Minute carcinoma of the pancreas measuring 1 cm or less in diameter--collective review of Japanese case reports

Abstract

Background/aims: 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.

Methodology: 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.