staging cancer pancreas RADIOLOGY
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Transcript of staging cancer pancreas RADIOLOGY
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7/31/2019 staging cancer pancreas RADIOLOGY
1/22
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mailto:[email protected]://dx.doi.org/10.1016/j.rcl.2012.03.008http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://radiologic.theclinics.com/http://dx.doi.org/10.1016/j.rcl.2012.03.008mailto:[email protected] -
7/31/2019 staging cancer pancreas RADIOLOGY
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w~o~`w~`goccp w`il`e`gol~ "hf~b oxjw `l ~b`w w~tnp bon
E`i, 5, "O) ]olgxdo~`g bdon ~tjfx "yb`~d oxxfyw) wddl o~ howdc`ld gfxfloc xopwtj xdgflw~xtg~`fl ~f dlgowd "`lufcudjfxd ~bol ?2=) ~bd iow~xfntfndloc ox~dxp "INO) oln ~bd gfjjfl bd}o~`g "GBO), ^bd }o~`dl~ ~bdl tlndxydl~}xdf}dxo~`ud gbdjf~bdxo}p oln xon`o~`fl ~bdxo}p, "H) Gfxfloc xopwtj xdgflw~xtg~`fl exfj efccfy*t} wgol wbfyw~bd }x`joxp joww ~f boud ndgxdowdn "yb`~d oxxfyw) ht~ ~f w~`cc dlgowd ~bd iow~xfntfndloc oln gfjjfl bd}o~`gox~dx`dw, ^bd }o~`dl~ tlndxydl~ wtxidxp# yb`gb wbfydn lf u`ohcd ~tjfx `lufcu`li ~bd GBO, Ox~dx`oc ixoe~ yow}cogdn oln `w wbfyl y`~b ol oxxfy fl ~bd }fw~f}dxo~`ud J@] `joid "G), ^bd cfydx qtoc`~p fe }fw~f}dxo~`ud xdgfl*w~xtg~`flw `w hdgotwd fe ~b`gadx or`oc wftxgd `joidw,
E`i, 4, ^p}dw fe GBO xdgflw~xtg~`flw, ]olgxdo~`g bdon ~tjfxw ~p}`goccp owgdln ~bd iow~xfntfndloc ox~dxp "INO) ~f`lufcud ~bd GBO, @e ~tjfx `lufcudjdl~ `w j`l`joc "O)# ~bdl o }x`joxp olow~fjfw`w fe ~bd dr`w~`li GBO dlnw gol hdnfld, Bfydudx# `e ~bd `lufcudn GBO wdijdl~ `w cflidx "H)# ~bdl o uowgtcox ixoe~ `w lddndn, Efx ol olow~fjfw`w ~f hd}fww hcd# ~tjfxjtw~ lf~ `lufcud ~bd }xfr`joc ? gj fe ~bd gfjjfl bd}o~`g ox~dxp ow `~ fx i`lo~dwexfj ~bd gdc`og ~xtla,
W~oi`li ]olgxdo~`g Ondlfgoxg`lfjo >??
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7/31/2019 staging cancer pancreas RADIOLOGY
6/22
gbdjfxon`o~`fl),?5 Etx~bdx w~tn`dw oxd tlndxyop ~f
gcox`ep ~bd xfcdw fe gbdjf~bdxo}p oln xon`o~`fl
~bdxo}p `l ~bd onktuol~ wd~~`li, It`ndc`ldw exfj
~bd Lo~ floc Gfj}xdbdlw`ud Golgdx Ld~yfxa
"LGGL) wt}}fx~ ~bd twd fe }fw~f}dxo~`ud gbdjf*
~bdxo}p fx gbdjfxon`o~`fl ~bdxo}p,?? Fld fe ~bd
c`j ~o~`flw lf~dn efx ~bd onktuol~ o}}xfogb bowhddl ~bo~ t} ~f 77$ gollf~ tlndxif onktuol~
~bdxo}p# fx `~ `w ndcopdn# hdgotwd fe `ccldww,?8#?9#?2
@~ bow hddl onufgo~dn ~bo~ xdw~oi`li `joi`li duoc*
to~`flw hd }dxefxjdn `jjdn`o~dcp hdefxd w~ox~`li
onktuol~ ~bdxo}p ~f drgctnd xdw`ntoc ~tjfx fx doxcp
}xfixdww`fl,??
]XDF]DXO^@UD ^BDXO]P
]xdf}dxo~`ud ~bdxo}p yow ndudcf}dn ow ol oc~dx*
lo~`ud o}}xfogb ~f onktuol~ ~bdxo}p efx ~bd
efccfy`li xdowflw, ]xdf}dxo~`ud ~bdxo}p ouf`nw~bd }xfhcdj fe }fw~f}dxo~`ud jfxh`n`~p ndcop`li
fx drgctn`li }o~`dl~w exfj tlndxif`li onktuol~
~bdxo}p, ]xdf}dxo~`ud ~bdxo}p ~xdo~w }xdwtjdn
j`gxfjd~ow~owdw c`adcp }xdwdl~ o~ ~bd ~`jd fe }xd*
wdl~o~`fl i`udl ~bo~ jfw~ }o~`dl~w ybf tlndxif
}f~dl~`occp gtxo~`ud xdwdg~`fl w~`cc n`d fe xdgtxxdl~
}olgxdo~`g golgdx, ]xdf}dxo~ ud ~bdxo}p ocwf
}xfu`ndw o ~`jd `l~dxuoc hdefxd wtxidxp `l yb`gb
`lnd~dxj`lo~d cdw`flw ~bo~ jop hd jd~ow~owdw
gol hd hd~~dx gboxog~dx`{dn hp `joi`li efccfy*t}
"E`i, 9), @~ bow ocwf hddl wtiidw~dn ~bo~ }o~`dl~wybf ndudcf} fudx~ jd~ow~owdw ntx`li ~b`w }dx`fn
fe `l~dlwd }xdf}dxo~`ud ~bdxo}p c`adcp boud ol oi*
ixdww`ud ~tjfx h`fcfip oln ~bdxdefxd yftcn boud
nfld }ffxcp dudl `e ~bdp bon }xfgddndn n`xdg~cp
~f wtxidxp, ]f~dl~ occp lddncdww wtxidxp jop ~bdxd*
efxd hd ouf`ndn, @l onn`~`fl# }xdf}dxo~`ud gbdjf*
xon`o~`fl jop occfy efx ~tjfx nfylw~oi`li "E`i, 2)
oln# `l w`licd*`lw~`~t~`fl w~tn`dw# bow hddl wbfyl
~f xdwtc~ `l cfydx xo~dw fe wtxi`goc joxi`l }fw`*
~`u`~p,?087 W~tn`dw o~ ftx `lw~`~t~ fl boud wbfyl
jdn`ol wtxu`uoc fe t} ~f 7> jfl~bw efx ~bfwd ybftlndxif }xdf}dxo~ ud ~bdxo}p oln wtxidxp# ht~
wtxu`uoc efx ~bfwd ybf n`n lf~ }xfgddn ~f wtxidxp
bow hddl flcp 9 ~f ?? jfl~bw,8>#84 T} ~f 7=$ fe
}o~ dl~w ybf tlndxif ldfonktuol~ ~bdxo}p nf
lf~ tlndxif wtxidxp hdgotwd fe ndudcf}jdl~
fe jd~ow~owdw1 `l gfl~xow~# `wfco~dn cfgfxdi`floc
}xfixdww`fl `l ~bd }xdf}dxo~`ud }bowd bow hddl
xoxd "`d# cfww fe o y`lnfy fe f}}fx~tl`~p efx wtxi`goc
xdwdg~`fl),8>#85 ^f ftx alfycdnid# ~bdxd boud hddl
lf }xfw}dg~`ud ~x`ocw gfj}ox li }xdf}dxo~ ud
~bdxo}p efccfydn hp wtxidxp y`~b t}exfl~ wtxidxp
efccfydn hp onktuol~ ~xdo~jdl~,
W^OI@LI FE ]OLGXDO^@G GOLGDX;OJDX@GOL KF@L^ GFJJ@^^DD FL GOLGDXIT@NDC@LDW
^bd jfw~ gfjjflcp twdn w~oi`li wpw~dj `w ~bo~
exfj ~bd Ojdx`gol Kf`l~ Gfjj`~~dd fl Golgdx
"OKGG),89 ^b`w wpw~dj owwdwwdw ~bd w~o~tw fe ~bd
}x`joxp ~tjfx "^)# cpj}b lfndw "L)# olnjd~ow~owdw
"J), W~oidw oxd nde`ldn howdn fl ^LJ ixondw,
^bd ^ w~o~tw gol hd wtjjox`{dn ow efccfyw"E`i, 0); ~bd ^=# ^R# oln ^`w gcoww`e`go~`flw xdedx
~f coga fe du`ndlgd efx o }x`joxp ~tjfx# `loh`c`~p
~f duocto~d ~bd }x`joxp ~tjfx# fx goxg`lfjo `l
w`~t# xdw}dg~`udcp, ^? ~tjfxw oxd ~bfwd cdww ~bol
E`i, 9, O 70*pdox*fcn yfjol y`~b }olgxdo~`g golgdx# lf~dn fl "O) howdc`ld or`oc `joidw ~f boud `lnd~dxj`lo~d c`udxcdw`fl"hcogaoxxfy)# ~ff wjocc~f gboxog~dx`{d, ]o~`dl~ yow ~bdxdefxd gflw`ndxdnhfxndxc`ldefx xdwdg~oh`c`~p# oln tlndx*ydl~ }xdf}dxo~`ud gbdjf~bdxo}p oln xon`o~ fl ~bdxo}p, Efccfy*t}or`oc}fx~oc udlftw }bowd`joi`li "H) wbfyw cdw fl"hcoga oxxfy) ~f boud lgxdowdn l w`{d# gflw w~dl~ y`~b o c`udx jd~ow~ow`w,
^ojj d~ oc>?8
-
7/31/2019 staging cancer pancreas RADIOLOGY
7/22
fx dqtoc ~f 8 gj oln hftlndn hp ~bd }olgxdow, ^8
~tjfxw oxd coxidx ~bol 8 gj ht~ w~`cc hftlndn hp
}olgxdow, 7 ~tjfxw oxd ~bfwd ~bo~ dr~dln hdpfln
~bd }olgxdow# ht~ nf lf~ `lufcud ~bd gdc`og fx
wt}dx fx jdwdl~dx`g ox~dx`dw, ^> ~tjfxw `lufcud
d`~bdx ~bd gdc og fx ~bd wt}dx`fx jdwdl~dx`g ox~dx`dw
oln# `l jfw~ `lw~`~t~`flw# xd}xdwdl~ tlxdwdg~ohcd~tjfx, Y`~b ~bd onudl~ fe uowgtcox xdwdg~ flw
oln xdgflw~xtg~`flw# ~bdxd bow hddl o wb e~ `l
w~oi`li ~f dj}bow`{d ox~dx`oc `lufcudjdl~# oln
xdedxdlgdw ~f udlftw `lufcudjdl~ efx ~bd ^ ixondw
boud hddl dc j`lo~dn,82 ^bd L ~dxj gol hd
wtjjox {dn ow efccfyw; LR "tlohcd ~f duocto~d
lfnoc w~o~tw)# L= "lf jd~ow~owdw ~f xdi`floc lf*
ndw)# oln L? "}xdwdlgd fe jd~ow~owdw ~f xdi`floc
lfndw), ^bd J ~dxj `w d`~bdx J= "lf jd~ow~owdw)
fx J? "n`w~ol~ jd~ow~owdw oxd }xdwdl~),
W~oi`li gol hd wtjjox`{dn ow efccfyw "E`i, ?=);
~bd }xdwdlgd fe olp jd~ow~owdw gcoww e`dw o }o~`dl~ow w~oid @U, ^bd }xdwdlgd fe ^> n`wdowd "gdc`og fx
WJO `lufcudjdl~) y`~bft~ jd~ow~owdw xdlndxw olp
}o~`dl~ ow w~oid @@@, W~oid @@O `w ^7 n`wdowd `l ~bd
ohwdlgd fe lfnoc fx n`w~ol~ jd~ow~owdw# oln w~oid
@@H `w ^? ~f ^7 n`wdowd `l ~bd wd~~`li fe xdi`floc
E`i, 2, O 5?*pdox*fcn jol y`~b golgdx fe ~bd }olgxdo~`g bdon, Howdc`ld }fx~oc udlftw }bowd `joi`li "O) wbfyw~tjfx "cfli yb`~d oxxfyw) jdowtx`li ldoxcp 4 gj# y`~b gdl~xoc tcgdxo~`fl "hcoga oxxfy) f}og`ep`li y`~b iow~xf*`l~dw~`loc gfl~xow~ exfj gfjjtl`go~`fl y`~b ntfndltj, Jfxd wt}dx`fxcp fh~o`ldn or`oc `joid " H) wbfyw ondl*f}o~bp "yb`~d oxxfyw) ldox ~bd GBO oln `l ~bd }fx~ogouoc xdi`fl, Wfe~ ~`wwtd w~xoln`li "yb`~d oxxfybdon) `w wddl
~f oht~ "jdol`li ?2=
fe `lufcudjdl~) ~bd gdc`og ~xtla, Efccfy*t} `joi`li oe~dx gbdjfxon`o~`fl "G) wbfyw ~bo~~tjfx "cfli yb`~d oxxfyw) bow ndgxdowdn# ht~ w~`cc oht~w ~bd w}cdlf}fx~oc gflectdlgd "W]G), Fl o jfxd wt}dx`fxcpfh~o`ldn `joid "N) ondlf}o~bp "yb`~d oxxfy) bow ndgxdowdn fx xdwfcudn, Wfe~ ~`wwtd w~xoln`li "yb`~d oxxfybdon)ldox ~bd gdc`og ~xtla `w w`j`cox fx wc`ib~cp `lgxdowdn, ]o~`dl~ ydl~ fl ~f wtxidxp# y`~b wtggdwwetc ~tjfx xdwdg~`fl#flcp ?$ u`ohcd ~tjfx# oln lf }fw`~`ud xdi`floc cpj}b lfndw efx golgdx,
E`i, 0, ^? "38*gj ~tjfx# hftlndn hp }olgxdow)# ^8 "~tjfx8 gj# ht~ hftlndn hp }olgxdow)# ^7 "~tjfx dr~dln`lihdpfln }olgxdow ht~ lf~ `lufcu`li ~bd gdc`og fx wt}dx`fx jdwdl~dx`g ox~dx`dw)# oln ^> n`wdowd "~tjfx `lufcu`li ~bdgdc`og fx wt}dx`fx jdwdl~dx`g ox~dx`dw), WJU# wt}dx`fx jdwdl~dx`g ud`l1 WJO# wt}dx`fx jdwdl~dx`g ox~dxp,
W~oi`li ]olgxdo~`g Ondlfgoxg`lfjo >?7
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7/31/2019 staging cancer pancreas RADIOLOGY
8/22
lfnoc jd~ow~owdw ht~ lf~ n`w~ol~ jd~ow~owdw,
W~oid @ n`wdowd `w ^? fx ^8 n`wdowd y`~bft~ lfnoc
fx n`w~ol~ jd~ow~owdw,82
GCOWW@E@GO^@FL FE XDWDG^OHCD#HFXNDXC@LD# OLN TLXDWDG^OHCD N@WDOWD
Oc~bftib ~bd OKGG gx`~dx`o }xfu`nd gcoww`e`go~`flw
efx w~oi`li# f~bdx deefx~w boud hddl jond ~f ixft}
}o~ dl~w efx }tx}fwdw fe gc`l`goc joloidjdl~,
Xdgdl~cp }thc wbdn }olgxdo~`g ondlfgoxg`lfjo
flgfcfip it`ndc`ldw hp ~bd LGGL ndwgx`hd ixft}*
`li }o~ dl~w howdn fl xon`fixo}b`g gx ~dx o `l~f
~bfwd y`~b gcdoxcp xdwdg~ohcd n`wdowd# hfxndxc`ld
xdwdg~ohcd n`wdowd# fx gcdoxcp tlxdwdg~ohcd n`w*dowd#80#7= yb`gb wt}}fx~w f~bdx }thc`go~`flw tw`li
wtgb ixft}`liw,9#?0#7?#78
Gcdoxcp xdwdg~ohcd n`wdowd "OKGG w~oidw @ oln @@)
`w nde`ldn ow lf fudx~ jd~ow~o~`g n`wdowd# lf fudx~
ondlf}o~bp# oln# `j}fx~ol~cp# lf du`ndlgd fe olp
~tjfx gfl~og~ y`~b uowgtco~txd "E`i, ??) f~bdx ~bol
}dxbo}w ~bd iow~xfntfndloc ox~dxp `l ~bd gowd fe
}olgxdo~`g bdon ~tjfxw "~b`w udwwdc `w xdwdg~dnow }ox~ fe o Yb`}}cd }xfgdntxd), ^b`w gcoww`e`go~`fl
jdolw ~bo~ ol `l~og~# tl`lufcudn# wf*goccdn gcdol
eo~ }cold wtxxftlnw udwwdcw wtgb ow ~bd WJO#
~bd gdc`og ~xtla# oln ~bd gfjjfl bd}o~`g ox~dxp,
Efx f~bdx udwwdcw ~bo~ oxd `l gfl~og~ y`~b ~bd
}olgxdow# wtgb ow ~bd wt}dx`fx jdwdl~dx`g ud`l#
udwwdcw flcp boud gfl~og~ y`~b gcdoxcp lfxjoc
}olgxdo~`g }oxdlgbpjo fx eo~ oln wbfy lf ndefx*
j`~p fx loxxfy`li ~bo~ `w ~bftib~ ~f hd wdgflnoxp
~f ~tjfx `lufcudjdl~,
Gcdoxcp tlxdwdg~ohcd n`wdowd "w~oidw @@@ oln @U) `w
xd}xdwdl~dn hp gcdoxcp `ndl~`e`ohcd n`w~ol~ jd~ow*~owdw "w~oid @U)# fudx~ ondlf}o~bp ft~w`nd ~bd
wtxi`goc e`dcn# fx ~tjfx dlgowdjdl~ "
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7/31/2019 staging cancer pancreas RADIOLOGY
9/22
fe ~bd gfjjfl bd}o~`g ox~dxp "yb`gb yftcn
}xdgctnd }cogdjdl~ fe ol ox~dx`oc ktj} ixoe~),
^bd jfxd n`ee`gtc~ ixft} ~f gcoww`ep# i`udl ~bd
dufct~ fl fe ~xdo~jdl~ ~dgbl`qtdw "wtxidxp# xo*
n`o~`fl ~bdxo}p# oln gbdjf~bdxo}p)# `w ~bo~ fe
hfxndxc`ld fx joxi`loc xdwdg~ohcd n`wdowd, Og*
gfxn`li ~f ~bd gtxxdl~ LGGL nde l ~`flw# hfx*
ndxc ld xdwdg~ohcd }o~`dl~w boud lf n`w~ol~
jd~ow~owdw# udlftw `lufcudjdl~ ~bo~ `w o~ jfw~
wbfx~*wdijdl~ fggctw`fl y`~b wt ~ohcd udwwdc
ohfud oln hdcfy ~bd }f`l~ fe fhw~xtg~`fl efx
xdwdg~`fl oln xdgflw~xtg~`fl "E`i, ?>)# wt}dx`fxjdwdl~dx`g oln gdc`og ox~dx`oc `lufcudjdl~ c`j`~dn
~f oht~jdl~ "lf
-
7/31/2019 staging cancer pancreas RADIOLOGY
10/22
@JOI@LI; ^DGBL@_TD
^bd gboxog~dx w~ gw twdn ~f nde ld xdwdg~ohcd#
hfxndxc`ld xdwdg~ohcd# oln tlxdwdg~ohcd n`wdowd
oxd howdn fl ~bd twd fe gxfww*wdg~`floc `joi`li
oln xdqt`xd ~bd twd fe `joi`li ~dgbl`qtdw ~bo~
f}~`j`{d ~bd u`wtoc`{o~`fl fe ~tjfx# `~w xdco~`flwb`}
~f onkogdl~ olo~fj`g w~xtg~txdw oln `~w }fww`hcd
w}xdon ~f lfndw ft~w`nd ~bd wtxi`goc e`dcn# oln
n`w~ol~ w`~dw wtgb ow ~bd c`udx# }dx`~fldtj# ctli#
oln hfld,??#?0#7= ^bd LGGL it`ndc ldw xdgfj*
jdln }olgxdow*w}dg`e`g G^ fx JX `joi`li,7=
Hdefxd n`wgtww`li ~dgbl`qtdw# `~ `w `j}fx~ol~ ~f
gflw`ndx ~bd ~`j`li efx tw`li w}dg`e g `joi`li
~dgbl`qtdw, @l ftx dr}dx`dlgd# ~bd yfxa*t} efx}o~ dl~w y`~b ohnfj`loc }o`l oln&fx kotln`gd
twtoccp hdiol y`~b ~xolwohnfj`loc tc~xowftln ~f
duocto~d ~bd }fww`h`c`~p fe gbfcdgpw~`~`w fx w`j}cp
~bd }xdwdlgd fe ioccw~fldw, @e tc~xowftln wbfydn
dr~xobd}o~`g h`c`oxp n`co~o~`fl# }o~`dl~w ~bdl ~p}`*
goccp tlndxydl~ dlnfwgf}`g xd~xfixond gbfcoli`f*
}olgxdo~fixo}bp "DXG]) efx n`oilfw~`g yfxa*t}
oln efx ~xdo~jdl~, Bfydudx# ~bd wthwdqtdl~
`jjdn`o~d }cogdjdl~ fe o h`c`oxp w~dl~ fe~dl dc`j*
`lo~dn u`wtoc {o~`fl fe ~bd }f`l~ fe h c`oxp fh*
w~xtg~`fl# dc`j`lo~`li o twdetc n`oilfw~`g `joi`li
edo~txd efx wthwdqtdl~ `joi`li y`~b G^# JX
`joi`li# fx DTW "oln efx it`n`li h`f}wp efx wth~cd
cdw`flw), Jfxd `j}fx~ol~cp# DXG]# hxtwb`liw# oln&
fx h`f}wp }xfgdntxdw gol occ gotwd }fw~}xfgdntxd
}olgxdo~`~`w "E`i, ?5)# yb`gb gol joxadncp c`j`~ ~bd
oh c`~p ~f u`wtoc {d ~bd ~tjfx oln ~bd `l~dxeogd
hd~yddl ~tjfx oln udwwdc# c`j ~`li wthwdqtdl~
h`f}wp o~~dj}~w oln }xdudl~`li oggtxo~d w~oi`li#
oln ndcop`li fx }xdgctn`li dlxfccjdl~ `l gc`l`goc
~x`ocw, Efx ~b`w xdowfl# o~ ftx `lw~`~t~`fl# }o~`dl~w
ybf }xdwdl~ y`~b wtw}`g`fl fe }olgxdo~`g golgdx
tlndxif gxfww*wdg~`floc `joi`li efx w~oi`li "G^fx JX `joi`li) hdefxd olp `l~dxudl~`fl,
G^
Jtc~`nd~dg~fx*xfy G^ "JNG^) `w }xfhohcp ~bd jfw~
y`ndcp twdn gxfww*wdg~ floc jfnoc`~p efx ~bd
w~oi`li fe }olgxdo~`g golgdx, ^b`l*wdg~`fl "7 jj
E`i, ?7, O 55*pdox*fcn jol y`~b tlxdwdg~ohcd "w~oid@@@) golgdx fe ~bd }olgxdo~ g bdon, Or`oc }fx~oc udlftw}bowd `joidw wbfy ~tjfx "yb`~d oxxfyw) dlgow`liixdo~dx ~bol ?2= fe g`xgtjedxdl~`oc `lufcudjdl~ fe~bd WJU# y`~b 75= fe g`xgtjedxdl~`oc `lufcudjdl~fe ~bd WJO,
E`i, ?>, Hfxndxc`ld udlftw fggctw`fl `l o 5=*pdox*fcn yfjol, Howdc`ld or`oc }fx~oc udlftw }bowd `joid "O) wbfyw}olgxdo~`g bdon joww "yb`~d oxxfyw) ~bo~ fggctndw ~bd WJU, Flcp ~bd WJO `w u`wtoc`{dn, W~dl~ "w~) `w }xdwdl~,Efccfy`li o gftxwd fe gbdjfxon`o~`fl# efccfy*t} w~tnp "H) or`oc `joid oln "G) gfxfloc xdgflw~xtg~`fl `joidwbfy ldy j`l`joc }o~dlgp fe ~bd WJU "cfli yb`~d oxxfy), WJO oln W]G oxd lf~dn, ]fw~f}dxo~`ud "N) or`oc `joidwbfyw ixoe~ "i) ~bo~ yow wtggdwwetccp }cogdn, WJO `w lf~dn,
^ojj d~ oc>?5
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7/31/2019 staging cancer pancreas RADIOLOGY
11/22
fx ~b`lldx)# h`}bow`g ~dgbl`qtd `w gxtg`oc ~f `ndl~`ep
~bd }x`joxp ~tjfx# nd~dxj`ld `~w cfgoc dr~dl~# ow
ydcc ow ~f `ndl~ ep n`w~ol~ jd~ow~owdw, Twtoccp#
`lkdg~`fl xo~dw fe 7 ~f 4 jC&w oxd twdn y`~b o wtee`*
g`dl~ ufctjd fe gfl~xow~ efx o 7=*wdgfln `lkdg~`fl
ntxo~`fl,7774 ^bd e`xw~ }fw~gfl~xow~ }bowd fe
`joi`li `w fh~o`ldn ntx`li ~bd }bowd fe }doa}olgxdo~ g }oxdlgbpjoc dlbolgdjdl~ ~f jor`*
j`{d ~bd gflw}`gt`~p fe ~bd ~tjfx "E`i, ?9), ^b`w
}bowd `w o}}xfr`jo~dcp >= ~f 4= wdgflnw oe~dx ~bd
w~ox~ fe gfl~xow~ `lkdg~`fl,75 ^bd co~dx }fx~oc udlftw
}bowd# yb`gb jor`j`{dw dlbolgdjdl~ fe ~bd c`udx
}oxdlgbpjo "o}}xfr`jo~dcp 5=9= wdgflnw oe~dx
`lkdg~`fl)# `w twdetc efx `ndl~`e`go~`fl fe c`udx jd~ow*
~owdw oln ocwf xdwtc~w `l drgdccdl~ f}og`e`go~`fl fe
~bd jdwdl~dx`g# w}cdl`g# oln }fx~oc ud`lw# yb`gb `w
twdetc efx duocto~`fl efx ~tjfx `lufcudjdl~ fe ~bdwd
w~xtg~txdw,75 Yd ~p}`goccp xdgflw~xtg~ or`oc `joidw
~f 8 wc`gd ~b`galdwwdw# 8,4 jj efx }x`joxp xdu`dy#
oln =,584 ~f ?,84 jj "nd}dln`li fl ~bd JNG^
}co~efxj) ~f occfy efx }fw~}xfgdww`li, Efx droj}cd#
yd gxdo~d gfxfloc oln woi`~~oc 8,4*jj ~b`ga
gfl~`itftw jtc~`}colox xdgflw~xtg~`flw "wdd E`i,
?9)# ht~ ~bdwd ~b`lldx or`oc `joidw oxd ocwf
twdetc efx gxdo~`li gtxudn }colox xdefxjo~`flw#
jor`jtj* l~dlw`~p }xfkdg~`fl "J@])# j`l`jtj*
`l~dlw`~p }xfkdg~`fl# ow ydcc ow ufctjd*xdlndxdn
oln wdijdl~dn ufctjd xdlndxdn `joidw,
E`i, ?5, O 98*pdox*fcn yfjol y`~b h`f}wp*}xfudl w~oid @ }olgxdo~ g ondlfgoxg`lfjo, Howdc`ld or oc G^ `joid o~ ftx`lw~`~t~`fl"O) wbfyww~dl~"w~)}cogdnhp ft~w`nd `lw~`~t~`fl,Coxidyb`~doxxfywbfyw dndjo~ftw gbolidw `l jdwdl~dx geo~# owg ~dw "o)# olnect`nldox ~bd}olgxdo~ g bdon "cfliyb`~doxxfy) gflw w~dl~y`~b }fw~w~dl~}cogdjdl~}olgxdo~`~ w,@l ~b`w wd~~`li# `~ `w lf~ gcdox ybd~bdx w~xoln`li "yb`~d oxxfybdon) ldox ~bd WJO xd}xdwdl~w ~tjfx fx `lecojjo~`fl,^tjfx "jdn`tj yb`~d oxxfy) `lufcudw ~bd }olgxdo~`g bdon oln tlg`lo~d }xfgdww, "H) ]fw~~xdo~jdl~ wgol wbfyw xdwf*ct~`fl fe }olgxdo~`~`w# y`~b xdwfct~`fl fe owg`~dw# oln eo~ "h`i yb`~d oxxfyw) ol~dx`fx oln }fw~dx`fx ~f ~bd w~fjogb lfcflidx o}}dox`li dndjo~ftw, Eo~ `l~dxeogd "yb`~d oxxfybdon) ldox WJO lfy o}}doxw `l~og~ y`~b }xdu`ftwcp wddlw~xoln`li bou`li xdwfcudn, ]cow~`g w~dl~ yow xd}cogdn y`~b o jd~occ`g w~dl~ "w~),
E`i, ?4, O 95*pdox*fcnyfjol y`~b hfxndxc`ld w~oid @@ ~f@@@ }olgxdo~`g ntg~oc ondlfgoxg`lfjo fe ~bd }olgxdo~`gbdon, Or`oc }fx~oc udlftw }bowd `joi`li wbfyw ~tjfx"yb`~d oxxfyw) y`~b oht~jdl~ "bdxd 3?2= fe g`xgtjedx*dl~`oc `lufcudjdl~) fe ~bd WJO oln WJU "yb`~d oxxfy*bdonw), Iow~xfgfc`g ~xtla "IG^) `w ocwf lf~dn,
W~oi`li ]olgxdo~`g Ondlfgoxg`lfjo >?9
-
7/31/2019 staging cancer pancreas RADIOLOGY
12/22
]olgxdo~`g ondlfgoxg`lfjo bow o ~p}`goccp bp*
}fndlwd o}}doxolgd fl ~bd }olgxdo~`g }oxdl*
gbpjoc }bowd "wdd E`i, ?9) ht~ gol hd `wfndlwd#
oln d`~bdx xdjo`lw bp}fndlwd fl ~bd }fx~oc
udlftw }bowd fx jop hdgfjd `wfndlwd, Or`oc
`joidw oln gfxfloc oln woi`~~oc xdefxjo~`flw oxd
twdetc efx }xfu`n`li o gfj}xdbdlw`ud xdu`dy fe
~bd gdc`og# wt}dx`fx jdwdl~dx`g# gfjjfl bd}o~`g#
oln w}cdl`g ox~dx`dw ow ydcc ow ~bd jo`l }fx~oc#
w}cdl`g# oln wt}dx`fx jdwdl~dx`g ud`lw oln ~bd`x
jokfx hxolgbdw "iow~xfgfc`g ~xtla# e`xw~ kdktloc
ud`l# oln `cdfgfc`g ~x`ht~ox`dw),
JX @JOI@LI
JX `joi`li feedxw ~bd onuol~oid fe jtc~`}cd
wdqtdlgdw ~bo~ gol }xfu`nd `lefxjo~`fl xdioxn`li
~bd }x`joxp ~tjfx# `~w cfgoc dr~dl~# uowgtcox `l*
ufcudjdl~# oln n`w~ol~ jd~ow~owdw, Jtc~ }cd xd*
gdl~ ~dgbl`goc ndudcf}jdl~w `lgctnd }co~efxjw
y`~b b`ibdx e`dcn w~xdli~b# `lgxdow`licp }fydxetc
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wdqtdlgdw, Ol droj}cd fe o ~p}`goc `joi`li droj*
`lo~`fl "E`iw, ?2 oln ?0) `lgctndw ^8*yd`ib~dn eo~*
wt}}xdwwdn# ^?*yd`ib~dn# `l oln ft~ fe }bowd#
n`eetw`fl*yd`ib~dn# oln ^?*yd`ib~dn nploj`goccp
fh~o`ldn }fw~gfl~xow~ jtc~`}colox `joi`li "wtgbow ~bxdd*n`jdlw`floc Q7NZ ixon`dl~ xdgoccdn dgbf
ufctjdw fh~o`ldn y`~b }oxoccdc `joi`li), Nploj`*
goccp fh~o`ldn `joidw gol hd fh~o`ldn ow w`licd
hxdo~b bfcnw o~ 8=# 5=# ?8=# oln ?2= wdgflnw oe~dx
~bd w~ox~ fe gfl~xow~ `lkdg~ fl,79#72 Wtgb wdqtdlgdw
ow Eow~ @joi`li Dj}cfp`li W~donp*W~o~d Ogqt`w`*
~`fl "E@DW^O1 ID Jdn`goc Wpw~djw# J`cyotadd#
Y@) y`~b eo~ wt}}xdww`fl "wdd E`i, ?0) gol bdc} ~f
n`eedxdl~`o~d eo~# udwwdcw# ~tjfx# oln tl`lufcudn
}olgxdow, @joidw oxd jfw~ gfjjflcp fh~o`ldn
n`xdg~cp `l ~bd or`oc }cold, Bfydudx# f~bdx }coldw
gol hd fh~o`ldn n`xdg~cp, Gfxfloc*}cold E@DW^O
`joidw oxd twdetc efx duocto~`li ~bd xdco~`flwb`}
fe ~tjfx ~f udwwdcw# }ox~`gtcoxcp ~bd fx`i`l fe ~bd
gdc`og oln wt}dx`fx jdwdl~dx`g ox~dx`dw `l gxfww
wdg~`fl# oln ~f u`wtoc {d ~bd dr~dl~ fe gfjjfl
bd}o~`g ox~dxp `lufcudjdl~,
]olgxdo~`g ondlfgoxg`lfjo bow o uox`ohcd o}*
}doxolgd fl JX `joi`li nd}dln`li fl ~bdwdqtdlgd hd`li droj`ldn, Fl nploj`g `joidw#
`~w o}}doxolgd `w w`j cox ~f ~bo~ fl gfl~xow~*
dlbolgdn G^# hd`li bp}f`l~dlwd ~f onkogdl~
}olgxdo~`g }oxdlgbpjo# ht~ o~ ~`jdw ocwf o}}dox*
`li `wf`l~dlwd# `l yb`gb gowd `ndl~`e`go~`fl fe }x`*
joxp ~tjfx gol hd n ee gtc~, O xdgdl~ ox~`gcd
wtiidw~dn ~bo~ JX `joi`li jop hd ohcd ~f u`wt*
oc`{d t} ~f 90$ fe ~tjfxw ~bo~ o}}dox `wfndlwd
~f lfxjoc }olgxdo~`g }oxdlgbpjo fl jtc~`}bow`g
G^ w~tn`dw,70
DTW
Tw`li o gfjh`lo~ fl fe xon`oc oln gtxu`c ldox
oxxopw# DTW bow ndudcf}dn o w`il`e gol~ xfcd `l
~bd oh c`~p ~f `joid cdw`flw oln }xfu`nd ~`wwtd
E`i, ?9, O 47*pdox*fcn jol y`~b w~oid @@*@@@ hfxndxc`ld }olgxdo~`g bdon ntg~oc ondlfgoxg`lfjo fl howdc`ld jtc~`*}bow`g droj`lo~`fl, "O) Or`oc }olgxdo~`g }oxdlgbpjoc }bowd `joid wbfyw ~tjfx "yb`~d oxxfyw) oht~~`li ~bd W]Goln wtxxftln`li w~dl~ "w~), "H) Fl }fx~oc udlftw }bowd `joid# ~tjfx "yb`~d oxxfy) `w cdww gflw}`gtftw, ^tjfxloxxfyw ~bd ydcc*f}og`e`dn }fx~oc ud`l "]U) wt}dx`fx ~f ~bd W]G, Lflw}dg`e`g w~xoln`li oht~w ~bd x`ib~ hfxndxfe ~bd WJO, Gfxfloc xdgflw~xtg~`fl fe ~bd }fx~oc udlftw }bowd "G) wbfyw ~bo~ ~bd ~tjfx "yb`~d oxxfyw) gotwdwjoxadn loxxfy`li fe ~bd }fx~oc ud`l "cfli yb`~d oxxfy), n# ntfndltj,
^ojj d~ oc>?2
-
7/31/2019 staging cancer pancreas RADIOLOGY
13/22
E`i, ?0, O 5?*pdox*fcn jol y`~b w~oid @@O ~f H }olgxdo~`ggolgdx, ]fx~oc udlftw }bowd 7N w}f`cdnixon`dl~ ^?*yd`ib~dneo~*wt}}xdwwdn `joid "O) wbfyw ~tjfx "yb`~d oxxfyw) oht~~`li dlcoxidn gfjjfl bd}o~`g ox~dxp lfnd "yb`~d oxxfy*bdon) oln dlgow`li ~bd GBO "cfli yb ~d oxxfy), "H) Eo~*wt}}xdwwdn Eow~ @joi`li Dj}cfp li W~donp*W~o~d Ogqt`w ~`fl"E@DW^O) `joid w`j`coxcp wbfyw GBO dlgowdjdl~,
E`i, ?2, JX `joi`li fe o 45*pdox*fcn jol y`~b b`w~fxp fe w~oid @U }olgxdo~`g golgdx, ]olgxdo~`g ~tjfx " yb`~doxxfy) o}}doxw bp}f`l~dlwd fl "O) }olgxdo~`g }oxdlgbpjoc }bowd oln "H) }fx~oc udlftw }bowd, Udlftw w~xtg~txdwwtgb ow ~bd WJU oln e`xw~ kdktloc ud`l "?w~ Kdk Ul) oxd ydcc f}og`e`dn fl ~bd }fx~oc udlftw }bowd# f}~`j`{`li duoc*
to~`fl efx udlftw `lufcudjdl~, Fl n`eetw`fl yd`ib~dn `joi`li "G)# ~tjfx o}}doxw hx`ib~# oln fl o}}oxdl~ n`eet*w`fl gfdee`g`dl~ "ONG) jo} "N)# ~tjfx o}}doxw noxa# `ln`go~`li xdw~x`g~dn yo~dx jfudjdl~, C`udx jd~ow~ow`w"gtxudn yb`~d oxxfy) fl nploj`g ~bxdd*n`jdlw`floc "7N) w}f`cdn ixon`dl~ dgbf co~d ox~dx`oc }bowd "D) wbfywx`li dlbolgdjdl~1 fl "E) n`eetw`fl yd`ib~dn `joi`li o}}doxw hx`ib~ oln wbfyw cfy w`iloc fl ONG " I) gflw`w~dl~y`~b xdw~x`g~dn yo~dx jfudjdl~# wt}}fx~`li ~bo~ ~b`w `w o jd~ow~ow`w,
>?0
-
7/31/2019 staging cancer pancreas RADIOLOGY
14/22
n`oilfwdw u`o DTW*it`ndn ELO efx }olgxdo~`g
golgdx ~bxftib xdoc*~ jd `joi`li y`~bft~ ~bd
lddn efx onj`l`w~xo~`fl fe o gfl~xow~ oidl~,>=#>?
Et~txd n`xdg~`flw `lgctnd ~bd }fww`h`c`~p fe gfl~xow~
dlbolgdjdl~# ow ydcc ow }f~dl~`occp ~bd twd fe dcow*
~fixo}bp,>8 ^b`w oh c`~p ~f u`wtoc {d oln fh~o`l
~`wwtd w}dg`jdlw `l xdoc ~`jd `w ocwf twdetc efx ~bdduocto~`fl fe wtw}`g`ftw cpj}b lfndw, Bfydudx#
~bd xfcd fe DTW efx w~oi`li `w c`adcp jfxd c`j`~dn
~bol G^ fx JX `joi`li# i`udl `~w c`j`~dn u`dy fe
ohnfj`loc olo~fjp "n`wgtwwdn co~dx),
]FW@^XFL DJ@WW@FL ^FJFIXO]BP&G^
]fw`~xfl dj`ww`fl ~fjfixo}bp "]D^)&G^ `w twtoccp
}dxefxjdn y`~bft~ `l~xoudlftw gfl~xow~# oln
~bdxdefxd bow bon o c`j`~dn xfcd `l ~bd cfgoc w~oi`li
fe }olgxdo~`g golgdx i`udl `~w }ffx nd}`g~`fl fe~tjfx oln `~w xdco~`flwb`} ~f onkogdl~ uowgtco~txd,
Bfydudx# o w~tnp gfj}ox`li ]D^# tldlbolgdn
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efx `l~xoudlftw gfl~xow~*dlbolgdn ]D^&G^ "22$
uw 95$ efx tldlbolgdn ]D^&G^) efx w~oi`li# oln
yow wtiidw~dn ow o }fww`hcd w`licd ~dgbl`qtd efx
~bd w~oi`li fe }olgxdo~`g golgdx,>7 ^bd xfcd fe tl*
dlbolgdn ]D &G^ bow }x`jox cp hddl ~f nd~dg~
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efx tldr}dg~dn w`~dw hdgotwd `~ `w o ybfcd*hfnp`joi`li jfnoc`~p "E`iw, 8= oln 8?),>>
@JOI@LI OLN W^OI@LICfgoc W~oi`li
W~oi`li fl gxfww*wdg~`floc `joi`li gtxxdl~cp
`lufcudw nd~dxj`l`li `l gxfww wdg~`fl ~bd ndixddw
fe g`xgtjedxdl~`oc `lufcudjdl~ fe xdi`floc ox~dx`dw
oln ud`lw "wdd E`iw, ???7 oln ?4) hp ~tjfx oln
loxxfy`li&fggctw`fl fe ud`lw "wdd E`i, ?>), Ow
ndwgx`hdn fx`i`loccp hp Ct oln gfccdoitdw>4 `l
?009# tw`li o ~bxdwbfcn fe ixdo~dx ~bol ?2= fe
g`xgtjedxdl~ oc udwwdc `lufcudjdl~ ow `ln`go~`li
tlxdwdg~ohcd n`wdowd fl gfl~xow~*dlbolgdn G^
`joi`li p`dcndn o wdlw`~ u`~p fe 2>$ oln w}dg`e g ~p
fe 02$ efx tlxdwdg~ohcd n`wdowd# yb`gb jor`*
j`{dn ~bd wdln`li fe occ ~bfwd y`~b xdwdg~ohcd
n`wdowd ~f wtxidxp# o~ ~bd dr}dlwd fe tlndxgocc`li
tlxdwdg~ohcd n`wdowd, ^b`w yow `l ~bd wd~~`li fe
fcndx w~oi`li gx`~dx`o `l yb`gb udlftw `lufcudjdl~
jdol~ tlxdwdg~ohcd n`wdowd# oln c`adcp n`n lf~`lgctnd ~bd twd fe }xdf}dxo~`ud ~bdxo}p,>4 Nd~dx*
j`l`li ~bd oggtxogp fe G^ oln JX `joi`li efx
w~oi`li bow gtxxdl~cp hdgfjd jfxd gfj}cdr i`udl
~bd uox`oh`c`~p fe ~bdxo}p oln wtxi`goc o}}xfogbdw
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uol~ ~bdxo}p, Ldudx~bdcdww# jfxd xdgdl~ w~oi`li
w~tn`dw boud wbfyl wdlw`~`u`~`dw efx tlxdwdg~ohcd
n`wdowd hd~yddl 48$ oln 0?$# oln w}dg`e`g`~`dw
fe 08$ ~f ?==$# ht~ ~bdxd ydxd c`adcp n`eedxdlgdw
hd~yddl `lw~`~t~ flw `l ybo~ yow gflw`ndxdn wtxi`*goccp xdwdg~ohcd n`wdowd,>54= @l onn`~`fl# `l ~bdwd
E`i, 8=, O 92*pdox*fcn jol y`~b h`f}wp*}xfudl w~oid @U }olgxdo~`g golgdx, Or`oc etwdn `joidw exfj ]D^&G^ w~tnpwbfyw "O) ectfxfndfrpictgfwd "ENI) ou`n }olgxdo~`g bdon joww "yb`~d oxxfy) wtxxftln`li w~dl~ "w~)# "H) c`udxjd~ow~ow`w "gtxudn yb`~d oxxfy)# "G) x`ib~ b`cox lfnoc jd~ow~ow`w "gtxudn yb`~d oxxfybdon)# oln "N) f~bdx# wc`ib~cpcdww ENI ou`n# b`cox oln jdn`ow~`loc lfndw "gtxudn yb`~d oxxfybdonw),
^ojj d~ oc>8=
-
7/31/2019 staging cancer pancreas RADIOLOGY
15/22
w~tn`dw# wjocc*ufctjd jd~ow~owdw ~f ~bd c`udx fx
}dx`~fldtj ydxd ow gfjjfl# fx jfxd gfjjfl#
~bol uowgtcox `luow`fl ow gotwdw efx }o~ dl~w hd`li
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n`n lf~ wbfy o w`il`e gol~ n`eedxdlgd `l }dxefx*
jolgd hd~yddl idldxo~`flw,>2 Olf~bdx qtdw~`fl
`w ~bo~ fe JX udxwtw G^ efx w~oi`li, JX feedxw
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~bo~ oxd dufcu`li wf xo}`ncp# wdudxoc w~tn`dw boud
wbfyl gfj}oxohcd }dxefxjolgd hd~yddl JX
oln G^ efx cfgoc w~oi`li,>5#4? @~ `w ~bdxdefxd }xfh*
ohcp hdw~ ~f twd ~bd w~xdli~bw fe o i`udl `lw~`~t~`fl
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twd efx nd~dxj`l`li cfgoc w~oi`li,Olf~bdx gfleftln`li eog~fx `w ~bo~ fe }xdf}dxo*
~`ud gbdjfxon`o~`fl "E`i, 88), ^f no~d# `~ `w lf~
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gbolidw, Xon`o~`fl ~bdxo}p gol gotwd gbolidw
oxftln udwwdcw ~bo~ yd boud eftln ~f }x`jox cp
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howdc`ld w~tn`dw twdetc efx `ndl~`ep`li ~bd dr~dl~
fe ~tjfx hdefxd xon`o~`fl ~bdxo}p1 `l ftx dr}dx`*
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ybf ndudcf}# fx wbfy w~ohcd# j`l`joc w~xoln`li
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~f udwwdcw wbftcn lf~ hd }xdudl~dn exfj tlndx*
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~f ~bo~ xd}fx~dn `l ~bd ohwdlgd fe }xdf}dxo~ ud
~bdxo}p,>0
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j`l`li uowgtcox `luow`fl `w lf~ gcdox# hdgotwd
xdwtc~w boud hddl j`rdn, O w~tnp hp Ndy`~~ oln
gfccdoitdw fe ?8= }o~`dl~w wbfydn DTW ~f hd
wt}dx`fx ~f G^ efx ~tjfx w~oi`li "59$ uw >?$)#ht~ dqt`uocdl~ efx lfnoc w~oi`li ">>$ uw >9$)#
oln w`j`cox fx wc`ib~cp `ledx`fx ~f G^ efx ktni`li
E`i, 88, O 47*pdox*fcnyfjoly`~bhfxndxc`ld w~oid @@ ~f@@@}olgxdo~ g golgdx# y`~b `joi lihdefxd# olnefccfy`li# gbd*jfxon o~`fl, "O) Gfxfloc ixop wgocd xdefxjo~`fl wbfyw# o~ }xdwdl~o~`fl# wth~cd w~xoln li "yb`~d oxxfybdon) ldox ~bdWJO fx`i`l, GO# gdc`og or`w, "H) Efccfy*t} gfxfloc xdgflw~xtg~`fl o~ ~bd wojd cdudc efccfy`li gbdjfxon`o~`fl# hdefxdwtxidxp, Wfe~ ~`wwtd ~b`gadl`li bow hdgfjd jfxd }xfj`ldl~ "yb`~d oxxfybdon) ht~ nfdw lf~ boud ~bd o}}doxolgdfe nde l ~d wfc n ~`wwtd, ^bd }o~ dl~ tlndxydl~ wtxidxp# y`~b ldio~`ud xdwdg~ fl joxi`l fl j`gxfwgf}p# oln lf }fw ~`udxdi`floc cpj}b lfndw,
E`i, 8?, O 40*pdox*fcn jol y`~b w~oid @U }olgxdo~`gondlfgoxg`lfjo, Or`oc etwdn ]D^&G^ `joid wbfywENI*ou`n cde~ wt}xogcou`gtcox ondlf}o~bp "gtxudnyb`~d oxxfybdonw) gflw`w~dl~ y`~b jd~ow~o~`g n`wdowd,
W~oi`li ]olgxdo~`g Ondlfgoxg`lfjo >8?
-
7/31/2019 staging cancer pancreas RADIOLOGY
16/22
xdwdg~oh c`~p "22 uw 08$), Bfydudx# `l olf~bdx
w~tnp# ~bd DTW edo~txd fe cfww fe ~bd `l~dix`~p fe
~bd dgbf}cold wtxxftln`li o udwwdc `ln`go~dn
~tjfx onbdxdlgd ~f uowgtco~txd `l flcp 80$ fe
gowdw# oln `l lfld yow ~bdxd b`w~fcfi`g du`ndlgd
fe `luow`fl,48 O }xfw}dg~`ud hc`lndn w~tnp fe 58
}o~`dl~w duocto~`li oggtxogp fe cfgfxdi`floc w~oi*`li tw`li wtxi`goc gfle xjo~ fl gfj}oxdn DTW#
JX `joi`li# oln G^ oln wbfydn oggtxog`dw fe
58$# 52$# oln 9>$ xdw}dg~`udcp,47 @l ~bd wojd
w~tnp# G^ bon ol oggtxogp fe 27$ efx uowgtcox
`luow`fl udxwtw 94$ efx DTW, ^bdwd `ludw~`io~fxw
gflgctndn ~bo~ DTW jop hd hdw~ twdn ow o }f~dl*
~`occp gfle`xjo~fxp ~dw~ efccfy`li G^ efx xdwdg~ohcd
~tjfxw,47 O wpw~djo~`g xdu`dy fe ~bd c`~dxo~txd hp
Ndy`~~ oln gfccdoitdw4> gflgctndn ~bo~ bd~dxfid*
ldftw w~tnp ndw`il# w~tnp qtoc ~p# oln n`eedx`li
xdwtc~w }xdudl~dn o gcdox nd~dxj`lo~`fl fe ybd~bdx
G^ fx DTW yow hd~~dx efx duocto~`fl fe }o~`dl~w
hdefxd wtxidxp oln ~bo~ ydcc*gfl~xfccdn }xfw}dg*
~`ud w~tn`dw ydxd ldgdwwoxp,
Tldlbolgdn ]D^&G^# ow ocxdonp lf~dn# nfdw
lf~ boud o xfcd efx cfgoc w~oi`li fe }olgxdo~ g
golgdx, Bfydudx# ow ocwf ocxdonp lf~dn# ybdl
}dxefxjdn y`~b `l~xoudlftw gfl~xow~# `~ wddjw ~f
}dxefxj gfj}oxohcp y`~b gfl~xow~*dlbolgdn G^,
O~~dl~`fl ~f ~dgbl`qtd# `lgctn`li ~b`l*wdg~`fl
`joi`li oln ~bd ~`j`li fe }bowdw fe `joid ogqt`*
w`~`fl# c`adcp xdjo`l `j}fx~ol~ efx oggtxo~d w~oi`li,
Lfnoc N`wdowd
^bd oggtxogp efx owwdww`li lfnoc n`wdowd `w
c`j`~dn xdioxncdww fe ~bd jfnoc ~p twdn, Lfnoc
w`{d fe ixdo~dx ~bol ? gj `l ~bd wbfx~ or`w bow
jfw~ gfjjflcp hddl twdn fl JX `joi`li oln
G^ ow o ~bxdwbfcn efx `ndl~`ep`li jd~ow~o~`g lfndw#
ht~ `w lflw}dg`e`g, @l o w~tnp tw`li o w`{d gx`~dx`fl
fe ?,4 gj fx coxidx fl G^ ow o w`il fe jd~ow~o~`g
lfnoc n`wdowd# flcp ?5,9$ fe }o~`dl~w y`~b lfnoc
`lufcudjdl~ ydxd `ndl~ e`dn ow bou`li lfnocn`wdowd fl }xdf}dxo~`ud G^,4= Ldudx~bdcdww# `~ `w
`j}fx~ol~ ~f `ndl~`ep lfndw ft~w`nd ~bd gfludl*
~`floc wtxi`goc e`dcn# wtgb ow lfndw ~f ~bd cde~ fe
~bd WJO "E`i, 87), ]D^&G^ bow hddl xd}fx~dn ~f
boud wdlw`~`u`~`dw fe >5$ ~f 9?$ oln w}dg`e`g`~`dw
fe 57$ ~f ?==$4449 efx lfnoc n`wdowd "wdd E`iw,
8= oln 8?), ]D^&G^ `w }xfhohcp twdetc `l ~bd wd~~`li
fe `ndl~`ep`li lfndw jfw~ wtw}`g`ftw efx h`f}wp#
ht~ `w c`j`~dn efx wjocc*ufctjd n`wdowd# oln gollf~
n`eedxdl~`o~d hd~yddl `lecojjo~fxp ondlf}o~bp
udxwtw jd~ow~o~`g ondlf}o~bp, ^bd c`j ~dn e`dcn
fe u`w`h`c`~p fe DTW }xdudl~w o gfj}xdbdlw`ud duoc*to~`fl fe ~bd ohnfjdl efx ondlf}o~bp# }ox~`gtcoxcp
efx lfndw ft~w`nd ~bd wtxi`goc e`dcn,42Ow y`~b f~bdx
jfnoc`~`dw# `~w wdlw`~`u`~p `w ocwf c`j`~dn hdgotwd fe
~bd `loh`c`~p ~f nd~dg~ lfnoc j`gxfjd~ow~owdw, ^bd
gfjh`lo~`fl fe DTW y`~b ELO bow hddl wbfyl ~fixdo~cp `lgxdowd ~bd w}dg`e g`~p fe n`oilfw`w efx
}olgxdo~`g golgdx#40 oln oc~bftib `lefxjo~`fl `l
~bd c`~dxo~txd `w c`j`~dn# `~ `w dr}dg~dn ~bo~ DTW*
ELO yftcn boud b`ib w}dg`e g ~p# oln ~bdxdefxd
twdetcldww# `l ~bd duocto~`fl fe wtw}`g`ftw cpj}b
lfndw# joa`li `~ o twdetc }xfhcdj wfcudx ybdl
wtgb nd~dxj`lo~`flw lddn ~f hd jond# oc~bftib
`~w oh`c`~p ~f duocto~d wtgb lfndw `w oio`l c`j`~dn
hp ~bd xolid fe u`wtoc`{o~`fl fe ~bd ohnfjdl hp
DTW# ~bd xolid fe woed oggdww efx ELO h`f}wp#
oln ~bd }xfhcdjw fe woj}c`li dxxfx `lbdxdl~ y`~blfnoc j`gxfjd~ow~owdw, Doxcp yfxa wtiidw~w ~bo~
DTW }o`xdn y`~b dcow~fixo}bp jop boud }xfj`wd
`l `j}xfu`li `~w wdlw`~`u`~p oln w}dg`e`g`~p efx lfnoc
`lufcudjdl~,5=
Jd~ow~owdw
]olgxdo~`g golgdx jfw~ gfjjflcp jd~ow~ow`{dw
~f c`udx# }dx ~fldtj# ctliw# oln hfld# oc~bftib
hfld jd~ow~owdw ~p}`goccp fggtx co~d `l ~bd gftxwd
fe ~b`w n`wdowd, G^# JX `joi`li# oln ]D^&G^ }cop
gfj}cdjdl~oxp xfcdw `l ~bd duocto~`fl efx jd~o*w~o~`g n`wdowd,
C`udx jd~ow~owdw oxd jfw~ gfjjflcp owwdwwdn
hp d`~bdx G^ fx JX `joi`li, Oc~bftib fcndx w~tn`dw
boud xd}fx~dn G^ "wdd E`i, 91 E`i, 8>) bou`li
E`i, 87, O 4>*pdox*fcn jol y`~b h`f}wp*}xfudlhfxndxc`ld w~oid @@ ~f @@@ }olgxdo~`g golgdx olnxdi`floc lfnoc n`wdowd, Or`oc `joid exfj howdc`ld G^w~tnp wbfyw ~tjfx `l ~bd tlg`lo~d "yb`~d oxxfy)oht~~`li hp jfxd ~bol 0= ~bd WJO# hp dr~dlw`flocfli ~bd @]NO "yb`~d oxxfybdon), ^f ~bd cde~ fe ~bdWJO `w ondlf}o~bp "gtxudn yb`~d oxxfybdon),
^ojj d~ oc>88
-
7/31/2019 staging cancer pancreas RADIOLOGY
17/22
o wdlw`~`u`~p fe 94$ ~f 29$#5?57 o xdgdl~ w~tnp
gfj}ox li JNG^ y`~b G^ ox~dx`oc }fx~fixo}bp
oln G^*oww`w~dn bd}o~`g ox~dx`fixo}bp wbfydn
JNG^ ~f boud o wdlw`~`u`~p fe >2,>$ oln w}dg`*
e`g`~p fe 09,0$ efx c`udx jd~ow~owdw,5> Wjocc*
ufctjd jd~ow~owdw ~f c`udx# }ox~`gtcoxcp }dx`~fldoc
`j}col~w ~f ~bd c`udx wtxeogd# boud hddl o n`ee`gtc~pefx gxfww*wdg~`floc `joi`li# ow `w ocwf ~bd coga fe
w}dg`e`g`~p fe udxp wjocc cdw`flw,>9>0 JX `joi`li
bow fe~dl wdxudn ow o }xfhcdj wfcudx efx c`udx
jd~ow~owdw "E`i, 84)# oln xdgdl~ ndudcf}jdl~w
wtgb ow n`eetw`fl*yd`ib~dn `joi`li "E`i, 85) oln
~bd twd fe c`udx*w}dg`e`g gfl~xow~ oidl~w oxd }xfj*
`w`li, @l o w~tnp fe ?4 }o~`dl~w y`~b 58 c`udx jd~ow*
~owdw# gfj}ox`li ionfrd~`g og`n JX `joi`li "oc`udx*w}dg`e`g oidl~ ~bo~ gol ocwf hd twdn efx
E`i, 8>, O 4>*pdox*fcn yfjol y`~b jtc~`}cd c`udx jd~ow~owdwexfj}olgxdo~ g golgdx, "O) ]olgxdo~`g }oxdlgbpjoc}bowdwbfyw jtc~ }cd jd~ow~owdw "hcoga oxxfyw) ~bo~ wbfy }dx }bdxoc bp}dxndlwd dlbolgdjdl~ oln gdl~xoc bp}fndlw ~p, "H)]fx~oc udlftw }bowd `joid wbfyw flcp o bp}fndlwd o}}doxolgd fe jd~ow~owdw "hcoga oxxfyw),
E`i, 84, O >7*pdox*fcn yfjol hd`li duocto~dn efx }fww`hcd c`udx jd~ow~owdw, Gfl~xow~*dlbolgdn }fx~oc udlftw}bowd G^ `joid "O) wbfyw cdw`flw wtw}`g`ftw efx jd~ow~owdw "hcoga oxxfyw) o}}dox`li wc`ib~cp bp}fndlwd fxwbfy`li tltwtoc# wc`ib~cp }xfj`ldl~# dlbolgdjdl~, Wthwdqtdl~ JX `joi`li droj`lo~`fl "H) wbfyw co~d ox~dx`oc}bowd x`li dlbolgdjdl~ efx wdudxoc cdw`flw y`~b "G) yowbft~ fl }fx~oc udlftw }bowd# o}}dox`li jfxd }xfj`ldl~fl ~bd JX `joi`li ~bol fl G^ oln gfle`xj`li ~bo~ wdudxoc fe ~bdwd cdw`flw oxd c`udx jd~ow~owdw,
W~oi`li ]olgxdo~`g Ondlfgoxg`lfjo >87
-
7/31/2019 staging cancer pancreas RADIOLOGY
18/22
nploj`g `joi`li) y`~b JNG^# JX `joi`li bon
ixdo~dx wdlw`~`u`~p ~bol G^ "24$ uw 50$),54 JX
`joi`li owwdwwjdl~ fe ~bd }x`joxp ~tjfx yow~bftib~ ~f hd w`j cox ~f ~bo~ fe JNG^ efx ~bd
}tx}fwdw fe cfgoc w~oi`li,54 C`j`~dn `lefxjo~`fl
`w ouo`cohcd fl ~bd xfcd fe ]D^&G^ `l ~bd n`oilfw`w
fe c`udx jd~ow~owdw "wdd E`i, 8=), W~tn`dw ~bo~ duoc*
to~dn ybfcd*hfnp ectfxfndfrpictgfwd "ENI) ]D^
wbfydn wdlw`~ u ~`dw fe o}}xfr`jo~dcp 59$ ~f
9=$,5552 O jfxd xdgdl~ w~tnp gfj}ox`li `l~xo*
udlftw gfl~xow~*dlbolgdn ]D^&G^# tldlbolgdn
]D^&G # oln ]D^ ocfld wbfydn wdlw`~ u`~`dw
efx c`udx jd~ow~owdw fe 28$# >5$# oln >5$#
xdw}dg~`udcp,
>7
]olgxdo~ g jd~ow~owdw ~f ~bd }dx ~fldtj oxd
twtoccp fe wjocc ufctjd oln boud hddl n`ee`gtc~
~f nd~dg~ hp olp jfnoc`~p "E`i, 89), ^b`w n`ee`gtc~p
bow cdn ~f ~bd wtiidw~`fl fe tw`li co}oxfwgf}p
~f wgxddl }o~ dl~w efx }dx ~fldoc n`wdowd, ^b`w
o}}xfogb bow ~bd c`j ~o~`fl ~bo~ w`~dw `ndl~`e`dn
fl co}oxfwgf}p jop lf~ hd `ndl~ e`ohcd fl
gxfww*wdg~`floc `joi`li# oln ~bdxdefxd yftcn
lf~ hd ojdlohcd ~f `joi`li efccfy*t}, @l onn`*
~`fl# o jd~o*olocpw`w wtiidw~dn ~bo~# `l ~bd
wd~~`li fe ntoc*}bowd ~b`l*wdg~ fl G^# ~bd twd
fe onn`~`floc dr}cfxo~fxp co}oxfwgf}p yftcnoc~dx joloidjdl~ `l# o~ jfw~# >$ ~f ?4$ fe
}o~`dl~w,50
]D &G^ bow hddl onufgo~dn ow o jdolw efx
`ndl~`ep`li tldr}dg~dn n`w~ol~ w`~dw fe jd~ow~o~`g
n`wdowd "wdd E`iw, 8= oln 8?) hdgotwd `~ `w
o ybfcd*hfnp jfnoc ~p# ow f}}fwdn ~f gfludl*
~`floc JNG^ oln JX `joi`li# yb`gb oxd ~p}`goccptwdn `l o loxxfy xolid fe olo~fj`g xdi`flw
"ohnfjdl# ohnfjdl&}dcu`w# fx# `l ~bd gowd fe
G^# gbdw~# ohnfjdl# oln }dcu`w), O w~tnp fe ?=7
}o~`dl~w `l yb`gb ~bd ENI*]D^ no~o ydxd xd*
u`dydn oln gfj}oxdn y`~b JNG^# ~bd nd~dg~`fl
xo~d efx c`udx jd~ow~owdw yow cdww ~bol ~bo~ fe
G^# ht~ hd~~dx ~bol G^ efx nd~dg~`fl fe xdjf~d
E`i, 85, O 9?*pdox*fcn yfjol y`~b }olgxdo~`g golgdx w~o~tw }fw~ Yb`}}cd }xfgdntxd 8 pdoxw doxc`dx, Cdw`fl " yb`~doxxfybdon) `l c`udx fl "O) }fx~oc udlftw }bowd wbfyw cfy*`l~dlw`~p gdl~dx oln }dx`}bdxoc dlbolgdjdl~, "H) Fleo~*wt}}xdwwdn ^8*yd`ib~dn `joi`li# ~bd cdw`fl wbfyw hx`ib~ gdl~xoc efgtw c`adcp xd}xdwdl~`li ldgxfw`w, Fl n`eet*w`fl "G)# ~bd cdw`fl o}}doxw hx`ib~, Lf~d ~bo~ ~bd x`j fe dlbolgdjdl~ fe c`udx jd~ow~owdw `w o uox`ohcd e`ln`lihd~yddl }o~`dl~w fl JX `joi`li,
E`i, 89, ]dx`~fldoc jd~ow~owdw `l o >5*pdox*fcn yfjoly`~b }olgxdo~`g golgdx, Or`oc gfl~xow~*dlbolgdn}fx~oc udlftw }bowd G^ `joid wbfyw }dx`~fldocn`wdowd jol`edw~`li ow wjocc lfntcd "gtxudn yb`~doxxfy) oln ow hxfon wfe~ ~`wwtd ~b`gadl`li "yb`~doxxfybdonw),
^ojj d~ oc>8>
-
7/31/2019 staging cancer pancreas RADIOLOGY
19/22
cpj}b lfnd oln hfld jd~ow~owdw,9= Bfydudx# ~bd
wojd w~tnp ocwf lf~dn ~bo~ JNG^ `ln`go~dn f~bdx
lflgtxo~`ud eog~fxw `l ~bdwd }o~`dl~w, Occ }o~`dl~w
ybf ydxd lf~ xdwdg~ohcd gftcn hd `ndl~ e`dn ow
wtgb y`~bft~ ENI*]D^, Onn`~`floc `lefxjo~`fl `w
lddndn ~f `ndl~`ep ybd~bdx ~bdxd `w onndn hdlde`~
efx ]D^&G^ gfj}oxdn y`~b JNG , Olf~bdxgflw`ndxo~`fl `w ~bd twd fe gfl~xow~*dlbolgdn
]D &G # yb`gb gftcn occfy efx ~b`w jfnoc ~p ~f
hdgfjd o w`licd ~dgbl`qtd efx ybfcd*hfnp w~oi`li
fe }olgxdo~`g golgdx# }xfu`n`li `lefxjo~`fl fl ~bd
etcc iojt~ exfj cfgoc uowgtcox `lufcudjdl~ ~f
n`w~ol~ c`udx# ctli# hfld# oln eox n`w~ol~ lfnoc
jd~ow~owdw,>7
XD]FX^@LI FE @JOI@LI E@LN@LIW
Efccfy`li `joi`li oln `~w oggtxo~d `l~dx}xd~o~`fl#
}xfhohcp ~bd ldr~ jfw~ `j}fx~ol~ `wwtd `w ~bo~ e`ln*
`liw hd ndwgx`hdn `l o gcdox# gflw`w~dl~ jolldx#
tlndxw~olnohcd hp occ }bpw`g`olw ybf oxd `lufcudn
`l o }o~ dl~w goxd, Tlgcdox xd}fx~w gol gxdo~d
gfletw`fl ~bo~ gol }f~dl~`occp xdwtc~ `l }o~`dl~w
hd`li oww`ildn `lgfxxdg~cp ~f ~xdo~jdl~ ~x`ocw, Efx
}o~`dl~w ~xoudc`li hd~yddl `lw~ ~t~`flw# tlgcdox
xd}fx~w gftcn xdwtc~ `l ~bd xd}do~ li fe `joi`li
w~tn`dw,
Efx ~b`w xdowfl# o~~dj}~w boud hddl jond ~f
w~olnoxn`{d xd}fx~`li fe `joi`li e`ln`liw efx
}olgxdo~`g golgdx, Ol ox~`gcd exfj ftx `lw~`~t~`flxdioxn`li jtc~ n`wg`}c`loxp goxd fe }o~`dl~w y`~b
}olgxdo~`g golgdx }xf}fwdn o ~dj}co~d efx n`g~o*
~`fl fe G^ e`ln`liw efx }o~ dl~w y`~b }olgxdo~`g
golgdx# `lgctn`li ndwgx`}~`flw fe ~bd }x`joxp
~tjfxw w`{d# cfgo~`fl# xdco~`flwb`} ~f udwwdcw
"tw`li ~bd ~dxjw oht~jdl~# ?2= fe gfl~og~#
oln dlgowdjdl~#
-
7/31/2019 staging cancer pancreas RADIOLOGY
20/22
?>, Ldf}~fcdjfw K]# Ntll KO# W~fgadl NN# d~ oc,
Onktuol~ gbdjfxon`f~bdxo}p oln gbdjf~bdxo}p
`l xdwdg~ohcd }olgxdo~`g golgdx; o xolnfj`wdn
gfl~xfccdn ~x`oc, Colgd~ 8==?1742"0807);?49524,
?4, Ldf}~fcdjfw K]# W~fgadl NN# Ex`dww B# d~ oc,
O xolnfj`{dn ~x`oc fe gbdjfxon`f~bdxo}p oln
gbdjf~bdxo}p oe~dx xdwdg~`fl fe }olgxdo~`g golgdx,L Dlic K Jdn 8==>174="?8);?8==?=,
?5, Xdi`ld YE# Y`l~dx AO# Ohxojw XO# d~ oc, Ectfxf*
txog`c uw idjg`~oh`ld gbdjf~bdxo}p hdefxd oln
oe~dx ectfxftxog`c*howdn gbdjfxon`o~ fl efccfy*
`li xdwdg~`fl fe }olgxdo~ g ondlfgoxg`lfjo; o
xolnfj`{dn gfl~xfccdn ~x`oc, KOJO 8==21800"0);
?=?085,
?9, Aocwdx JB# Dccdlhdxi WW, ]olgxdo~`g golgdx, Onkt*
uol~ gfjh`ldn xon`o~ fl oln gbdjf~bdxo}p efc*
cfy`li gtxo~`ud xdwdg~`fl, Oxgb Wtxi ?0241?8="2);
2000=7,
?2, Ocf`o ^O# Cdd KD# Uot~bdp KL# d~ oc, Ndcopdn
xdgfudxp oe~dx }olgxdo~`gfntfndldg~fjp; o jokfx
eog~fx `j}o`x li ~bd ndc udxp fe onktuol~ ~bdxo}p6
K Oj Gfcc Wtxi 8==918=>"7);7>944,
?0, Uoxonbogboxp IX# ojj D]# Ohhxt{{dwd KC# d~ oc,
Hfxndxc`ld xdwdg~ohcd }olgxdo~`g golgdx; nde`l`~`flw#
joloidjdl~# oln xfcd fe }xdf}dxo~`ud ~bdxo}p, Oll
Wtxi Flgfc 8==51?7"2);?=74>5,
8=, Wowwfl OX# Yd~bdx`li~fl XY# Bfeejol K]# d~ oc,
Ldfonktuol~ gbdjfxon`f~bdxo}p efx ondlfgoxg`*
lfjo fe ~bd }olgxdow; olocpw`w fe b`w~f}o~bfcfip
oln ft~gfjd, @l~ K Iow~xf`l~dw~ Golgdx 8==717>"87);?8?2,
8?, Yb`~d XX# R`d BH# If~~ex dn JX# d~ oc, W`il`e`golgd fe
b`w~fcfi`goc xdw}flwd ~f }xdf}dxo~`ud gbdjfxon`f*
~bdxo}p efx }olgxdo~ g golgdx, Oll Wtxi Flgfc
8==41?8"7);8?>8?,
88, ]`li}ola KE# Bfeejol K]# Xfww DO# d~ oc, Deedg~ fe
}xdf}dxo~`ud gbdjfxon`f~bdxo}p fl wtxi`goc joxi`l
w~o~tw fe xdwdg~dn ondlfgoxg`lfjo fe ~bd bdon
fe ~bd }olgxdow, K Iow~xf`l~dw~ Wtxi 8==?14"8);
?8?7=,
87, Bd`lx`gb W# Wgboedx J# Ydhdx O# d~ oc, Ldfonktuol~
gbdjf~bdxo}p idldxo~dw o w`il`e gol~ ~tjfx xd*
w}flwd `l xdwdg~ohcd }olgxdo~`g golgdx y`~bft~
`lgxdow`li jfxh`n`~p; xdwtc~w fe o }xfw}dg~`ud }bowd
@@ ~x`oc, Oll Wtxi 8==218>2"5);?=?>88,
8>, Duolw NH# Uoxonbogboxp IX# Gxold GB# d~ oc,
]xdf}dxo~`ud idjg ~oh`ld*howdn gbdjfxon`o~`fl
efx }o~`dl~w y`~b xdwdg~ohcd ondlfgoxg`lfjo fe ~bd
}olgxdo~`gbdon, K Gc`l Flgfc 8==2185"8?);7>054=8,
84, Uoxonbogboxp IX# Yfcee XO# Gxold GB# d~ oc, ]xdf}*
dxo~ ud idjg`~oh`ld oln g`w}co~`l efccfydn hp
idjg ~oh`ld*howdn gbdjfxon`o~`fl efx xdwdg~ohcd
ondlfgoxg`lfjo fe ~bd }olgxdo~`g bdon, K Gc`l Fl*gfc 8==2185"8?);7>2904,
85, Bd`lx`gb W# ]dw~ocf{{` HG# Wgboedx J# d~ oc, ]xfw}dg*
~`ud }bowd @@ ~x`oc fe ldfonktuol~ gbdjf~bdxo}p
y`~b idjg`~oh`ld oln g`w}co~`l efx xdwdg~ohcd
ondlfgoxg`lfjo fe ~bd }olgxdo~`g bdon, K Gc`l Fl*
gfc 8==2185"?4);84857?,
89, Drfgx`ld oln dlnfgx`ld }olgxdow, @l; Dnid WH#
Hpxn NX# Gfj}~fl GG# d~ oc# dn`~fxw, OKGG golgdx
w~oi`li joltoc, 9~b dn ~`fl, Ldy Pfxa; W}x lidx1
8=?=, }, 8>?4=,
82, Etbxjol IJ# Cdogb WN# W~ocdp GO# d~ oc, Xo~`f*locd efx dl hcfg ud`l xdwdg~`fl `l ~bd ~xdo~jdl~ fe
}olgxdo~`g ondlfgoxg`lfjo onbdxdl~ ~f ~bd wt}d*
x`fx jdwdl~dx`g*}fx~oc ud`l gflectdlgd, ]olgxdo~`g
^tjfx W~tnp Ixft}, Oll Wtxi ?0051887"8);
?4>58,
80, dj}dxf JO# Oxlfcd~~` K]# Hdbxjol W# d~ oc, ]olgxd*
o~`g ondlfgoxg`lfjo, K Lo~c Gfj}x Golg Ld~y
8=?=12"0);098?=?9,
7=, Lo~`floc Gfj}xdbdlw`ud Golgdx Ld~yfxa @, Gc`l`goc
}xog~`gd it`ndc`ldw `l flgfcfip; }olgxdo~`g ondlf*
goxg`lfjo, Q}ne e`cdZ, 8=??, ?,8=?8, Ouo`cohcd o~;
b~~};&&yyy,lggl,fxi&}xfedww`flocw&}bpw`g`olVicw&]NE&
}olgxdo~`g,}ne, Oggdwwdn Lfudjhdx 9# 8=??,
7?, Ao~{ JB# ]`w~dxw ]Y# Cdd KD# d~ oc, Hfxndxc`ld
xdwdg~ohcd }olgxdo~`g golgdx; ybo~ boud yd cdoxldn
oln ybdxd nf yd if exfj bdxd6 Oll Wtxi Flgfc
8=??1?2"7);5=2?=,
78, Ohxojw XO# Cfyp OJ# FXd`ccp DJ# d~ oc, Gfjh`ldn
jfnoc ~p ~xdo~jdl~ fe xdwdg~ohcd oln hfxndx*
c`ld xdwdg~ohcd }olgxdow golgdx; dr}dx~ gflwdl*
wtw w~o~djdl~, Oll Wtxi Flgfc 8==01?5"9);
?94?5,
77, A`j # Jtxoaoj` # oaobowb` W# d~ oc, ]olgxdo~`g G^`joi`li; deedg~w fe n eedxdl~ `lkdg~ fl xo~dw oln
nfwdw fe gfl~xow~ jo~dx`oc, Xon`fcfip ?00018?8"?);
8?084,
7>, Wgbtdccdx I# Wgb`jo Y# Wgbtdccdx*Yd`ndaojj G#
d~ oc, Jtc~ nd~dg~fx G^ fe }olgxdow; deedg~w fe
gfl~xow~ jo~dx`oc ecfy xo~d oln `ln`u`ntoc`{dn wgol
ndcop fl dlbolgdjdl~ fe }olgxdow oln ~tjfx
gfl~xow~, Xon`fcfip 8==518>?"8);>>?2,
74, ^thc`l JD# dwwcdx EL# Gbdli WC# d~ oc, Deedg~ fe
`lkdg~`fl xo~d fe gfl~xow~ jdn`tj fl }olgxdo~`g
oln bd}o~`g bdc goc G , Xon`fcfip ?00018?="?);
09?=?,
75, Ecd~gbdx KI# Y`dxwdjo JK# Eoxxdcc JO# d~ oc, ]olgxd*
o~`g joc ilolgp; uoctd fe ox~dx`oc# }olgxdo~`g# oln
bd}o~`g }bowd `joi`li y`~b jtc~`*nd~dg~fx xfy G^,
Xon`fcfip 8==71880"?);2?0=,
79, Eopon CJ# J ~gbdcc NI, Joild~ g xdwflolgd
`joi`li fe }olgxdo~`g ondlfgoxg`lfjo, @l~ K Iow*
~xf`l~dw~ Golgdx 8==?17="?8);?084,
72, ]ojtacox D# Wdjdcao XG, JX `joi`li fe ~bd
}olgxdow, Joil Xdwfl @joi`li Gc l Lfx~b Oj
8==41?7"8);7?77=,
70, A`j KB# ]oxa WB# Pt DW# d~ oc, U`wtoccp `wfo~~dlto~`li}olgxdo~`g ondlfgoxg`lfjo o~ nploj`g*dlbolgdn
G^; exdqtdlgp# gc`l`goc oln }o~bfcfi`g gboxog~dx`w*
~`gw# oln n`oilfw`w o~ `joi`li droj`lo~`flw, Xon`*
fcfip 8=?=1849"?);2905,
^ojj d~ oc>85
http://www.nccn.org/professionals/physician_gls/PDF/pancreatic.pdfhttp://www.nccn.org/professionals/physician_gls/PDF/pancreatic.pdfhttp://www.nccn.org/professionals/physician_gls/PDF/pancreatic.pdfhttp://www.nccn.org/professionals/physician_gls/PDF/pancreatic.pdf -
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>=, ojj D]# Cfpdx DJ# Eox`o WG# d~ oc, Xd~xfw}dg~`ud
olocpw`w fe ntoc*}bowd JNG^ oln efccfy*t} DTW&
DTW*ELO `l ~bd n`oilfw`w fe }olgxdo~`g golgdx, Oh*
nfj @joi`li 8==9178"4);55=9,
>?, Y`dxwdjo JK# U`cjoll ]# I`fuoll`l` J# d~ oc, Dlnf*
wflfixo}bp*it`ndn e`ld*lddncd ow}`xo~`fl h`f}wp;
n`oilfw~`g oggtxogp oln gfj}c`go~`fl owwdwwjdl~,Iow~xfdl~dxfcfip ?0091??8">);?=2904,
>8, I`fuoll`l` J, ^bd }cogd fe dlnfwgf}`g tc~xowftln `l
h`c`f*}olgxdo~`g }o~bfcfip, Iow~xfdl~dxfc Gc`l H`fc
8=?=17>"20);>75>4,
>7, W~xfhdc A# Bd`lx`gb W# Hbtxd T# d~ oc, Gfl~xow~*
dlbolgdn ?2E*ENI ]D^&G ; ?*w~f}*wbf} `joi`li
efx owwdww`li ~bd xdwdg~oh`c`~p fe }olgxdo~`g golgdx,
K Ltgc Jdn 8==21>0"0);?>=2?7,
>>, Ndchdad N# Jox~`l YB, ]D^ oln ]D^&G^ efx }olgxd*
o~`g joc`ilolg`dw, Wtxi Flgfc Gc`l Lfx~b Oj 8=?=1
?0"8);8744>,
>4, Ct NW# Xdhdx BO# Axowlp XJ# d~ oc, Cfgoc w~oi`li fe
}olgxdo~`g golgdx; gx ~dx o efx tlxdwdg~oh`c ~p fe
jokfx udwwdcw ow xdudocdn hp }olgxdo~`g*}bowd#
~b`l*wdg~`fl bdc goc G , OKX Oj K Xfdl~idlfc
?0091?52"5);?>70>7,
>5, Cdd KA# A`j OP# A`j ]L# d~ oc, ]xdn`g~`fl fe uowgtcox
`lufcudjdl~ oln xdwdg~oh`c ~p hp jtc~`nd~dg~fx*xfy
G^ udxwtw JX `joi`li y`~b JX oli`fixo}bp `l
}o~ dl~w ybf tlndxydl~ wtxidxp efx xdwdg~ fl fe
}olgxdo~`g ntg~oc ondlfgoxg`lfjo, Dtx K Xon`fc
8=?=197"8);7?=5,
>9, Aoldaf FE# Cdd NJ# Yfli K# d~ oc, ]dxefxjolgd fejtc~`nd~dg~fx gfj}t~dn ~fjfixo}b`g oli`fixo}bp
`l nd~dxj`l`li wtxi`goc xdwdg~oh`c ~p fe }olgxdo~`g
bdon ondlfgoxg`lfjo, K Gfj}t~ Oww`w~ fjfix
8=?=17>"4);9782,
>2, [ojhfl` IO# Axtwaoc KH# Ufccjdx GJ# d~ oc, ]olgxd*
o~`g ondlfgoxg`lfjo; uoctd fe jtc~`nd~dg~fx G^
oli`fixo}bp `l }xdf}dxo~`ud duocto~ fl, Xon`fcfip
8==918>4"7);99=2,
>0, ojj D]# Cfpdx DJ# Eox`o W# d~ oc, W~oi`li fe
}olgxdo~ g golgdx y`~b jtc~ nd~dg~fx G^ `l ~bd
wd~~`li fe }xdf}dxo~`ud gbdjfxon`o~`fl ~bdxo}p, Oh*
nfj @joi`li 8==517?"4);4529>,
4=, Uoccw G# Oln`o D# Wolgbd{ O# d~ oc, Ntoc*}bowd
bdc`goc G^ fe }olgxdo~`g ondlfgoxg`lfjo; owwdww*
jdl~ fe xdwdg~oh`c ~p hdefxd wtxidxp, OKX Oj K
Xfdl~idlfc 8==81?92">);28?5,
4?, Oxwcol O# Htoldw # Id`~tli K , ]olgxdo~`g goxg`*
lfjo; JX# JX oli`fixo}bp oln nploj`g bdc goc
G^ `l ~bd duocto~`fl fe uowgtcox `luow`fl, Dtx K Xo*
n`fc 8==?172"8);?4?0,
48, Owcol`ol B# Wocdj X# Cdd K# d~ oc, DTW n`oilfw`w fe
uowgtcox `luow`fl `l }olgxdo~`g golgdx; wtxi`goc oln
b`w~fcfi`g gfxxdco~dw, Oj K Iow~xfdl~dxfc 8==41?=="5);?72?4,
47, Wfx`olf O# Gow~dccw O# Optwf G# d~ oc, ]xdf}dxo~`ud
w~oi`li oln ~tjfx xdwdg~oh`c ~p owwdwwjdl~ fe
}olgxdo~`g golgdx; }xfw}dg~`ud w~tnp gfj}ox li
dlnfwgf}`g tc~xowflfixo}bp# bdc`goc gfj}t~dn ~f*
jfixo}bp# joild~`g xdwflolgd `joi`li# oln
oli`fixo}bp, Oj K Iow~xfdl~dxfc 8==>100"7);
>084=?,
4>, Ndy`~~ K# Ndudxdotr HJ# Cdbjol IO# d~ oc, Gfj}ox*
`wfl fe dlnfwgf}`g tc~xowftln oln gfj}t~dn
~fjfixo}bp efx ~bd }xdf}dxo~ ud duocto~ fl fe}olgxdo~`g golgdx; o wpw~djo~`g xdu`dy, Gc`l Iow~xf*
dl~dxfc Bd}o~fc 8==51>"5);9?984 Qqt`{; 55>Z,
44, ]oa{on E# Ixfudw OJ# Dcc ]K, ^bd xfcd fe }fw`~xfl
dj`ww`fl ~fjfixo}bp `l ~bd joloidjdl~ fe
}olgxdo~`g golgdx, Wdj`l Ltgc Jdn 8==5175"7);
8>245,
45, Hoxdw X# Nfbjdl HJ# Gxdjdx`tw T# d~ oc, Xdwtc~w fe
}fw`~xfl dj`ww`fl ~fjfixo}bp y`~b ectfx ld*?2
cohdcdn ectfxfndfrpictgfwd `l n`eedxdl~`oc n`oilfw`w
oln w~oi`li fe }olgxdo~`g goxg`lfjo, Xon`fcfid
?005175"4);>74>= Q`l IdxjolZ,
49, Hoxdw X# Acdudx ]# Bot}~joll W# d~ oc, E*?2 ectfxf*
ndfrpictgfwd ]D^ `l u`uf duocto~`fl fe }olgxdo~`g
ictgfwd jd~ohfc`wj efx nd~dg~`fl fe }olgxdo~`g
golgdx, Xon`fcfip ?00>1?08"?);9025,
42, Aoco [# Uocda U# Bcouwo K# d~ oc, ^bd xfcd fe G^
oln dlnfwgf}`g tc~xowftln `l }xd*f}dxo~ ud w~oi*
`li fe }olgxdo~`g golgdx, Dtx K Xon`fc 8==9158"8);
?550,
40, J`~wtbowb` # Iboeox` W# Gboli GP# d~ oc, Dlnf*
wgf}`g tc~xowftln*it`ndn e`ld lddncd ow}`xo~`fl fe
~bd }olgxdow; gp~fjfx}bfcfi`goc duocto~`fl y`~b
dj}bow`w fl ondqtogp owwdwwjdl~# n`oilfw~`ggx`~dx`o oln gfl~oj`lo~`fl exfj ~bd iow~xf`l~dw~`loc
~xog~, Gp~f}o~bfcfip 8==51?9"?);7>>?,
5=, I`fuoll`l` J# ^bfjow H# Dxyol H# d~ oc, Dlnf*
wgf}`g tc~xowftln dcow~fixo}bp efx duocto~`fl fe
cpj}b lfndw oln }olgxdo~ g jowwdw; o jtc~ *
gdl~dx w~tnp, Yfxcn K Iow~xfdl~dxfc 8==01?4"?7);
?42907,
5?, X`gb~dx IJ# W`jfl G# Bfeejoll U# d~ oc, Bpnxfw}`xoc
G^ fe ~bd }olgxdow `l ~b`l wdg~`fl ~dgbl`qtd, Xon`fc*
fid ?005175"4);709>=4 Q`l IdxjolZ,
58, xdnd J# Xtjw~on~ H# Ydlnc A# d~ oc, Tc~xoeow~
joild~`g xdwflolgd `joi`li `j}xfudw ~bd w~oi`li
fe }olgxdo~ g ~tjfxw, Oll Wtxi ?0091885">);
707>=4 Qn`wgtww`fl; >=49Z,
57, Gocgtcc C# Gowond` X# N`ogflf N# d~ oc, Xfcd fe w}`xoc
gfj}t~dx`{dn ~fjfixo}bp `l ~bd w~oi`li fe }olgxd*
o~`g goxg`lfjo, Xon`fc Jdn ?002104">);7>>2 Q`l
@~oc`olZ,
5>, @at~o P# ^oaojfx` B# @adno F# d~ oc, Nd~dg~`fl fe c`udx
jd~ow~owdw wdgflnoxp ~f }olgxdo~`g golgdx; t~`c`~p
fe gfjh`ldn bdc`goc gfj}t~dn ~fjfixo}bp ntx`li
ox~dx`oc }fx~fixo}bp y`~b h`}bow`g gfj}t~dn ~fjfi*
xo}bp*oww`w~dn bd}o~`g ox~dx`fixo}bp, K Iow~xfdl~dx*fc 8=?=1>4"?8);?8>?5,
54, Jf~fwti T# @gb`aoyo ^# Jfx`woao B# d~ oc, Nd~dg~`fl
fe }olgxdo~`g goxg`lfjo oln c`udx jd~ow~owdw y`~b
ionfrd~`g og`n*dlbolgdn JX `joi`li; gfj}ox`wfl
W~oi`li ]olgxdo~`g Ondlfgoxg`lfjo >89
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y`~b gfl~xow~*dlbolgdn jtc~`*nd~dg~fx xfy G^, Xon`*
fcfip 8=??185="8);>>547,
55, Wobol` NU# Aocuo W]# E`wgbjol OK# d~ oc, Nd~dg~`fl
fe c`udx jd~ow~owdw exfj ondlfgoxg`lfjo fe ~bd
gfcfl oln }olgxdow; gfj}ox`wfl fe jolioefn`} x
~x`wfn`tj*dlbolgdn c`udx JX@ oln ybfcd*hfnp
ENI ]D , OKX Oj K Xfdl~idlfc 8==41?24"?);870>5,
59, Exfbc`gb O# N`dndx`gbw GI# W~o`h C# d~ oc, Nd~dg~`fl
fe c`udx jd~ow~owdw exfj }olgxdo~`g golgdx tw`li
ENI ]D^, K Ltgc Jdn ?0001>="8);84=4,
52, N`dndx gbw GI, ]olgxdo~`g golgdx, @l; Xtbcjoll K#
Fdbx ]# H`dxwoga BK# dn`~fxw, ]D^ `l flgfcfip,
Hdxc`l; W}x`lidx*Udxcoi1 ?000, }, ?827>,
50, ]`w~dxw ]Y# Cdd KD# Uot~bdp KL# d~ oc, Co}oxfwgf}p
`l ~bd w~oi`li fe }olgxdo~`g golgdx, Hx K Wtxi 8==?1
22"7);78479,
9=, @{t`wb` A# Pojojf~f P# Wolf # d~ oc, @j}og~ fe ?2*
ectfxfndfrpictgfwd }fw`~xfl dj`ww fl ~fjfixo}bp
fl ~bd joloidjdl~ fe }olgxdo~`g golgdx, K Iow~xf*
`l~dw~ Wtxi 8=?=1?>"9);??4?2,9?, Duolw NH# Gxold GB# Gboxlwolioudk G# d~ oc, ^bd
onndn uoctd fe jtc~`n`wg`}c`loxp goxd efx }o~ dl~w
y`~b }olgxdo~`g golgdx, Oll Wtxi Flgfc 8==21
?4"2);8=922=,
98, If~~c`dh X# d~ oc, G^ flgf }x`joxp }olgxdow joww
~dj}co~d, 8=??, Ouo`cohcd o~; b~~};&&yyy,xonxd}fx~,
fxi&~r~&=====?2, Oggdwwdn Lfudjhdx ?># 8=??,
^ojj d~ oc>82
http://www.radreport.org/txt/0000018http://www.radreport.org/txt/0000018http://www.radreport.org/txt/0000018http://www.radreport.org/txt/0000018