Early-detection demo · Pancreatic cancer

Branch-duct IPMN with high-risk stigmata — pre-malignant catch

1.6 cm branch-duct IPMN with mural nodule — worrisome stigmata; pre-malignant lesion identified.

Patient: Robert · 64 · new-onset diabetesModality: MRIRisk: elevated · 62/100

Risk profile

What OCTON knew before the scan

Risk

elevated

Tier

elevated

Father had pancreatic adenocarcinoma at 67. New-onset diabetes 8 months ago without family history of T2DM. 30 pack-year smoker (quit 5 yrs).

Contributing factors

First-degree relative with pancreatic adenocarcinoma+22
New-onset diabetes after age 50+15
Heavy smoking history (30 pack-year)+12
Age >60+8
BMI 31 (obese)+5

Narrative

Robert is in the elevated-risk band. New-onset diabetes after 50 in a thin/middle-aged adult is a recognized harbinger — it can precede pancreatic adenocarcinoma by 24–36 months. Combined with his FDR history, EUS or MRCP surveillance is warranted (CAPS Consortium 2020).

Scan + AI report

What MRI found · Abdominal MRCP, T2-weighted axial, breath-hold

MRI · DEMO

Fukuoka Worrisome

OCTON · scanning · live

conf 0.79

OCTON Impression · 79% confidence

1.6 cm cystic lesion in the pancreatic head with communication to a side-branch duct — consistent with branch-duct IPMN. A 5 mm enhancing mural nodule is identified along the cyst wall; main pancreatic duct measures 4 mm.

Findings

16 mm side-branch IPMN in the uncinate process · Pancreatic head, uncinate16 mm
5 mm enhancing mural nodule on T1 post-contrast · Cyst wall, dependent5 mm
Main pancreatic duct mildly prominent at 4 mm · Pancreatic body
No lymphadenopathy, no liver lesions · Abdomen

Differential diagnosis

Branch-duct IPMN with worrisome stigmata70%
Mucinous cystic neoplasm (MCN)15%
Serous cystadenoma10%
Early invasive pancreatic adenocarcinoma5%

Recommended actions

▸Endoscopic ultrasound (EUS) with fine-needle aspiration of the mural nodule within 2 weeks
▸Cyst-fluid CEA and KRAS analysis
▸Multidisciplinary pancreas tumor-board review
▸Consider surgical resection (Whipple) given mural nodule

Caveats

AI cannot definitively distinguish IPMN-with-low-grade dysplasia from early carcinoma — tissue is required.
Worrisome ≠ malignant; ~20% of mural-nodule IPMNs harbor invasive disease.

360° Preventative plan

Drugs · surveillance · diet · exercise · lifestyle — generated for this case

Clinical anchors

Drugs · labs · imaging · surveillance

Medical

EUS-FNA of mural nodule

FrequencyWithin 2 weeks (current finding)

Startsage 64

Fukuoka 2017 worrisome-feature management

Monitoring

Pancreas MRI with MRCP

FrequencyAnnual surveillance · 6-monthly post current finding

Startsage 50

CAPS Consortium · International Cancer of the Pancreas Screening 2020

Monitoring

Glycemic surveillance + ampullary symptom check

FrequencyQuarterly

Startsage 50

Sharma et al., new-onset diabetes as PDAC harbinger

What changed

The early-detection win

Robert was enrolled in OCTON's high-risk pancreas surveillance pathway after his father's diagnosis. On his 4th annual MRCP, the AI overlaid a 5 mm enhancing nodule on a previously stable 14 mm IPMN — the human radiologist confirmed. Resection found IPMN with high-grade dysplasia and a 3 mm focus of invasive carcinoma — Stage IA. 5-year survival for resected Stage IA PDAC is 60–80%, versus 3% for metastatic disease; the early catch was the difference.

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