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How is pancreatic cancer diagnosed?

Patients with symptoms suspicious for pancreatic cancer will have tests to determine the cause of these symptoms. These may include: a CT scan to ensure that very small tumors can be detected and that spread of the cancer to other organs is not detected; or endoscopic ultrasound, which is used to diagnose small tumors that cannot be detected by a CT scan or MRI. The endoscopic ultrasound provides image guidance for placing a fine needle to extract cells for evaluation, also known as a biopsy. A definite tissue diagnosis of pancreatic cancer will then allow radiation and/or chemotherapy to proceed.

Your doctor may use a variety of tests to diagnose pancreatic cancer. An ultrasound, which uses sound waves to "see" your pancreas, may be used. An endoscopic ultrasound, in which the ultrasound sensor is inserted into your stomach through a tube that passes down your throat, can also be used. Magnetic resonance imaging (MRI) or a computerized tomography scan (or CT scan), are other ways doctors can see images of your pancreas. Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography are two types of tests that use dye to make parts of the pancreas more visible when X-rayed. In addition to these tests, a biopsy, in which a small piece of pancreatic tissue is removed for laboratory examination, may be done to confirm the diagnosis. Staging the cancer often takes place at the same time as diagnosis.

The tests and procedures that may be ordered by your doctor for diagnosis and staging of pancreatic cancer include:

  • Blood work: often includes liver function tests and other tests that identify abnormalities in pancreatic function. A test called CA19-9 (tumor marker) may be drawn. CA19-9 is a substance that some pancreatic tumor cells release into the bloodstream. It does not provide a diagnosis of pancreatic cancer by itself but may be used in conjunction with other tests.
  • Computed tomography (CT): a series of detailed pictures of areas inside your body taken from different angles. The pictures are created by a computer linked to an x-ray machine. This helps doctors determine the extent of the disease.
  • Endoscopic ultrasound (EUS): a procedure in which an endoscope is inserted through your mouth and into your stomach. An endoscope is a thin, tube-like instrument that has a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal organs to make a picture. This allows the physician to view the pancreas and surrounding organs and tissues.
  • Endoscopic retrograde cholangiopancreatography (ERCP): a procedure that uses an endoscope to examine and x-ray the pancreatic and biliary ducts. The endoscope is passed through your mouth and down into the first part of your small intestine (duodenum). A dye is injected through the catheter into the ducts, and an x-ray is taken. If a duct is found to be blocked, a bile duct stent can be placed during this procedure to relieve your symptoms, including jaundice.
  • Magnetic Resonance Imaging (MRI): MRI uses a strong magnetic field and radiofrequency waves to provide a clear picture of your body's soft tissues. MRI can detect abnormal areas that are sometimes hard to see on standard x-rays or CT scans.
  • Positron emission tomography/computed tomography (PET/CT): the combination of positron emission tomography (PET) with computed tomography (CT) represents the frontier of diagnostic cancer imaging. The technology provides physicians with two sets of information from a single scan: the anatomical data from a CT scan together with the metabolic information provided by PET.
  • Biopsy: used to confirm suspected pancreatic cancer. A tissue sample may be obtained by inserting a needle in your pancreas to remove cells. This procedure is called fine-needle aspiration (FNA). The tissue is then examined under the microscope.
Dr. Ajay K. Sahajpal, MD
Transplant Surgeon

Typically it is diagnosed both by thorough history and physical followed by radiographic imaging including CT or MRI. Following that, a tissue diagnosis usually requires an endoscopy, specifically ERCP (Endoscopic Retrograde Cholagiopancreatography) and EUS (Endoscopic Ultrasound) to get tissue brushings and biopsies.

Detecting and diagnosing pancreatic cancer can be difficult, especially because the symptoms are not always obvious, often develop gradually, and can be mistaken for other conditions. At times, pancreatic tumors are found incidentally when a patient is exploring another medical condition. If pancreatic cancer is suspected, there are a variety of tests your doctor may perform. After assessing your situation, your doctor may then perform blood tests, order imaging studies, and/or biopsy the mass. These tests will help your doctor arrive at the most accurate diagnosis and help to direct your treatment plan.

The most common diagnostic test to find and follow pancreatic cancer is the use of positron emission tomography (PET) scans. PET scans are extremely sensitive and accurate, able to identify changes not visible on computed tomography (CT or CAT) scans, a type of computerized x-ray.

Endoscopic Ultrasound (EUS). An endoscopic ultrasound (EUS) may be performed for suspected pancreatic tumors, inflammatory diseases of the pancreas (acute and chronic pancreatitis), and cysts (small, fluid-filled sacs that can be found on the pancreas).

Fine Needle Aspiration. If a cyst is detected, the endoscopist will perform a fine needle aspiration.

Endoscopic Retrograde Cholangiopancreatography (ERCP). ERCP may be performed to x-ray the bile ducts leading from the pancreas to the gallbladder. Pancreatic cancer may cause these ducts to narrow or become blocked.

SpyGlass Direct Visualization System for Single-Operator Duodenoscopic-Assisted Cholangiopancreatoscopy (SODAC). Our gastrointestinal endoscopists also may use the SpyGlass Direct Visualization System for single-operator duodenoscopic-assisted cholangiopancreatoscopy, or SODAC - the latest technology to visualize and evaluate the bile and pancreatic ducts.

Other tests may include:

  • Intraductal ultrasound to obtain a very fine, detailed view of the pancreas itself by entering the pancreatic ducts with very small probes
  • Laparoscopy or "keyhole surgery" if the tumor has spread to other organs or tissues
  • Magnetic resonance imaging (MRI)
  • Percutaneous transhepatic cholangiography (PTC)
  • Pancreas biopsy
  • Special blood tests

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.