Differentials
Chronic pancreatitis
SIGNS / SYMPTOMS
Because typical symptoms of chronic pancreatitis are also seen in pancreatic cancer, distinguishing between these two diseases can be difficult. Patients may present with pain radiating to the back, malabsorption, malnutrition, and pancreatic endocrine insufficiency. There may be a past history of repeated admission for acute pancreatitis or alcohol abuse.
INVESTIGATIONS
A few histologic features are diagnostic for pancreatic cancer, which can differentiate between pancreatic cancer and chronic pancreatitis.[68]
Bile duct stones
SIGNS / SYMPTOMS
Obstructive jaundice may be painful due to calculous disease. Patients may be younger.
INVESTIGATIONS
Stones can be demonstrated on abdominal ultrasound, both in the gallbladder and in the bile duct. However, stones may also be seen in patients with pancreatic cancer. Endoscopic retrograde cholangiopancreatography will clarify the situation by ruling out stricture (seen in pancreatic cancer) and confirming bile duct stones, which can be cleared at the time of intervention.
Ampullary carcinoma
SIGNS / SYMPTOMS
Patients may present with iron-deficiency anemia before presenting with obstructive jaundice. Jaundice may be of a waxing and waning nature due to sloughing of ampullary cancer, resulting in transient resolution of the jaundice.
INVESTIGATIONS
Upper gastrointestinal endoscopy will confirm the presence of ampullary lesion, and biopsy at the time of procedure will verify presence of dysplasia or cancer. A side-viewing endoscope gives a better view of ampullary lesions than the traditional front-viewing endoscope.
Cholangiocarcinoma
SIGNS / SYMPTOMS
Mid- and low bile-duct cancers are indistinguishable on presentation from pancreatic cancer. Both present with painless obstructive jaundice.
INVESTIGATIONS
Cross-sectional imaging such as CT scan or MRI may reveal absence of pancreatic mass and perhaps thickening of bile duct suggestive of cholangiocarcinomas.
Autoimmune pancreatitis
SIGNS / SYMPTOMS
Almost no distinguishing features between pancreatic cancer and autoimmune pancreatitis.
In contrast to pancreatic cancer, autoimmune pancreatitis is at least twice as common in men as it is in women. And, rarely, patients with autoimmune pancreatitis present with symptoms related to extrapancreatic organ involvement (renal, pulmonary, hepatic, gastroduodenal, or involvement of the hypophysis have been reported).[69]
INVESTIGATIONS
A uniformly enlarged pancreas without duct dilation on axial scanning may prompt serum IgG4 levels or pancreatic biopsy (which may be diagnostic), but this should be managed at a pancreatic center. One systematic review and meta-analysis suggests that MRI features such as multiple main pancreatic duct strictures, absence of upstream marked main pancreatic duct dilatation, peripancreatic rim, and duct penetration sign can significantly differentiate autoimmune pancreatitis from pancreatic cancer.[70]
Use of this content is subject to our disclaimer