Curbside Consultation in Endoscopy: 49 Clinical Questions, Second Edition

Joseph Leung, MD; Simon Lo, MD

Question 25: What Is The Best Endoscopic Method To Diagnose Pancreatic Cancer? What Is The Best Way To Sample Tissue To Diagnose Suspected Bile Duct Cancer? (continued)

John G. Lee, MD

In the United States, the diagnosis of pancreatic cancer requires histological or cytological confirmation because most physicians and patients will accept only a definitive diagnosis, whereas in Japan, for example, most cancers are diagnosed on clinical and radiological findings alone. In addition, a definitive diagnosis is required to initiate treatment because oncologists will not treat based on a clinical diagnosis (sometimes even in patients with radiographical evidence of metastasis) or on elevated CA 19-9 level, however compelling it may be. Many surgeons also request a definitive…