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A work-up for cancer can be a stressful period. What begins as an incidentally discovered “mass” found on the pancreas, can result in a long road of tests, studies, and psychological duress leading to an eventual treatment plan or surgery, chemo or neither. In the case of pancreas cancer, the average time from discovery to treatment is 5.5 weeks (which for the patient, often seems like 5.5 years).
In the case of pancreas cancer–one of the most aggressive cancers out there in terms of growth rate and time to metastasis (spreading)–many patients are overly worked-up. Evaluations have been know to last for months, much of which is spent waiting for scheduled tests and studies, or appointments with specialists. While some cases are complex and require multiple studies, tests, and procedures, VERY FEW actually require much more than a simple high-quality CT scan.
Despite the reality that most cancer are quickly evaluated enough to make a treatment plan, patients often have “the kitchen sink” thrown at them, including studies such as a PET scan which has never been proven to help in the evaluation of pancreas cancer like it has for lung, lymphoma and other cancers. Pancreas specialists have long noted that patients who have clearly removable cancers have too many unnecessary delays before surgery, most of which are the result of non-specialists trying to do a “thorough” work-up before referral to a surgeon. The result is patients are told they need to have biopsies, lab tests, or MRI’s. But when the results of these many tests do not influence the management of the cancer, then they are unnecessary. Furthermore, they delay treatment for a cancer known to grow especially fast.
Take a patient with a newly discovered pancreas tumor. If the mass meets criteria for surgical removal, then it should be removed immediately. Needle biopsies sample only a small piece of a mass and the biopsy can be negative even when there is a small focus of cancer within the tumor. Consider that if the biopsy is negative and the recommendation would be to still have it removed, then the biopsy does not really influence the treatment/surgery plan and should not be done. Futhermore, a simple CT is as good of a test as any in determining whether pancreas cancer has spread or not. So the take home message is: Beware of too many delays for tests and studies which do not matter.
Pancreas cancer is one of the fastest growing cancers that exist within the universe of cancer. Thus prompt surgical removal for appropriate cancer should be the goal and patients should ask with every intermediate step: “Will this change what we do?” If I as a pancreas specialist has an incidentally found 4 cm tumor discovered on my pancreas on a routine CT scan done for another reason, I would likely find myself a surgeon and get it out within a few days.
Be sure to discuss these issues with your doctor.