[The diagnostic process in carcinoma of the pancreas].

Early diagnosis of carcinoma of the pancreas is considerably difficult because the disease is often in the advanced stage at the time of clinical manifestation. We have, however, no choice for improving the prognosis of the disease but to make an early diagnosis by detecting small tumors. Ultrasonography (US) is the most useful diagnostic technique in detecting the initial sign of carcinoma of the pancreas. The patient suspected of having this disease should first undergo US combined with measurement of serum pancreatic enzymes (amylase or elastase-1) and the tumor marker (CA 19-9). Those patients with positive results on the first examinations should undergo dynamic CT, ERCP or endoscopic US (EUS) to corroborate suspicions of the disease. Percutaneous fine needle biopsy of the pancreas may be recommended as a reliable method for making a definite diagnosis, when these diagnostic modalities fail to elucidate the disease. In conclusion, appropriate combined use of these diagnostic techniques can facilitate the early diagnosis of carcinoma of the pancreas.