Diagnosing pancreatic cancer
If your doctor suspects pancreatic cancer, you may have one or more of the following tests to diagnose the cancer:
- Imaging tests to create pictures of your internal organs. Imaging tests help your doctor visualize your internal organs, including your pancreas. Imaging tests used to diagnose pancreatic cancer include ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI).
- Using a scope to create ultrasound pictures of your pancreas. An endoscopic ultrasound (EUS) uses an ultrasound device to make images of your pancreas from inside your abdomen. The ultrasound device is passed through a thin, flexible tube (endoscope) down your esophagus and into your stomach in order to obtain the images. Your doctor may also collect a sample of cells (biopsy) during EUS.
Using a scope to inject dye into the pancreatic ducts. Endoscopic retrograde cholangiopancreatography (ERCP) uses a dye to highlight the bile ducts in your pancreas.
During ERCP, an endoscope is passed down your throat, through your stomach and into the upper part of your small intestine. A dye is then injected into the pancreatic and bile ducts through a small hollow tube (catheter) that's passed through the endoscope. Finally, X-rays are taken of the ducts.
A tissue or cell sample (biopsy) can be collected during ERCP.
Removing a tissue sample for testing (biopsy). A biopsy is a procedure to remove a small sample of tissue from the pancreas for examination under a microscope.
A biopsy sample can be obtained by inserting a needle through your skin and into your pancreas (fine-needle aspiration). Or it can be done using endoscopic ultrasound to guide special tools into your pancreas where a sample of cells can be obtained for testing.
Staging pancreatic cancer
Once a diagnosis of pancreatic cancer is confirmed, your doctor will work to determine the extent (stage) of the cancer. Your cancer's stage helps determine what treatments are available to you. In order to determine the stage of your pancreatic cancer, your doctor may recommend:
- Using a scope to see inside your body. Laparoscopy uses a lighted tube with a video camera to explore your pancreas and surrounding tissue. The surgeon passes the laparoscope through an incision in your abdomen. The camera on the end of the scope transmits video to a screen in the operating room. This allows your doctor to look for signs cancer has spread within your abdomen.
- Imaging tests. Imaging tests may include CT and MRI.
Blood test. Your doctor may test your blood for specific proteins (tumor markers) shed by pancreatic cancer cells.
One tumor marker test used in pancreatic cancer is called CA19-9. But the test isn't always reliable, and it isn't clear how best to use the CA19-9 test results. Some doctors measure your levels before, during and after treatment.
Stages of pancreatic cancer
Using information from staging tests, your doctor assigns your pancreatic cancer a stage. The stages of pancreatic cancer are:
Nov. 22, 2014
- Stage I. Cancer is confined to the pancreas.
- Stage II. Cancer has spread beyond the pancreas to nearby tissues and organs and may have spread to the lymph nodes.
- Stage III. Cancer has spread beyond the pancreas to the major blood vessels around the pancreas and may have spread to the lymph nodes.
- Stage IV. Cancer has spread to distant sites beyond the pancreas, such as the liver, lungs and the lining that surrounds your abdominal organs (peritoneum).
- What you need to know about cancer of the pancreas. National Cancer Institute. http://www.cancer.gov/cancertopics/wyntk/pancreas. Accessed Aug. 27, 2013.
- Abeloff MD, et al. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2008. http://www.clinicalkey.com. Accessed Aug. 27, 2013.
- Pancreatic adenocarcinoma. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed Aug. 27, 2013.
- Tarceva (prescribing information). Farmingdale, N.Y.: OSI Pharmaceuticals Inc.; 2013. http://www.tarceva.com/patient/considering/index.jsp. Accessed Aug. 27, 2013.
- Clark KL, et al. Psychological distress in patients with pancreatic cancer — An understudied group. Psycho-Oncology. 2010;19:1313.
- Distress management. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed Aug. 27, 2013.
- Pancreatic SPOREs. National Cancer Institute. http://trp.cancer.gov/spores/pancreatic.htm. Accessed Aug. 27, 2013.
- EGRP-supported epidemiology consortia. National Cancer Institute. http://epi.grants.cancer.gov/Consortia/single/pacgene.html. Accessed Aug. 27, 2013.
- Gastrointestinal genetic epidemiology — Gloria M. Petersen. Mayo Clinic. http://mayoresearch.mayo.edu/petersen_lab/index.cfm. Accessed Aug. 27, 2013.
- Shimosegawa T, et al. International consensus diagnostic criteria for autoimmune pancreatitis: Guidelines of the International Association of Pancreatology. Pancreas. 2011;40:352.
- Sugumar A, et al. Distinguishing pancreatic cancer from autoimmune pancreatitis. Current Gastroenterology Reports. 2010;12:91.
- Kendrick ML, et al. Total laparoscopic pancreaticoduodenectomy. Archives of Surgery. 2010;145:19.
- Townsend CM Jr, et al. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 19th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. https://www.clinicalkey.com. Accessed Aug. 27, 2013.
- Golden AK. Decision Support System. Mayo Clinic, Rochester, Minn. July 12, 2013.
- Estimated number of new cancer cases and deaths by sex, US, 2013. American Cancer Society. http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2013/index. Accessed Sept. 4, 2013.