Diagnosing and staging 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) scans, magnetic resonance imaging (MRI) and, sometimes, positron emission tomography (PET) scans.
- 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.
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.
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.
Using a scope to inject dye into the pancreatic ducts. In certain cases, your doctor may recommend endoscopic retrograde cholangiopancreatography (ERCP), which 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, images are taken of the ducts.
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.
Stages of pancreatic cancer
Using information from staging tests, your doctor assigns your pancreatic cancer a stage. The stages of pancreatic cancer are:
- Stage I. Cancer is confined to the pancreas and can be removed using surgery.
- Stage II. Cancer has spread beyond the pancreas to nearby tissues and organs and may have spread to the lymph nodes. At this stage, surgery may be possible to remove the cancer.
- Stage III. Cancer has spread beyond the pancreas to the major blood vessels around the pancreas and may have spread to the lymph nodes. Surgery may or may not be possible to remove the cancer at this stage.
- 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). Surgery isn't an option at this stage in the disease.