Although there is a broad differential diagnosis for a pancreatic mass, for patients over the age of 40, the diagnosis is pancreatic cancer until proven otherwise. Other diagnoses include pancreatic endocrine tumors (younger patients, atypical findings on imaging, lack of biliary or pancreatic duct obstruction, associated familial syndrome (MEN-1), metastases to the pancreas (from breast cancer or renal cancer), focal chronic pancreatitis, such as autoimmune pancreatitis. Jaundice, abdominal pain and weight loss are common presenting symptoms of patients with pancreatic masses. Pancreatic head masses tend to present earlier due to biliary obstruction than those in the pancreatic body or tail.
Evaluation of a presumed pancreatic cancer begins with a good quality CT or MRI scan looking for evidence of locally advanced disease (involving the portal vein, superior mesenteric vein, or superior mesenteric artery); or metastatic disease. If there is evidence of locally advanced disease or metastases then a tissue diagnosis (either by CT- guided biopsy or EUS-guided biopsy) of the primary or metastatic lesion followed by chemotherapy is indicated. Otherwise evaluation for surgical resection is warranted. Preoperative biliary stent placement for jaundice is indicated for pruritus, cholangitis or a prolonged delay prior to surgical resection. Preoperative tissue diagnosis, often with EUS-guided biopsy may be warranted for a pancreatic mass in which the diagnosis is unclear, although a negative biopsy does not exclude the diagnosis of malignancy.
At the Yale Pancreas Disease Program, we offer expert multidisciplinary evaluation, diagnosis, and treatment of patients with pancreatic masses, especially those with presumed pancreatic cancer.