How Is Pancreatic Cancer Diagnosed?

 

If you have some of the symptoms of pancreatic cancer, your doctor will begin your diagnosis with a medical history and physical exam.

  • Medical history and physical examination - The doctor checks you for risk factors and symptoms of pancreatic cancer. He or she also does a complete physical exam to help evaluate your overall health. The doctor checks your skin and the whites of your eyes for jaundice (yellow discoloration). The doctor also feels your abdomen for changes caused by the cancer; however, because the pancreas is behind the upper abdomen, it can be hard for the doctor to feel it. The doctor might also check for ascites (an abnormal buildup of fluid in the abdomen), which can be a sign of cancer.

The doctor may take samples of blood to check for abnormal levels of bilirubin and other substances.

  • Bilirubin - Bilirubin is a substance that passes from the liver to the gallbladder to the intestine. If a tumor is blocking the common bile duct, the bilirubin cannot pass through normally and the amount of bilirubin in the blood, stool, or urine can become very high. High bilirubin levels can result from cancer or from noncancerous conditions.
  • CA 19-9 - Pancreatic cancer cells release CA 19-9 into the blood and this substance can be detected by blood tests. A high level of CA 19-9 by itself should not be used to make a diagnosis of pancreatic cancer because it could be due to other conditions, such as pancreatitis, cirrhosis of the liver, and blockage of the common bile duct. However, the doctor may periodically order this test to see if the cancer has recurred after the treatment.

The only way to be sure whether you have pancreatic cancer is by removing a small sample of the tumor for examination under the microscope. The procedure to remove a tissue sample is called a biopsy. Several procedures are used to take a biopsy tissue to diagnose pancreatic cancer, including:

  • Fine needle aspiration (FNA) - The doctor inserts a thin needle through your skin and into the pancreas. The doctor uses computed tomography (CT) scanning images (CT-guided needle biopsy) or endoscopic ultrasonography to see the position of the needle and make sure that it is in the tumor. The doctor removes small pieces of tissue through the needle to examine under the microscope.
  • Laparoscopy (keyhole surgery) - The surgeon inserts a small telescope-like instrument into the abdominal cavity. This is usually connected to a video monitor. Using this, the surgeon can look at your abdomen and see how big the tumor is and whether it has spread. Usually the surgeon will put some gas, usually carbon dioxide, into the abdomen to make it easier to see everything. You will be sedated, which means that you will be asleep during this procedure.

Tissues can also be removed by endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EU). Descriptions of these procedures are available in the list of imaging tests below.

Imaging procedures allow doctors to learn where the cancer is located and whether it has spread from the pancreas to other areas of the body. However, pancreatic cancer tumors often do not develop as a single large tumor mass, and therefore can be difficult to see on imaging.

  • Abdominal (or transabdominal) ultrasound - Ultrasonography uses sound waves to produce images of internal organs, such as the pancreas. For abdominal ultrasonography, a device (transducer) on the abdomen sends out sound waves and detects the echoes bounced off internal organs. A computer processes the pattern of echoes to produce images. The echoes made by most pancreatic tumors are different from those of normal pancreatic tissue. The different echo patterns can help the doctor figure out the type of pancreatic tumor.
  • Angiography - This is an x-ray to examine blood vessels. The doctor injects a small amount of contrast material into an artery to outline the blood vessels and then takes x-rays. Angiography can show whether the tumor is blocking or pushing the blood flow in one area and whether any abnormal blood vessels (feeding the cancer) are in the area. Angiography is also useful for finding out if a pancreatic cancer has grown through the walls of certain blood vessels. It is usually used to help surgeons decide whether the cancer can be completely removed without damaging vital blood vessels and helps them plan the operation.
  • Computed tomography (CT or CAT) scan - Instead of taking one picture, like a conventional x-ray, a CT scanner takes many pictures as it rotates around you. A computer is used to combine these pictures into an image of a slice of your body (like a loaf of sliced bread).

CT scans are often used to make the initial diagnosis of pancreatic cancer and can help stage the cancer (determine how far it has spread). CT scans show the pancreas fairly clearly and often can confirm the location of the cancer. CT scans can also show the organs near the pancreas, as well as lymph nodes and distant organs where the cancer might have spread (metastasized). The CT scan can help your doctor decide whether surgery is a good treatment option for you.

  • Endoscopic retrograde cholangiopancreatography (ERCP) - The doctor passes a thin, lighted, flexible tube (endoscope) down your throat, through your esophagus and stomach, into the first part of your small intestine, and into the common bile duct. The doctor then injects a small amount of dye (contrast material) through the tube into the common bile duct. This dye helps outline the bile duct and pancreatic duct in x-ray images that are taken as part of this procedure. The images can show narrowing or blockage of the bile duct or pancreatic duct that might be due to a pancreatic tumor. The doctor can also put a small brush through the tube to remove cells for examination under a microscope (biopsy) to see whether they are cancerous (malignant). You will probably be sedated (made sleepy) during this procedure.
  • Endoscopic ultrasound (EUS) - Endoscopic ultrasound is more accurate than abdominal ultrasound and is probably the best way to diagnose pancreatic cancer. The doctor attaches an ultrasound probe to an endoscope (a thin, lighted, flexible, fiberoptic tube) and places it through your mouth or nose into the stomach. The probe can be pointed toward the pancreas, which is next to the small intestine. This gives a very accurate picture and is better than CT scans for spotting small tumors. It can also be used to biopsy a tumor. You will be sedated (made sleepy) during this procedure.
  • Magnetic resonance imaging (MRI) - This procedure uses powerful magnets and radio waves to take detailed cross-sectional images. MRI produces images of cross-sectional slices of your body like a CT scanner; it can also produce images of slices that are parallel to the length of your body. MRI images are particularly useful in examining pelvic tumors. They are also helpful in detecting cancer that has spread to the brain or spinal cord.
  • Percutaneous transhepatic cholangiography (PTC) - The doctor inserts a thin needle through the skin and into the liver. The doctor injects a dye through the needle so that the bile ducts show up on x-rays. By looking at the x-rays, the doctor can tell whether the bile ducts are blocked by a pancreatic tumor.
  • Positron emission tomography (PET) - Cancer cells use glucose (sugar) more quickly than most other body organs. During a PET scan, the doctor injects a small amount of glucose that has a radioactive atom into your arm. A special camera in the PET machine can detect the radioactivity. This test is useful to see if the cancer has spread to lymph nodes or to find out where your cancer has spread.
  • PET/CT scans - These combine a CT scan and a PET scan to pinpoint the tumor more accurately. This test may be especially useful for finding cancer that has spread beyond the pancreas and cannot be removed by surgery. It can also be useful to stage the cancer. 

This content has been reviewed and approved by Myo Thant, MD.

This content was last reviewed August 15, 2010 by Dr. Reshma L. Mahtani.
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