Suspect pancreatic cancer need to do what check?

1. Blood examination when obstructive jaundice, serum bilirubin was found to be significantly elevated, mainly direct bilirubin, serum alkaline phosphatase was significantly elevated, and serum alanine aminotransferase could be normal or increased. Urine bilirubin test was positive or strongly positive. Serum amylase may increase temporarily, fasting blood glucose may increase in some patients, and the positive rate of glucose tolerance test is high. Carcinoembryonic antigen (CEA) can be elevated in about 70% of patients, but it is not specific. The digestive tract associated antigen CA-199 is considered to be a diagnostic indicator of adenocarcinoma. 2. Ultrasound examination is a non-invasive examination, which is the first choice for pancreatic cancer. The pancreas has a substantial mass with irregular glands. Most pancreatic tumors that can be detected by ultrasound are over 2 cm, and small tumors are often difficult to detect. Ultrasonography can detect dilatation of the pancreatic duct, dilatation of the bile duct (intrahepatic or extrahepatic), gallbladder enlargement, and intrahepatic metastases. The presence of bile duct dilatation without jaundice or cholelithiasis on ultrasonography may be an early sign of periampullary carcinoma, and further examination should be performed. Ultrasonography is often affected by thick subcutaneous fat and gas in the gastrointestinal tract, and it is difficult to clearly show pancreatic cancer hidden in the posterior abdominal wall. Recently, THE ULTRASOUND probe OF FIBEROPTIC gastroscope can be inserted into the stomach and pressed against the posterior wall of the stomach to make a comprehensive examination of the pancreas, thus greatly improving the diagnostic accuracy. The accuracy of preoperative diagnosis for pancreatic cancer was 92%, ampullary carcinoma was 88%, and local lymph node metastasis was more than 80%. 3.CT examination showed low-density mass in the pancreas, irregular contour of the pancreas, and imbalance of the ratio of the head, body and tail of the pancreas (the size of the normal head of the pancreas is about the same as that of the vertebral body of the spine, and the size of the normal head of the pancreas: body and tail is 3:2.5:2). CT can detect tumors with a diameter of about 1cm, but there are still many false negative or false positive results in the diagnosis of pancreatic cancer by CT. If combined with selective arteriography, the diagnostic accuracy can be improved. CT can detect signs of pancreaticobile duct dilatation, liver metastasis, peripancreatic lymph node infiltration and great vessel involvement. 4. Retrograde cholangiopancreatography (ERCP) has certain diagnostic value for pancreatic cancer - pancreatic duct angiography can detect pancreatic duct interruption, stenosis, and wall stiffness. Dilatation or displacement, all of which suggest the possibility of a tumor in the body and tail of the pancreas. Cancer of the head of the pancreas often obstructs the opening of the pancreatic duct, making angiography less successful. In bile duct radiography may find bile duct bottom filling defect, narrow, the pressure and so on, this is a sign of cancer around ampulla, ampulla carcinoma (including the lower common bile duct carcinoma and pancreatic head carcinoma), if the pancreatic head carcinoma tissue pathological changes have involvement of duodenal papilla, the duodenum mirror can be observed directly, and confirmed by pathological biopsy can be. 5. Percutaneous transhepatic cholangiography (PTC) and drainage (PTCD) are suitable for pancreatic cancer patients with obstructive jaundice. On the one hand, PTC can clearly show the location and nature of bile duct obstruction, the degree of bile duct dilatation, and the filling defect of the lower end of the common bile duct, asymmetric stenosis, or wall stiffness, which is helpful for the diagnosis of pancreatic cancer. On the other hand, PTCD can decompress the bile duct and reduce jaundice, which can be used as a measure of preoperative treatment to reduce surgical complications and mortality. 6. Selective angiography is helpful for pancreatic cancer, and celiac artery, superior mesenteric artery or common hepatic artery angiography are often selected. 7. Routine barium meal examination (GI) is of limited value in the diagnosis of pancreatic cancer. In late stage pancreatic head carcinoma, duodenal circle enlargement, duodenal peristalsis, mucosal texture disorder, mucosal interruption, duodenal descending or horizontal segment stenosis may indicate the need for gastrointestinal anastomosis (short-circuit anastomosis).

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