New diagnostic methods of the carcinoma of the pancreas

Prognosis of the carcinoma of the pancreas is very poor, because of difficulty of its early diagnosis and its radical operation. Only 12% out of 69 cases who were treated in our hospital dur ing past 9 years were operated radically and only 2 cases of the carcinoma of the Papil la vater i survive now. Now, the development of new methods for the early diagnosis is a very impor tan t problem. We are t ry ing new diagnostic methods, and report thei r value and l imit in this paper. (1) Laparoscopy: A laparoscopy was carr ied out for 21 cases of the carcinoma of the pancreas and the Papil la vater i . The normal pancreas and small cancer of the pancreas are never visible by a laparoscopy, however, large pancreat ic cancer was seen in 6 cases. These mass, with uneven surface and hard consistency, were si tuated deeply upper or lower s tomach and covered wi th omentum. The findings of the l iver are almost normal in the case of the carcinoma of the body or tail, and swollen l iver wi th greenish color are seen in those of the head. These findings of the l iver are not so valuable for diagnosis, however, those of the gal lbladder are more character is t ic . The gal lbladder is swollen in almost cases with or without Courvoisier 's sign or jaundice, and its surface has l i t t le change. These findings are very different f rom those of the gallstone disease or the carc inoma of the gallbladder, however, almost the same as the carcinoma of the choledochus. (2) Ul t rasonic methods: Ultrasonic diagnosis is a new methods of soft t issue visualization. The usual method f rom the body surface was carr ied out in 19 cases of the carcinoma of the pancreas and int raper i toneal method wi th a narrow probe placed direct ly on the abdominal organs under laparoscopic observation in 11 cases. A mal ignant echoes are detected in 12 cases (57%) of them. When mal ignant echoes are detected from the pancreat ic area ot the cases whose laparoscopic picture shows "Courvois ie r ' s s ign" , the carc inoma of the pancreas is correctly diagnosed. By this method, morever , the differentiation of o ther benign tumor, which laparoscopic finding is s imilar to the mal ignant mass, is capable. (3) Int raper i toneal Radioactive Phocphorus Counting: We are invest igat ing the value of diagnosis of intraper i toneal neoplasm, us ing 32p which concentra tes in the mal ignant neoplasm more than normal tissues. At 24 hours a f te r intravenous injection of 400N600 microcuries of 32p acetate, the needle type of G-M tube is inserted into the peri toneal cavity under laparoscopic observation and E-ray is measured by radia t ion counter f rom the surface of intraper i toneal organs. We detected higher counts f rom the pancreatic area of the 2 out of 4 cases of the carcinoma of the pancreas and Papil la vateri , comparing with the counts of the surrounding normal t issues. But this method is valuable only in the cases which neoplasm exposes over the surface of the organ. (4) Pancreozymin Secretin test : The increasing curve of volume of the pancreatic juice and the concentra t ion of enzymes in it is very low both in the cases of the carcinoma of the pancreas and of chronic pancreat i t is . In other words, this phenomenon shows severe depletion of the exocrine function of the pancreas, and is not character is t ic for the cancer of this organ. Conclusion: Each method above ment ioned has both some value and some l imit for diagnosis of the carc inoma of the pancreas, however, the combined use of these methods enhances the i r diagnostic value.