused by mass-forming chronic pancreatitis or secondary to posttreatment fibrosis). The emergence of PET technology has therefore set out to address some of these limitations.

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