Revised 12 June 2013
CT scan of the chest and abdomen/pelvis is recommended to assess the extent of local involvement and to exclude distant metastases. A pancreas-protocol CT scan or MRI is indicated if the patient is thought to be an operative candidate. If a mass is not clearly identified or if there is uncertainty regarding vascular involvement, an EUS should be performed.
If there appears to be an isolated pancreatic lesion, refer to a hepatobilliary surgeon who will determine if the disease is resectable or unresectable. If definitive resection is being planned then a biopsy is not always required but may be performed if clinically indicated.
CT/PET scan is not routinely recommended for staging purposes, but may be considered in high-risk patients.
If there are obvious metastases, then the pancreatic mass or metastases can be biopsied percutaneously with ultrasound CT guidance or by endoscopic with fine needle aspiration.
If no metastases are seen on baseline imaging, a laparoscopic evaluation for peritoneal metastases may be considered in high risk patients prior to surgical resection.
Recommend baseline tumour markers at diagnosis: CEA, CA 19-9