Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
To differentiate pancreatic cancer from other causes of obstructive jaundice in your patients:
- Refer all patients aged 40 years and over presenting with jaundice urgently via a suspected cancer pathway to exclude pancreatic cancer, as jaundice in this age group is often indicative of serious underlying malignancy NICE CKS.
- Assess liver function tests (LFTs) for a cholestatic or obstructive pattern (raised bilirubin with raised alkaline phosphatase) which warrants referral to a gastroenterologist or upper gastrointestinal surgeon for further evaluation NICE CKS.
- For patients with obstructive jaundice and suspected pancreatic cancer, arrange a pancreatic protocol CT scan before any biliary drainage to identify pancreatic masses or ductal obstruction NICE NG85.
- If CT findings are inconclusive, consider further imaging with fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) and/or endoscopic ultrasound (EUS) with EUS-guided tissue sampling to obtain cytological or histological diagnosis NICE NG85.
- In cases where endoscopic retrograde cholangiopancreatography (ERCP) is performed to relieve obstruction and no tissue diagnosis exists, obtain biliary brushings for cytology NICE NG85.
- Consider other causes of obstructive jaundice such as gallstones, which are a common cause of cholestatic jaundice and may require referral to an upper gastrointestinal surgeon NICE CKS.
- Exclude other differential diagnoses such as chronic pancreatitis, autoimmune pancreatitis, or pancreatic cystic lesions by clinical assessment and imaging, as these can mimic pancreatic cancer but have different management pathways NICE CKS,NICE NG104.
- Immediate referral or admission is indicated for all patients with unexplained jaundice due to the high likelihood of serious pathology including malignancy NICE CKS.