Pancreatic cancer differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]

Overview

Pancreatic cancer must be differentiated from choledocholithiasis, pancreatic pseudocyst, cystic neoplasm and carcinoma of the biliary tract

Differentiating Pancreatic Cancer from other Diseases

The following diseases have a similar presentation as pancreatic cancer:

Origin	Disease	Differentiation based on Investigations
Pancreas	Chronic pancreatitis Autoimmune pancreatitis Pseudocyst of pancreas Neuroendocrine tumors of pancreas Gastrinoma VIPoma Somatostatinoma Insulinoma	Imaging: Non-contrast helical CT Biopsy findings Serum IgG4 levels for autoimmune pancreatitis For pancreatic NETs: Gastrin levels Somatostatin levels Insulin levels Serum electrolytes
Bile duct	Choledocholithiasis Gallstones (Cholelithiasis) Choledochal Cysts Cholangiocarcinoma Bile duct strictures Cholangitis Cholecystitis	Imaging: MRI MRCP USG bile duct ERCP Biopsy findings
Duodenum	Ampullary cancer Duodenal cancer	Imaging: MRI ERCP Upper GI Endoscopy Biopsy findings
Lymphovascular tissue	Abdominal aortic aneurysm Intestinal ischemia Lymphomas Gastric Pancreatic	Imaging: MRI MR Angiography CT Angiography Biopsy for lymphoma
Metastasis	Skin(Melanoma) Kidney Breast Colon Liver(Hepatocellular carcinoma) Stomach	Imaging: MRI PET scan CT Biopsy Specific markers for different cancers: HCC: AFP Breast: BRCA 1 and 2 Colon cancer: CEA Melanoma: S100