Curbside Consultation in GI Cancer for the Gastroenterologist: 49 Clinical Questions

Douglas G. Adler, MD

Question 14: A 54-Year-Old Woman Has Weight Loss And Back Pain. An Ultrasound Is Suggestive Of A Solid Mass In Her Pancreas. How Should Her Evaluation Best Proceed With Regards To Diagnosis And Staging? (continued)

Randall K. Pearson, MD

Pain and weight loss are the cardinal symptoms of pancreatic cancer (PC), but as these are nonspecific, the diagnosis is often delayed. In my referral practice, it is common for patients to undergo routine upper endoscopy, several months of empiric proton pump inhibitor therapy, and even the occasional laparoscopic cholecystectomy before appropriate cross-sectional imaging reveals the offending pancreatic mass. We have all been taught in medical school about the radiation of pancreatic pain into the back, most commonly precipitated by meals. In addition to pain, weight loss is at least…