How can I differentiate between pancreatic cancer and other causes of obstructive jaundice in my patients?

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 ¹.
• 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 ¹.
• 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 ².
• 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 ².
• In cases where endoscopic retrograde cholangiopancreatography (ERCP) is performed to relieve obstruction and no tissue diagnosis exists, obtain biliary brushings for cytology ².
• 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 ¹.
• 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 ³,⁴.
• Immediate referral or admission is indicated for all patients with unexplained jaundice due to the high likelihood of serious pathology including malignancy ¹.