Pancreatic cancer: ESMO Clinical Recommendations for diagnosis, treatment and follow-up

Abstract

Staging consists of complete history and physical examination, blood counts, liver enzymes, chest X-ray, imaging of the abdomen by sonography and CT scan or magnetic resonance, and possibly by endosonography. Patients with pancreatic cancer may be staged according to the TNM system and can be grouped as shown in the table below. However, the distinction of whether or not a tumor remains resectable is not well reflected in the TNM system, as demonstrated by the wide range of survival figures given for each stage. Evaluation of resectability often requires surgery, preferably by staging laparoscopy, to exclude clinically occult intraabdominal and lymph node metastases. To be resectable, tumors must show no evidence of extrapancreatic disease or direct tumor extension to the celiac axis and superior mesenteric artery but evidence of nonobstructive superior mesenteric–portal vein confluence does not always preclude tumor resection. Less than 20% of all patients have resectable disease. treatment of resectable tumors