Pancreatic head mass, what can be done? Diagnosis: laboratory.

In the field of laboratory medicine, efforts are being made to provide clinicians with evidence conducive to correct clinical decision-making in patients with pancreatic diseases. In patients with pancreatic head mass, the diagnosis can only be made by deciding whether or not pancreatic cancer is present. The diagnostic work-up may start with the study of different biological samples, including sera and/or urine which are easy to collect, unlike pancreatic juice, bile or pancreatic tissue samples, which require invasive techniques, and are therefore less widely used. The serological diagnosis of pancreatic head mass depends mainly on the use of tumor markers, which must have a sensitivity and a specificity of almost 100% if they are to be clinically effective, allowing a differential diagnosis between cancer and benign diseases of the pancreas (which are mainly chronic pancreatitis). Several families of molecules have been studied as possible tumor markers, including oncofetal antigens (CEA and POA), pancreatic enzymes, blood group-related antigens and, more recently, oncogenes and tumor suppressor genes [1, 2]. Neither pancreatic enzymes nor CEA are useful in clinical practice, since they have a sensitivity and specificity of below 50%. Blood group related antigens, CA 19-9 in particular, have the highest diagnostic efficacy in distinguishing between pancreatic cancer and chronic pancreatitis. Figure 1 shows the biochemistry of the Lewis blood group-related antigens [3]. Figure 1. Blood group related antigens