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Pancreatic Cancer — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyPancreatic CancerRACP Adult Medicine

A 50-year-old man with type 2 diabetes presents with unintentional weight loss of 8 kg over 3 months, epigastric pain radiating to the back, and new-onset diabetes. CT abdomen reveals a 3.5 cm mass in the pancreatic body with encasement of the superior mesenteric artery. What is the most appropriate next step?

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Correct answer: D — Endoscopic ultrasound-guided biopsy

The SMA encasement makes this locally advanced/borderline unresectable pancreatic cancer. EUS-guided FNA/biopsy is needed to confirm tissue diagnosis before commencing treatment. NCCN and Cancer Council Australia guidelines recommend tissue confirmation before initiating chemotherapy. If confirmed, neoadjuvant therapy may be considered to assess for downstaging.

Reference: Cancer Council Australia – 2020 – Optimal Care Pathway for Pancreatic Cancer; NCCN – 2025 – Pancreatic Cancer