The most appropriate management is surgical resection of the pancreatic mass. This patient likely has localized and potentially resectable pancreatic adenocarcinoma. Strong supportive data include clinical risk factors (age ≥50 years, cigarette smoking, new-onset diabetes mellitus), symptoms (weight loss, dyspepsia), and CT imaging findings (a discrete, solid, low-attenuating mass with dilation of the upstream pancreatic duct and common bile duct [“double-duct sign”]).

Percutaneous or endoscopic ultrasound−guided tissue sampling is generally not recommended in patients who are operative candidates with potentially resectable (localized) pancreatic cancer because negative results may simply represent sampling error and are insufficient to rule out the presence of cancer. Thus, they entail risk and do not affect management.

The tumor marker CA 19-9 has variable sensitivity and specificity for pancreatic cancer and is generally not recommended as a screening test; management will not be changed by the results of this test at this time, however, it can add prognostic value for patients diagnosed with metastatic pancreatic cancer.