Minute carcinoma of the pancreas measuring 1 cm or less in diameter--collective review of Japanese case reports.
OBJECTIVE
According to Tsuchiya's collective review on small pancreatic cancer measuring 2 cm or less in diameter (5), more than half of them had obstructive jaundice and the 5-year survival rate was as low as 30%. Thus, a more aggressive diagnostic approach is needed to detect a smaller and more curable cancer of the pancreas.


METHODS
Thus, we collected 36 reported cases of "minute" pancreatic cancer measuring 1 cm or less in diameter, from Japanese medical literature, to analyze the relationships between the diagnostic processes and long-term results.


RESULTS
Excluding 3 patients with obstructive jaundice, the other 33 patients did not show any specific initial symptoms. However, 28 (78%) out of 36 patients showed an elevation in serum pancreatic enzyme levels and/or glucose intolerance. Among the 35 patients who had received ultrasonography (US) and/or computed tomography (CT), 20 (57%) patients showed duct dilation alone, whereas only 9 patients (26%) showed tumor mass. Among 35 patients who received an endoscopic retrograde pancreatography (ERP), all patients showed positive findings such as obstruction/stenosis, filling defect or duct dilation. All 36 patients underwent pancreatectomy and the 5-year survival rate was 57%. However, the 5-year survival rate was 34% in the 13 patients with jaundice and/or tumor mass depicted in US/CT, while it was 69% for the 22 patients without these two findings (p < 0.05).


CONCLUSIONS
These data lead us to conclude that an elevation of serum pancreatic enzyme levels, glucose intolerance, and duct dilation alone depicted by US/CT should not be overlooked. ERP should be more widely applied to such patients, instead of persisting in delineating the tumor mass by US/CT or follow-up by tumor marker.
Ishikawa
O
O
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan.
Ohigashi
H
H
Imaoka
S
S
Nakaizumi
A
A
Uehara
H
H
Kitamura
T
T
Kuroda
C
C
D000368:Aged; D002277:Carcinoma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003952:Diagnostic Imaging; D006801:Humans; D007564:Japan; D008297:Male; D010179:Pancreas / Q000000981:diagnostic imaging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography