Pancreatic and Liver Cancer Screening: Guidelines for High-Risk Patients

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• Pancreatic Cancer Screening Challenges
• Liver Cancer Screening Effectiveness
• High-Risk Pancreatic Cancer Groups
• Imaging Tools: MRI and Ultrasound
• The Role of Medical Second Opinion
• Full Transcript

Pancreatic Cancer Screening Challenges

Dr. Kent Yucel, MD, a specialist in MRI and CT, provides a clear perspective on pancreatic cancer screening. He states that screening the general population for pancreatic cancer is not currently recommended. The disease is both deadly and fast-growing. A significant challenge is the high prevalence of benign pancreatic cysts.

Dr. Kent Yucel, MD, explains that these benign lesions are often found during screening. It is difficult to determine their significance when they are small. This leads to years of unnecessary follow-up scans for patients. The time window to detect a treatable pancreatic cancer is very short. Screening with annual CT or MRI does not improve outcomes over standard medical care.

Liver Cancer Screening Effectiveness

In contrast to pancreatic cancer, liver cancer screening is highly effective for specific high-risk patients. Dr. Kent Yucel, MD, identifies this as a critical exception. Patients with underlying liver disease are the primary candidates for surveillance. This includes individuals with cirrhosis or fibrosis from various causes.

Common causes are alcoholism, viral hepatitis B, and hepatitis C. These patients face a significant risk of developing hepatocellular carcinoma. Annual screening with ultrasound and liver MRI is the standard of care. Dr. Kent Yucel, MD, emphasizes that this proactive approach often finds liver cancer at an early, curable stage.

High-Risk Pancreatic Cancer Groups

While general screening is not advised, Dr. Yucel acknowledges certain high-risk groups may benefit. These patients have a significantly elevated genetic or medical predisposition to pancreatic cancer. Key risk factors include a strong family history of the disease and specific genetic mutations.

These mutations include BRCA1, BRCA2, and p16. Other conditions like hereditary pancreatitis, Peutz-Jeghers syndrome, and cystic fibrosis also increase risk. For these select individuals, a personalized screening plan with a specialist may be appropriate. Dr. Anton Titov, MD, often discusses the importance of genetic counseling in such cases.

Imaging Tools: MRI and Ultrasound

The choice of imaging modality is crucial for effective cancer surveillance. Dr. Kent Yucel, MD, is an expert in utilizing MRI and CT for diagnosis. For liver cancer screening in cirrhotic patients, both ultrasound and MRI are employed. MRI, including MRCP sequences, offers detailed visualization of the liver and bile ducts.

For pancreatic concerns, MRCP can visualize the pancreatic duct. However, its utility in screening is limited by the factors Dr. Yucel described. The CA 19-9 blood test is sometimes used but is only about 80% accurate. It is not a reliable standalone screening tool for the general population.

The Role of Medical Second Opinion

Seeking a medical second opinion is a powerful step for patients navigating a cancer diagnosis or high-risk status. Dr. Anton Titov, MD, highlights its importance for confirming treatment plans. A second opinion can verify if advanced imaging like MRI or MRCP is truly indicated. It also helps ensure the chosen treatment strategy is the most current and effective available.

This process provides patients and families with confidence in their care journey. Consulting with a specialist like Dr. Kent Yucel, MD, can offer clarity on complex radiology findings. It is a proactive measure to achieve the best possible health outcomes.

Full Transcript

Pancreatic cancer screening and liver cancer screening are hot topics. Pancreatic cancer is a deadly disease. Many patients with viral hepatitis and fatty liver are at high risk for liver cancer.

Dr. Anton Titov, MD: How should pancreatic cancer screening be done? Is it effective to screen patients for pancreatic cancer with MRCP or CT?

Pancreatic cancer screening and liver cancer screening are important. Early detection of pancreatic cancer is most important. All doctors and patients hope for effective screening tests for pancreatic cancer. Screening for pancreatic cancer in the general population is not currently recommended. The pancreatic cancer screening test is the oncogene CA-19-9, but it is only 80% accurate.

Medical second opinion can confirm when MRI or MRCP in high-risk cancer patients is indicated. Medical second opinion also helps to choose the best treatment strategy for pancreatic cancer or liver cancer. Seek medical second opinion on pancreatic cancer and liver cancer and be confident that your treatment is the best available today.

Dr. Kent Yucel, MD: MRI screening for pancreatic cancer works for high-risk patients with a family history of pancreatic cancer. Pancreatic cancer early detection is important in patients with genetic mutations (BRCA1, BRCA2, p16) that predispose to pancreatic cancer.

People with viral hepatitis are at high risk for liver cancer. They should be screened for early hepatocellular carcinoma. Screening for early signs of liver cancer by MRI and MRCP is effective in high-risk patients.

Dr. Anton Titov, MD: Is MRCP an opportunity to screen for pancreatic or liver cancers, both of which are known to be very deadly?

Dr. Kent Yucel, MD: No, with one exception. Pancreatic cancer is very deadly. It is also very fast-growing. The pancreas is another area where there are benign lesions and benign cysts. So screening by MRCP does find a lot of unimportant, insignificant benign lesions in the pancreas.

When they are small, again, we rarely know whether they are significant or not. So we end up following patients for many years to prove they are not growing. But unfortunately, the time window is short to find pancreatic cancer between the time it is detectable by MRI and the time it has grown to the size when we would have found it anyway.

Doing CT or MRI every year will not detect the cancers in time to do anything about them. So screening is unlikely to do better than we would have done by just normal physical exam and normal medical care. Screening for pancreatic cancer, although it is a terrible disease and we'd love to find a way to prevent it, is not helpful.

The one area where MRI is helpful in screening is in patients who have liver cirrhosis or fibrosis of the liver, or fatty liver disease. It can be due to alcoholism, or it can be due to viral disease, hepatitis B or hepatitis C. These patients are at significant risk of getting liver cancer.

Ultrasound as well as liver MRI and MRCP are used to screen those patients annually to look for early liver cancer. We can often find liver cancer in those patients at an early enough stage to treat them and cure the cancer.

So this is one exception for screening for liver and pancreatic disease by MRCP. But it is screening not in normal patients, but in patients with underlying liver disease. MRI and ultrasound screening are used.

Patients with high risk for pancreatic cancer may benefit from screening. High risk for cancer of the pancreas includes chronic pancreatitis, family history of pancreatic cancer, hereditary pancreatitis, Peutz-Jeghers syndrome, cystic fibrosis, and familial atypical multiple mole melanoma (FAMMM).

Dr. Anton Titov, MD: Should patients be screened for cancer?