Pancreatic cancer: The role of the primary care physician

Clinical diagnosis of pancreatic cancer by signs, symptoms, and physical examination alone is unreliable because the initial symptoms are nonspecific. A radiologic examination is an essential part of the work-up; ultrasound and CT are the most commonly used first-line tests. Tissue diagnosis by percutaneous fine-needle aspiration, endoscopic ultrasound-guided transduodenal biopsy, or diagnostic laparoscopy is most helpful for patients being considered for neoadjuvant therapy. Resection is currently the only potentially curative treatment; combination neoadjuvant therapy with radiation and systemic 5-fluorouracil significantly increases resectability rates. Management of patients with nonresectable tumors focuses on palliative therapy to reduce pain and binary or duodenal obstruction.