Pancreatic Cancer: Diagnosis
If your healthcare provider thinks you might have pancreatic cancer, you’ll need certain exams and tests to be sure. Diagnosing pancreatic cancer starts with your healthcare provider asking you questions. He or she will ask you about your health history, your symptoms, risk factors, and family history of disease. Your healthcare provider will also give you a physical exam.
What tests might I need?
You may have one or more of the following tests:
Imaging and endoscopy 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. They can sometimes help tell if a bile duct is blocked. This might be from a pancreatic tumor. These tests can't tell for sure if you have pancreatic cancer. This is 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.
This is a tumor marker. It’s a substance that can sometimes be found in your blood if you have cancer. This test by itself cannot diagnose pancreatic cancer, because not everyone who has pancreatic cancer has a high CA19-9 level. Plus, sometimes people have an elevated 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 do imaging and endoscopy tests to look for pancreatic cancer. Imaging tests use X-rays, sound waves, or other ways of taking pictures of the inside of your body. For endoscopy tests, a thin tube (endoscope) is put into your body. This lets your healthcare provider see organs and other tissues.
An ultrasound uses sound waves to look for abnormalities in your pancreas and bile ducts. The sound waves bounce off body parts and send back a series of signals. Then a computer turns these into images of your body. This might be the first imagine test you have because it’s easy and doesn’t use radiation. During an ultrasound, the sound waves come from a wand-like instrument that’s placed on the skin over your abdomen and aimed at your pancreas.
For an endoscopic ultrasound (EUS), the image of the pancreas is taken from inside your body. This makes a better picture. Your healthcare provider puts a thin, lighted tube called an endoscope down your throat, through your stomach, and into the first part of the small intestine. At the tip of the scope is an ultrasound device. It bounces waves into the nearby area, including the pancreas, to make an image of it. During the test, if your healthcare provider sees anything suspicious, he or she may pass a small, hollow needle down the endoscope to take a sample of tissue. This is called a biopsy.
A CT scan uses X-rays taken from many angles. It creates very detailed cross-section pictures of your pancreas and nearby organs. This test can often show pancreatic tumors and blocked bile ducts.
Positron emission tomography (PET) scan
For this test, your healthcare provider injects a radioactive substance, usually bound to a type of sugar, through your vein. Then your body is scanned. The radioactive sugar substance collects in cancer cells, which will show up on images. 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).
This test creates detailed images of your pancreas and nearby organs. It does this by using magnets and radio waves. While MRIs can show more detail than other imaging tests, they aren’t used as often as CT scans when looking for pancreatic cancer.
Endoscopic retrograde cholangiopancreatography (ERCP)
This test is a type of X-ray test to look at the bile ducts and the pancreatic duct. Your healthcare provider inserts an endoscope down your throat, through your stomach, and into your small intestine. Then, he or she slips a smaller tube through the larger tube into the common bile duct. Next, 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 to look for any places that might be blocked by a tumor. If your healthcare provider sees anything suspicious, he or she may take a tissue sample (biopsy) and check it for cancer.
Magnetic resonance cholangiopancreatography (MRCP)
This test 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. However, if your healthcare provider sees something suspicious, he or she cannot take a biopsy during this test.
Percutaneous transhepatic cholangiography (PTC)
This is another type of X-ray test of the bile duct. Your healthcare provider puts a thin needle through the skin on the right side of your abdomen and into your liver. He or she injects dye through the needle. The dye highlights blockages in bile ducts. These 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. Because this test is more invasive, it’s only done if an ERCP cannot be done.
If an imaging test shows something in your pancreas that looks like it might be cancer, your healthcare provider may take small samples of pancreas tissue. This is called a biopsy. This is usually the only way to be sure of a pancreatic cancer diagnosis. A doctor who specializes in looking at cells, called a pathologist, looks at the samples under a microscope. He or she can tell whether they contain cancer. There are different types of biopsies.
Percutaneous (though the skin) needle biopsy
For this test, your healthcare provider puts a thin, hollow needle through your skin and into the pancreatic tumor to get a sample of it. This is usually done during a CT scan or ultrasound of the pancreas. This lets your healthcare provider see the needle going into the tumor.
During procedures such as endoscopic ultrasound or ERCP, your healthcare provider may pass long, thin instruments down the scope to take samples of suspicious areas. This might be done with a thin, hollow needle or with a small brush.
For this test, your surgeon makes a small cut on your abdomen. He or she then puts a thin tube with a light and a tiny video camera on the end. This lets your him or her see your pancreas and nearby areas. Your surgeon may make other small cuts to insert other tools to remove cells for testing.
Getting your test results
When your healthcare provider has the results of your tests, he or she will contact you. Your provider will talk with you about other tests you may need if pancreatic cancer is found. Make sure you understand the results and what follow-up you need.
March 21, 2017
Alteri, Rick, MD,Gersten, Todd, MD