Pancreatic Cancer Imaging: What the Surgeon Wants to Know?

Abstract

Pancreatic cancer is rare but is one of the deadliest cancers. Complete surgical removal of the cancer with negative margins is the only potentially curative treatment. However, majority of the cases present with distant metastases and/or locally advanced disease, and only a limited subset (up to 20%) of patients are surgical candidates. Therefore, accurate staging of pancreatic cancer is very important for treatment planning. It is very important to distinguish between patients who are surgical candidates and those who would need palliative treatment. Imaging plays a crucial role in the detection of the primary tumor, vascular involvement and variants, metastasis, prediction of resectability, and monitoring treatment response. High-resolution multidetector computed tomography (CT) is the primary imaging modality of choice for diagnosing and staging pancreatic cancers. Nevertheless, integration of ultrasound, CT, and magnetic resonance imaging (MRI) may be needed for accurate determination of the tumor extent and optimal management. Herein, we aim to provide a radiological review for “what the surgeon wants to know about pancreatic cancer?” In this review, we highlight the main types of invasive pancreatic cancers and discuss the role of imaging in determining the resectability of pancreatic tumors and the role of neoadjuvant treatment in downstaging borderline or unresectable cases in addition to featuring significant postsurgical complications.

Current Treatment of Potentially Resectable Pancreatic Ductal Adenocarcinoma: A Medical Oncologist’s Perspective

“…Upon suspicion of the diagnosis of pancreatic cancer, patients should undergo triphasic abdominal computed tomography (CT) scan with pancreatic protocol and standardized reporting template. 135 - 137 Magnetic resonance imaging (MRI) should only be used in cases of indeterminate (small or isoattenuating) pancreatic lesions, cystic pancreatic lesions, indeterminate small hepatic lesions, allergy to iodinated contrasts, or impaired renal function. 137 Also, MRI with diffusion-weighted imaging (DWI) has been shown to detect liver metastases in 14–24% of patients with non-metastatic PDAC on CT scans, suggesting that abdominal MRI could become a new standard in terms of PDAC staging.…”

“… 135 - 137 Magnetic resonance imaging (MRI) should only be used in cases of indeterminate (small or isoattenuating) pancreatic lesions, cystic pancreatic lesions, indeterminate small hepatic lesions, allergy to iodinated contrasts, or impaired renal function. 137 Also, MRI with diffusion-weighted imaging (DWI) has been shown to detect liver metastases in 14–24% of patients with non-metastatic PDAC on CT scans, suggesting that abdominal MRI could become a new standard in terms of PDAC staging. 138 , 139 It is important to look for indirect signs of pancreatic cancer, as they may aid in the detection of pancreatic lesions.…”

Pancreatic stellate cells regulate branched-chain amino acid metabolism in pancreatic cancer

“…PDAC is the most lethal malignancy and has a 5-year survival rate of less than 9% (3). Although surgical resection is an effective treatment for PDAC (4), surgical tumor removal is suitable only for 20% of patients due to locally advanced or metastatic disease (5). Thus, finding new therapeutic targets for pancreatic cancer is urgently needed.…”