Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2018; 24(19): 2047-2060
Published online May 21, 2018. doi: 10.3748/wjg.v24.i19.2047
Challenges in diagnosis of pancreatic cancer
Lulu Zhang, Santosh Sanagapalli, Alina Stoita
Lulu Zhang, Santosh Sanagapalli, Alina Stoita, Department of Gastroenterology, St. Vincent’s Hospital Sydney, Darlinghurst 2010, NSW, Australia
Author contributions: Zhang L made substantial contribution to the collection and analysis of the data and drafted the initial manuscript; Sanagapalli S and Stoita A made substantial contributions to the analysis and interpretation of the data and Stoita A edited, made substantial contribution in writing and revised the final manuscript; all authors have given their final approval of the version published.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Alina Stoita, MBBS, FRACP, Doctor, Department of Gastroenterology St Vincent’s Hospital Sydney 390 Victoria Street, Darlinghurst 2010, NSW, Australia.
Telephone: +61-283826622 Fax: +61-83826602
Received: March 28, 2018
Peer-review started: March 30, 2018
First decision: April 11, 2018
Revised: April 28, 2018
Accepted: May 11, 2018
Article in press: May 11, 2018
Published online: May 21, 2018

Pancreatic cancer is a growing source of cancer related death, yet has poor survival rates which have not improved in the last few decades. Its high mortality rate is attributed to pancreatic cancer biology, difficulty in early diagnosis and the lack of standardised international guidelines in assessing suspicious pancreatic masses. This review aims to provide an update in the current state of play in pancreatic cancer diagnosis and to evaluate the benefits and limitations of available diagnostic technology. The main modalities discussed are imaging with computed tomography, magnetic resonance imaging, endoscopic ultrasound and positron emission tomography and tissue acquisition with fine needle aspiration. We also review the improvements in the techniques used for tissue acquisition and the opportunity for personalised cancer medicine. Screening of high risk individuals, promising biomarkers and common mimickers of pancreatic cancer are also explored, as well as suggestions for future research directions to allow for earlier detection of pancreatic cancer. Timely and accurate diagnosis of pancreatic cancer can lead to improvements in the current poor outcome of this disease.

Keywords: Pancreatic cancer, Diagnosis, Challenges, Imaging, Biomarkers, Screening, Endoscopic ultrasound, Pitfalls

Core tip: Pancreatic cancer is becoming a leading cause of cancer related death in Western societies. Rapid and accurate diagnosis of a pancreatic mass is crucial for improving outcomes. Current practice utilises multi-detector computed tomography and/or magnetic resonance imaging, with a dedicated pancreas protocol as the initial modality. Endoscopic ultrasound is the preferred method to further evaluate pancreatic masses as it has more superior diagnostic accuracy and can provide tissue acquisition. Pitfalls in diagnosis of pancreatic cancer are discussed, as careful recognition of these conditions is important. There are exciting developments of new diagnostic techniques that open the possibility of personalised cancer medicine.