Background: Early diagnosis and complete removal of pancreatic adenocarcinoma (PC) is essential to improve its poor prognosis. It is necessary to find PC when it is small and at an early stage if surgical treatment is to be successful. This is an investigation of the clinicopathologic features of small PC.
Methods: Thirty-one resected and histopathologically examined cases of small PC, 2 cm or less in greatest dimension, were collected from 7 institutions between 1989 and 1994, and their clinicopathologic features were analyzed in detail.
Results: Eighteen patients (58.1%) had some symptoms or signs at the time of diagnosis, however, the other 13 (41.9%) had no symptoms. There was no sensitive blood test for the detection of small PC. The detection rates of the pancreatic tumor mass on ultrasonography, endoscopic ultrasonography, and computed tomography were 64.5% (20/31), 73.7% (14/19), and 64.5% (20/31), respectively. Only 13 patients (41.9%) were in International Union Against Cancer (UICC) Stage I, and the other 18 were in Stage III or IV due to lymph node metastasis or peritoneal dissemination. The overall 4-year postoperative survival rate was 54.5% and that of patients in Stage I was 77.9%.
Conclusions: To detect a small PC, a thorough examination may be required in patients with slightly abnormal findings on laboratory tests or imaging modalities, even if the patient is asymptomatic. PC 2 cm or less and belonging to Stage I may be regarded as an early carcinoma, because of its good prognosis.