Diagnosis of small pancreatic carcinoma.

A retrospective analysis was performed to evaluate the clinical symptoms and abnormal test findings in small pancreatic carcinoma. Five hundred and thirty-six cases of pancreatic carcinoma with the histology of duct cell carcinoma were collected from 14 medical centers in Japan. In 440 of the cases, tumor size was measured at the time of laparotomy or from the resected specimen. Three hundred and seventy-seven patients (86%) had a carcinoma larger than 3.0 cm; only 30% of these were resectable. Sixty-three patients (14%) had a carcinoma of 3.0 cm or less, with resectability of 97%. Detecting a tumor of "3 cm or less" with a high probability of resectability is the objective of early diagnosis with the resulting possibility of a cure. In most cases these small carcinomas were found easily when obstructive jaundice was present (73%). However, the estimated occurrence of obstructive jaundice associated with carcinomas of 3 cm or less was only 10% among the total cases of pancreatic carcinoma studied. Therefore, it is necessary for early diagnosis to detect carcinomas of 3 cm or less presenting without jaundice. The symptoms of small carcinoma without jaundice are weight loss, anorexia, upper abdominal pain, back pain and a palpable abdominal mass. Among the various available examinations, endoscopic retrograde cholangiopancreatography, computerized tomography and ultrasonography were valuable in diagnosing these small carcinomas.