Clinical and Secretory Differences in Pancreatic Cancer and Chronic Pancreatitis

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Abstract
The differential diagnosis between chronic pancreatitis and pancreatic cancer can be very difficult. In 60 patients with either of these conditions, who had satisfactory ERCP [endoscopic retrograde cholangiopancreatography] study, clinical features were correctly matched with the final diagnosis by discriminant analysis in 44 (73%). The sensitivity of ERCP radiographic findings in pancreatic cancer was 80% and sensitivity of cytology was 54%. To see if exocrine function was specific for cancer, fresh pancreatic secretions were aspirated in 27 patients at the time of ERCP. By isoelectric focusing, a pattern of extreme zymogen depletion was observed in chronic alcoholic pancreatitis (group 1), pancreatic cancer (group 2) and chronic nonalcoholic pancreatitis (group 3). The 3 groups were not distinguishable. By contrast, significant changes in albumin, IgG and IgA concentrations were seen in group 2. The 2 groups of pancreatitis had similar concentrations of albumin and IgA. The ratio of albumin to IgG was also different in group 2 from other groups, suggesting different mechanisms for the appearance of proteins in pancreatic secretions. Nonzymogen protein levels can distinguish chronic pancreatitis from pancreatic cancer and further study of them may identify useful tumor-specific markers.