Most patients with newly diagnosed pancreatic cancer have disease that is considered locally advanced and unresectable at the initial diagnosis. Ultrasound is the common first line imaging for the evaluation of patients with a suspected pancreatic tumor.

Ultrasound imaging evaluation of a pancreatic tumor is basically the same as described in the 2 previous lessons.

Sophisticated imaging as CT or NMR for localization can complete the ultrasound evaluation, particularly in the case of suspected obstructive jaundice, for patients who have a potentially resectable disease at the initial diagnosis (10 to 20%).

Between 60 to 70 % of pancreatic cancers originate from the pancreatic head that is easily seen sonographically.

The hallmark of pancreatic head cancer is the double duct sign with both bile duct dilatation and pancreatic duct dilatation.