Accuracy of Diagnosis of Pancreatic Cancer Decreases with Increasing Age

Abstract

Pancreatic cancer is common in the elderly and often is diagnosed clinically without pathologic confirmation. We compared age distribution and survival of 240 elderly patients with clinically diagnosed pancreatic cancer and 712 elderly patients with pathologically confirmed adeno- and ductal pancreatic carcinoma. All patients were registered by the Kansas state cancer registry from 1975-1984. The percentage of clinical diagnoses increased significantly from 12% in those aged in their 60s to 59% for those in their 90s (P less than .005). Observed 5-year survival for all of the clinically diagnosed patients was 8.4% compared with 0.6% for those pathologically confirmed. When locally confined disease only was considered, 5-year survival was 27% for patients clinically diagnosed and 4% for those pathologically confirmed. Given the fact that long survival from pancreatic carcinoma is a rare event, these findings suggest that in many elderly patients clinical diagnoses of pancreatic cancer are wrong. The findings have implications for the statistics on increasing incidence of pancreatic cancer (particularly in the elderly) and in discussion of prognosis with elderly patients diagnosed with pancreatic cancer without pathologic confirmation.

Trends in pancreatic cancer mortality in Europe, 1955–1989

“…ultrasound, computerized tomography, endoscopic retrograde cholangiopancreatography, and fine-needle aspiration). Difficulties in diagnosis of pancreatic cancer (Yankaskas et al, 1985;Warshaw and Fernandez-del Castillo, 1992;Niederau and Gren-dell, 1992) and their implications in terms of misclassification biases have been pointed out (Gudjonsson et al, 1978;Lyon et al, 1989;Nieman and Holmes, 1989;Malats et al, 1993;Alanen and Joensuu, 1993). It is certainly reasonable to hypothesize that advances in imaging, biological and cytohistological techniques have furthered the diagnosis and certification of the disease (Yankaskas et al, 1985;Schadt et al, 1991;Arnar et al, 1991;Niederau and Grendell, 1992).…”

Difficulty with diagnosis of malignant pancreatic neoplasms coexisting with chronic pancreatitis

“…Discrimination between a well-differentiated pancreatic carcinoma [3] and chronic fibrotizing pancreatitis is a challenge not only to the radiologist [4] , but also to the pathologist [5,6] . As mentioned above, pancreatic adenocarcinoma and chronic pancreatitis may coexist, and a malignant tumor can develop as a complication of long-standing chronic pancreatitis.…”