Diagnostic difficulty of pancreatic head adenocarcinoma, a literature review

Keywords

pancreatic head adenocarcinoma - staging and diagnosis - pancreatic neoplasm

Pancreatic head adenocarcinoma (PHAC) is a highly aggressive neoplasm, often diagnosed at advanced stages due to the absence of early symptoms. Early diagnosis is crucial and involves a combination of imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI), along with biomarkers like carcinoembryonic antigen (CEA) and CA 19-9. Staging is essential for determining prognosis and treatment and is commonly performed using the TNM (Tumor, Node, Metastasis) system. Scores such as the Modified Glasgow Prognostic Score (mGPS) and the Pancreatic Cancer Staging System (PCSS) have been used to assess clinical condition and treatment response, contributing to more precise stratification. Recent studies highlight the importance of accurate staging in selecting therapies, surgeries, and/or chemotherapies to improve patient survival and quality of life. The objective of this literature review is to analyze the diagnostic challenges of pancreatic head adenocarcinoma, emphasizing the need for and importance of staging scores for patients with this neoplasm. For this literature review on PHAC, studies from the past 10 years related to the topic were used. The bibliographic search was conducted in online virtual libraries such as PubMed, Scielo, BVS, and guidelines from the Brazilian Society of Clinical Oncology (SBOC) and the American Society of Clinical Oncology (ASCO) on this pathology, using the terms “pancreatic head adenocarcinoma,” “staging and diagnosis of pancreatic neoplasm.” With significant advancements in the diagnosis and staging of PHAC, recent studies emphasize the use of the TNM system and PCSS for its evaluation. The diagnostic difficulty is due to its anatomical location and often asymptomatic nature in the early stages. When symptoms are present, they may be mistaken for other conditions, leading to delays in diagnosis and poorer prognosis. Additionally, changes in imaging tests may be subtle, such as pancreatic duct dilation and focal masses, complicating diagnosis. The combination of diagnostic and staging approaches represents a significant advancement in managing PHAC, concluding that TNM precision enhances understanding of progression and is also crucial for optimizing clinical management and improving prognosis for patients with PHAC.

Corresponding author: Maria Clara Moraes Rangel (e-mail: [e-mail]).