How pancreatic cancer is diagnosed
Usually, the first thing you do it see your GP, who will examine you. It may sometimes be difficult to diagnose pancreatic cancer, as the symptoms can resemble those caused by other, more common conditions.
Your GP will examine your eyes and skin color to determine whether you have jaundice and will take a sample of your urine and blood if necessary. They may also examine your abdomen to see if there is inflammation in the area of the liver. If your GP is unsure of what the problem is or if they believe it may be cancer, they will send you to a hospital for specialist treatment and advice. They will ask you about your overall health and prior medical problems and will examine you. You may have to have blood work and x-rays to check on your overall health.
To help diagnose pancreatic cancer, you may have several tests. If you are diagnosed with pancreatic cancer, you may have additional tests to determine the size and position of the tumor and whether it has spread to other parts of the body. The results will help your doctor reach a decision on the best treatment for you.
Ultrasound uses sound waves to create images of the internal organs. It only takes a few minutes, and during the procedure a gel will be spread across your abdomen and then a small device will be passed over the area where the gel has been applied. This device emits ultrasound waves used to form an image of the organs that can be seen using a computer. An ultrasound scan can also be given to help guide a biopsy, which involves taking tissue to be examined under a microscope.
- CT (computed tomography)
A CT takes a series of x-rays, creating a 3-D image of the inside of the body. It takes from 10 to 30 minutes and is painless. A small amount of radiation is used, though it is very unlikely to cause you any harm. You will be asked to refrain from eating and drinking for at least an hour before the procedure.
You may be given a drink or an injection with a dye, which makes it possible to see certain areas more clearly. This may make you feel hot for a few minutes. It is important that you inform your health professionals if you are allergic to iodine or have asthma, as you may have a reaction to the injection.
A CT scan can also be given to help guide a biopsy, which involves taking tissue to be examined under a microscope.
- Endoscopic ultrasound
This is like an endoscopy, but it has an ultrasound probe on the end. Ultrasound uses sound waves to create an image of the area. It helps give a better indication of the size and depth of the tumor.
They may take a sample of tissue (biopsy) and examine it under a microscope.
You will be asked not to eat or drink for about six hours before the test so that your stomach and duodenum are empty during the test.
You will be given an injection to help you relax (a sedative) and a local anesthetic will be sprayed on the back part of your throat.
- MRI (magnetic resonance imaging)
This test uses magnetism to build a detailed image of one of the areas of your body. The scanner is a powerful magnet, which is why you will be asked to fill out and sign a checklist and provide your consent. As part of this consent form, you will be asked if you have any implants such as a pacemaker or surgical clips. You should also tell your doctor if you have ever worked with metals or in the metal industry.
Before the scan, you will be asked to remove all metal belongings, including jewelery. Sometimes, a contrast dye is given by injection in a vein of the arm to help the images come through more clearly.
You will have to remain very still during the test, which lasts about 30 minutes. The process is painless but can be somewhat uncomfortable, and some people experience a bit of claustrophobia. It is also quite loud, though you will be given earplugs or headphones.
During a biopsy, a small sample of tissue are taken from the tumor so that it can be examined under a microscope.
A biopsy may be taken during an endoscopic ultrasound or an ERCP. Alternatively, the doctor may insert a needle through the tumor to obtain a sample of the cells. This is called a percutaneous biopsy. The doctor will first inject a local anesthetic on your skin to numb the area. Then, they will use images from an ultrasound scan or CT scan to guide the needle through the skin and into the tumor to obtain the sample of cells.
- ERCP (endoscopic retrograde cholangiopancreatography)
An ERCP can be performed to drain a bile duct as part of a treatment for jaundice. The procedure is also used sometimes to take a biopsy of the tumor.
You will be asked not to eat or drink for six hours before the test so that your stomach and duodenum are empty during the test.
You will be given a sedative and then the doctor will insert a long, thin tube called an endoscope through your mouth and into your stomach and then your duodenum. Once there, they will take a small sample of the tumor and sent it to the laboratory.
To treat obstruction of the bile duct, the doctor injects a contrast dye into the bile duct to help them see where the narrowing is. The area of narrowing is then stretched out and a tube called a stent is placed through an endoscope. The stent keeps the duct open and lets the bile duct drain.
- Blood tests
Many cancers of the pancreas produce a substance called CA 19-9, which can be measured in the blood. CA 19-9 is known as a tumor marker.
Some people who have pancreatic cancer do not show increased levels of CA 19-9, which is why a normal level of this substance does not mean a person does not have pancreatic cancer.
Measuring CA 19-9 levels isn't very useful for diagnosing pancreatic cancer, though it can be of help for checking on how the cancer is responding to treatment and during follow-up.
This can be done if other tests have not confirmed the diagnosis of pancreatic cancer or if there is a plan to remove the cancer. It consists of a simple operation carried out under general anesthesia and will mean having a short stay in the hospital. The test lets doctors observe the pancreas to see if an operation to eliminate the cancer is possible.
With the patient under general anesthesia, the doctor makes a small incision of about 2 cm in the skin and muscle that is near the belly button. The doctor then inserts a fine tube into your abdomen. The tube has a tiny camera and a light called a laparoscope on the end. The doctor uses the laparoscope to look inside the pancreas and the nearby tissues. Also, a biopsy can be taken.
If a laparoscopy isn't suitable for you, your surgeon may perform a laparotomy.
This is an operation to look inside the abdomen and is carried out under general anesthesia. The surgeon makes a larger incision in the abdomen so they may see the pancreas.
It may be performed if other tests do not yield a definitive diagnosis, though it is rarely necessary since most people can have a laparoscopy.