Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas
- Pancreatic Section of the British Society of Gastroenterology, Pancreatic Society of Great Britain and Ireland, Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, Royal College of Pathologists, Special Interest Group for Gastro-Intestinal Radiology
- Correspondence to:
MrC D Johnson
University Surgical Unit, Mail point 816, Southampton General Hospital, Southampton SO16 6YD, UK;
- CT, computed tomography
- MR, magnetic resonance
- MRCP, magnetic resonance cholangiopancreatography
- ERCP, endoscopic retrograde cholangiopancreatography
- MRA, magnetic resonance angiography
- FAP, familial adenomatous polyposis
- EUS, endosonography
- 5-FU, 5-fluorouracil
1.0 GUIDELINES—SUMMARY DOCUMENT
The following recommendations are introduced by brief statements which summarise the evidence and discussion presented in the relevant section of the full text of the guidelines.
1.1 Incidence, mortality rates, and aetiology
Pancreatic cancer is an important health problem for which no simple screening test is available. The strongest aetiological association is with cigarette smoking, although at risk groups include patients with chronic pancreatitis, adult onset diabetes of less than two years’ duration, hereditary pancreatitis, familial pancreatic cancers, and certain familial cancer syndromes. Periampullary cancers are a feature of familial adenomatous polyposis.
Continued health education to reduce tobacco consumption should lower the risk of developing pancreatic carcinoma (grade B).
All patients at increased inherited risk of pancreatic cancer should be referred to a specialist centre offering specialist clinical advice and genetic counselling and appropriate genetic testing (grade B).
Secondary screening for pancreatic cancer in high risk cases should be carried out as part of an investigational programme coordinated through specialist centres (grade B).
Examination and biopsy of the periampullary region is important in patients with longstanding familial adenomatous polyposis. The frequency of endoscopy is determined by the severity of the duodenal polyposis (grade B).
Patients with stage 4 duodenal polyposis who are fit for surgery should be offered resection (grade B).
Most pancreatic cancers are of ductal origin and present at a stage when they are locally advanced, and exhibit vascular invasion and lymph node metastases. Variants of ductal carcinomas and other malignant tumours of the pancreas are rare.
Proper recognition of variants of ductal carcinomas and other malignant tumours of the pancreas require specialist pathological expertise (grade C).
The minimum data set proposed by the Royal College of Pathologists (see appendix for details) should be used for reporting histological examination of pancreatic resection specimens (grade C).
1.3 Clinical features
In the majority of patients, the clinical …