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. You'll be asked about your health history, your symptoms, risk factors, and your family history of disease. Your healthcare provider will also do a physical exam focusing on your belly.

What tests might I need?

You may have 1 or more of these tests:

  • Blood tests

  • Imaging and endoscopy tests

  • Pancreatic biopsy

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. 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

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 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 do 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 see 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. Then 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 over your abdomen (belly) 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. Medicines are used to make you sleep for this test. Your healthcare provider then puts a thin, lighted tube (called an endoscope) down your throat, through your stomach, and into the first part of your small intestine. At the tip of the scope is an ultrasound device. It bounces waves into nearby tissues, including the pancreas, to make an image of it. 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 organs. 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 dye is put into your blood and over a certain time, pictures are taken of the pancreas as the dye moves through it. This can help your healthcare team see if surgery to take out the pancreas might be an option.

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). 

MRI

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.

Endoscopic retrograde cholangiopancreatography (ERCP)

This test is a type of X-ray test to look at the bile ducts and the pancreatic duct. You are given medicines to make you sleep, then a long thin tube called an endoscope is put down your throat, through your stomach, and into your small intestine. A smaller tube called a catheter is slid through the scope into the common bile duct. Dye is injected through the catheter. It goes into your bile and pancreatic ducts. Your healthcare provider then takes X-rays to look for any ducts that might be blocked or narrowed by a tumor. If your healthcare provider sees anything that does not look normal, a tissue sample (biopsy) might be taken out and checked for cancer.

Magnetic resonance cholangiopancreatography (MRCP)

This test is a lot like 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 to put an endoscope in them. But if your healthcare provider sees something that does not look normal, a biopsy cannot be done 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 (belly) and into your liver. A dye is 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 only done if an ERCP cannot 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 pancreas tissue. This is called a biopsy.

A biopsy is usually the only way to be sure that a person has pancreatic cancer. A doctor 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.

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. 

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 do not 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 in your skin over your abdomen (belly). A thin tube with a light and a tiny video camera on the end is put into this cut. This lets your provider see your pancreas and nearby areas. Other small cuts may be made to put in 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.

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