Which imaging modalities are recommended for the initial assessment of suspected pancreatic cancer in primary care?

For the initial assessment of suspected pancreatic cancer in primary care, the recommended imaging modality is an urgent, direct access contrast-enhanced computed tomography (CT) scan, ideally a pancreatic protocol CT scan, to be performed within 2 weeks. If CT is not immediately available, an urgent ultrasound scan may be considered as an alternative initial investigation. This approach is advised particularly for patients aged 60 and over presenting with symptoms such as weight loss combined with abdominal pain, diarrhoea, back pain, nausea, vomiting, constipation, or new-onset diabetes, which raise suspicion of pancreatic cancer. The pancreatic protocol CT scan provides detailed imaging of the pancreas and surrounding structures, facilitating early detection of pancreatic abnormalities and potential malignancy. If the CT scan reveals pancreatic abnormalities but the diagnosis remains unclear, further imaging with fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) and/or endoscopic ultrasound (EUS) with EUS-guided tissue sampling is recommended in secondary care settings. Magnetic resonance cholangiopancreatography (MRI/MRCP) may also be used, especially for pancreatic cysts or when additional information is needed after CT. These recommendations align with UK NICE guidelines and are supported by evidence from recent literature emphasizing the high sensitivity and specificity of pancreatic protocol CT in detecting pancreatic cancer and guiding subsequent management decisions.