Pancreatic Cancer: Diagnosis
If your healthcare provider thinks you might have pancreatic cancer, you’ll need certain
exams and tests to be sure. The process starts with your healthcare provider asking
you questions. You'll be asked about your health history, symptoms, risk factors,
and your family history of disease. A physical exam will be done, focusing on your
belly.
Based on the findings, your healthcare provider will decide what other tests are needed.
What tests might I need?
You may need one or more of these tests:
Blood tests
You may have blood tests to look for signs of pancreatic cancer.
Liver function tests (LFTs)
These tests look for certain chemicals in your blood to get an idea of how well your
liver is working. They can sometimes help tell if a bile duct is blocked. This might
be caused by a pancreatic tumor. Still, LFTs can't tell for sure if you have pancreatic
cancer because there are other causes of blocked bile ducts. But if the results of
these tests are abnormal, your healthcare provider may do other tests to check for
cancer.
CA19-9 marker
CA19-9 is a tumor marker. It’s a substance that can sometimes be found in high levels
in your blood if you have cancer. This test by itself can't diagnose pancreatic cancer.
That's because not everyone who has pancreatic cancer has a high CA19-9 level. Plus,
sometimes people have a high CA19-9 level without having pancreatic cancer. But if
this test is abnormal, your healthcare provider might do other tests to look for pancreatic
cancer.
Imaging and endoscopy tests
Your healthcare provider may use imaging and endoscopy tests to look for pancreatic
cancer. Imaging tests use things like X-rays and sound waves to take pictures of the
inside of your body. For endoscopy tests, a thin tube (called an endoscope) is put
into your body. A camera at the end of the tube lets your healthcare provider look
at your organs and other tissues.
Ultrasound
An ultrasound uses sound waves to look for changes in your pancreas and bile ducts.
The sound waves bounce off body parts and send back a series of signals. A computer
turns these into images of your insides. This might be the first test you have because
it’s easy and doesn’t use radiation. During an ultrasound, the sound waves come from
a wand-like device that’s moved over the skin on your belly (abdomen) and aimed at
your pancreas.
For an endoscopic ultrasound (EUS), the images of the pancreas are taken from inside
your body. This makes a better picture. Medicines are used to make you sleep for this
test. Then a thin, lighted tube (called an endoscope) is put down your throat, through
your stomach, and into the first part of your small intestine. At the tip of the endoscope
is a tiny ultrasound device. It bounces waves into nearby tissues, including the pancreas,
to make images on a computer screen. During the test, if your healthcare provider
sees anything of concern, a small, hollow needle may be passed through the endoscope
to take out a small piece (sample) of tissue. This is called a biopsy.
CT scan
A CT scan uses X-rays taken from many angles. It creates very detailed cross-section
pictures of your pancreas and nearby tissues. CT scans can often show pancreatic tumors
and blocked bile ducts.
Sometimes a special type of CT scan called a pancreatic protocol CT is used. For this
scan, a contrast dye is put into your blood to make images clearer. Over a certain
time, pictures are taken of the pancreas before the contrast is injected and multiple
times as the dye moves through it. This can help your healthcare team see if surgery
to take out the pancreas might be an option.
PET (positron emission tomography) scan
For this test, a radioactive sugar is put into your blood through a vein in your arm
or hand. Over time, the radioactive sugar collects in very active cells, like cancer
cells. A special camera is then used to make pictures that show where the radioactive
sugar collects. The picture from this test is not as detailed as a CT scan. It isn’t
used alone to diagnose pancreatic cancer. But it can still sometimes be helpful. A
PET scan may be done in combination with a CT scan (PET/CT scan).
MRI (magnetic resonance imaging)
This test uses magnets and radio waves to create detailed images of your pancreas
and nearby organs. While MRIs can show more detail than other imaging tests, they
aren’t used as often as CT scans when looking for pancreatic cancer.
ERCP (endoscopic retrograde cholangiopancreatography)
This test is a type of X-ray used to look at the bile ducts and the pancreatic duct.
Medicines are used to make you sleep. Then a long, thin tube (endoscope) is put down
your throat, through your stomach, and into your small intestine. A smaller tube (catheter)
is slid through the scope into the common bile duct. Dye is then injected through
the catheter. It goes into your bile and pancreatic ducts. The dye shows up on X-rays.
This can show ducts that might be blocked or narrowed by a tumor. If your healthcare
provider sees anything that doesn't look normal, a tissue sample (biopsy) might be
taken out and checked for cancer.
MRCP (magnetic resonance cholangiopancreatography)
This test is a lot like an ERCP, but it uses an MRI instead of an endoscope. MRCP
can show both the bile ducts and the pancreatic duct without the need to put a scope
in them. But if your healthcare provider sees something that doesn't look normal,
a biopsy can't be done during this test.
PTC (percutaneous transhepatic cholangiography)
This is another type of X-ray of the bile duct. A thin needle is put through the skin
on the right side of your belly and into your liver. A dye is then injected through
the needle. The dye highlights blockages in bile ducts, which can then be seen on
an X-ray. If a blocked bile duct is seen, your healthcare provider may take a biopsy
and check it for cancer. This test is mostly done if an ERCP can't be done.
Pancreatic biopsy
If an imaging test shows something in your pancreas that looks like it might be cancer,
your healthcare provider may take out small pieces (called samples) of the changed
tissue. This is called a biopsy.
A biopsy is usually the only way to be sure that a person has pancreatic cancer. A
healthcare provider who specializes in looking at cells, called a pathologist, looks
at the samples under a microscope. Tests are done to see if they contain cancer. There
are different types of biopsies. The type of biospy, in part, depends on where the
cancer may be located and the plan for treatment. Several samples should be taken
for diagnosis and to perform tests to see if the cancer cells have specific genetic
changes (mutations).
Percutaneous (through the skin) needle biopsy
For this test, a thin, hollow needle is put through your skin and into the pancreatic
tumor to get a sample of it. A CT scan or ultrasound of the pancreas is usually used
to help your healthcare provider guide the needle into the tumor.
Endoscopic biopsy
During procedures such as endoscopic ultrasound or ERCP, your healthcare provider
may pass long, thin tools down the scope to take samples of areas that don't look
normal. This might be done with a thin, hollow needle or a tiny brush.
Laparoscopic biopsy
For this test, your surgeon makes a small cut (incision) in your skin over your belly.
A thin tube with a light and a tiny video camera on the end is put into this cut.
This lets your healthcare provider see your pancreas and nearby areas. Other small
cuts may be made to put in other tools to remove cells for testing. This procedure
isn't done as often as in the past.
Getting your test results
When your healthcare provider has the results of your tests, they'll contact you.
Ask how you can expect to find out your biopsy results. Will it be a phone call, or
do you need to make an appointment?
Your healthcare provider will talk with you about other tests you may need if pancreatic
cancer is found. Make sure you understand the results and what your next steps should
be.