Detection Strategies and Examination of Early Pancreatic Cancer

Early diagnosis is essential to improve the prognosis of patients with pancreatic cancer (PC). A long-term prognosis should be expected in patients with PC of <10 mm. Main pancreatic duct (MPD) dilatation and pancreatic cystic lesions are important indirect findings that should be considered. Endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) are recommended to diagnose small tumor lesions that are difficult to be directly detected with external ultrasonography (US) and computed tomography (CT). Thereafter, EUS-guided fine-needle aspiration should be performed when a tumor lesion is detected using EUS. When localized irregular MPD stenosis, caliber MPD changes, and branch duct dilatation are detected, ERCP followed by pancreatic juice cytology is recommended. EUS and MRCP play important roles in detecting local irregular stenosis of the MPD or small cystic lesions in PC in situ, which is undetectable on cross-sectional images. Subsequently, ERCP and associated serial pancreatic juice aspiration cytologic examination obtained using endoscopic nasopancreatic drainage may be useful in the diagnosis of very early-stage PC. Additionally, collaborations between special doctors in pancreatic diseases and general practitioners play an important role in the early detection of PC.