Pancreatic Cancer: Tests After Diagnosis
After a diagnosis of pancreatic cancer, you will likely have other tests. These tests help your healthcare team learn more about your cancer. They can help show if the cancer has grown into nearby areas or spread to other parts of the body. The test results help your healthcare team decide the best ways to treat the cancer. If you have any questions about these or other tests, be sure to talk with your healthcare team.
The tests you may have can include:
Computed tomography (CT) scan
Magnetic resonance imaging (MRI)
Positron emission tomography (PET) scan
CT angiography or MR angiography
Endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP)
Imaging tests might be used to help learn the extent of the cancer in your body. One of the most important things your healthcare providers will look for is whether or not the cancer looks like it can be removed by surgery. Surgery is often the preferred treatment if it can be done.
During a CT scan (CAT scan or spiral CT scan), X-rays scan a part of your body, such as your chest or abdomen, to make detailed pictures. These pictures help your healthcare provider see where the cancer is. They can also show if the cancer has spread to nearby lymph nodes or to other organs. These can include your liver.
To have the test, you’ll lie still on a table as it slowly slides through the center of the CT scanner. A computer uses the data from the X-rays to make many detailed pictures. A CT scan is painless. In some cases, you’ll get an intravenous (IV) drip with a contrast medium before the scan. This helps any tumors show up better during the scan. You may be asked not to eat anything in the time between drinking the contrast and the scan. The contrast will slowly pass through your system. Then it will exit through your bowel movements.
An MRI uses magnets, radio waves, and a computer to make detailed pictures of the inside of your body. An MRI can show the extent of your cancer. It’s also used to see if the cancer has spread to other parts of your body. If it has, an MRI can also show the size and extent of the spread. Your healthcare provider may also do an MRI if the results of an X-ray or CT scan aren't clear. In some cases, you’re injected with a contrast dye before getting the scan.
MRIs are not painful. They can, though, take a long time. They may take up to an hour to do. During that time, you’ll lie still on a table that’s moved into a long, narrow tube. Some people say the test makes them feel claustrophobic. If you’ve had problems with enclosed spaces in the past, tell your healthcare provider before the test. He or she may give you a sedative to help you stay calm during the test. Newer, more open MRI machines can sometimes be used instead, but the images may not be as sharp in some cases. The equipment also makes loud banging noises. You can ask for earplugs if you think the noise will bother you.
Because the test uses powerful magnets, you won’t be allowed to have anything metal in the room. Even eyeglasses and ballpoint pens can become dangerous projectiles when the magnets are turned on. If you have any kind of metal implant, such as a heart valve or a joint pin, you may not be able to have an MRI. This depends on the type of metal it is made from. The equipment can also affect implants, such as a pacemaker.
A PET scan can give your healthcare provider a better idea of whether an abnormal area seen on another imaging test is a tumor or not. If you‘ve already been diagnosed with cancer, your healthcare provider may use this test to look for the spread of the cancer to lymph nodes or other parts of your body. A PET scan can also be helpful if your healthcare provider thinks the cancer may have spread, but doesn't know where. Because it scans your whole body, your healthcare provider may do a PET scan instead of ordering X-rays of different places on your body. The picture is not as detailed as a CT scan. But it can be used along with a CT scan to look for tumors.
For this test, you’re injected with a sugar that has a mildly radioactive substance. Cancer cells absorb more of this sugar than normal cells. This radioactive material shows up during the image from the scan. To have the scan, you’ll lie still on a table that’s pushed into the PET scanner. This is a machine that takes pictures that show where the sugar is in your body. The process may take several hours. A PET scan is painless and noninvasive. But if you’re sensitive to the sugar, you may have side effects. These can include headache, nausea, or vomiting.
CT or MR angiography
An angiogram is a test that looks at blood vessels. This type of test can be useful in finding out if a pancreatic cancer has grown into the walls of nearby major blood vessels. This can help your healthcare team decide if the cancer can be removed completely without damaging the blood vessels. It can also help them plan the surgery. In the past, this test was often done by putting a catheter into an artery (often in your inner thigh) to inject a dye. Then X-rays were taken of the area. Today, this test is more often done using a CT scanner (CT angiography) or an MRI scanner (MR angiography). These tests are less invasive. However, you still might need an IV injection of a dye.
ERCP or MRCP
These tests look at your bile ducts and pancreatic duct to see if there are any blockages. These tests are sometimes used to help plan surgery.
EERCP is a type of X-ray test. Your healthcare provider puts a long, flexible tube (endoscope) down your throat, through your stomach, and into your small intestine. He or she slips a smaller tube through the larger tube into the common bile duct. Then he or she injects dye through the tube. This goes into your bile and pancreatic ducts. Your healthcare provider then takes X-rays of the area. This is done to look for any areas that might indicate blockage by a tumor. If he or she sees a blocked duct, your healthcare provider may put a small tube (stent) into the duct to help keep it open.
MRCP is similar to an ERCP except it uses an MRI instead of an endoscope. MRCP can show both the bile ducts and the pancreatic duct without the need for an endoscope passed into the duct. But unlike ERCP, this test cannot be used to put a stent into a blocked duct.
Laparoscopic surgery (staging laparoscopy)
Sometimes it can be hard to tell just how far the cancer has spread based on imaging tests alone. If this is the case, you may need laparoscopic surgery. This procedure can give your healthcare team a better idea of exactly how far the cancer has spread. This can help them determine if surgery to remove the cancer might be an option. For this surgery, your surgeon makes several small cuts in your abdomen. Then he or she puts long, thin tools, one of which has a small video camera on the end, into these cuts. This lets your surgeon to look at the pancreas and nearby organs. He or she can also take biopsy samples if needed to see how far the cancer has spread.
If you’ve been diagnosed with pancreatic cancer, blood tests can check the disease and your health.
This is a tumor marker. This substance can sometimes be found in the blood if a person has cancer. If your CA19-9 level is high, this test can be used to help monitor your cancer during treatment. If all of the cancer has been removed, this test can also check if the cancer is coming back.
Liver function tests (LFTs) and blood chemistry tests
These tests look for certain chemicals in your blood. They can help tell how your liver, kidneys, and other organs are working.
Working with your healthcare provider
Your healthcare provider will talk with you about which tests you'll have. Make sure to get ready for the tests as instructed. Ask questions and talk about any concerns you have.
March 21, 2017
Alteri, Rick, MD,Gersten, Todd, MD