Diagnosis of pancreatic cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing pancreatic cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for pancreatic cancer or other health problems.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as pancreatic cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of pancreatic cancer.

The following tests may be used to rule out or diagnose pancreatic cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest pancreatic cancer
• smoking tobacco
• obesity
• diabetes
• chronic pancreatitis (inflammation or infection of the pancreas)

Your doctor may also ask about a family history of:

• pancreatic cancer
• hereditary breast and ovarian cancer (HBOC) syndrome
• familial atypical multiple mole melanoma (FAMMM) syndrome
• Peutz-Jeghers syndrome
• Lynch syndrome (also called hereditary non-polyposis colorectal cancer, or HNPCC)
• hereditary pancreatitis

A physical exam allows your doctor to look for any signs of pancreatic cancer. During a physical exam, your doctor may:

• check your skin and the whites of your eyes for jaundice
• feel your abdomen for any lumps or swelling
• feel your abdomen to see if your gallbladder, liver or spleen are larger than normal
• check your legs for swelling
• check the lymph nodes above your collarbone and in other places to see if they are swollen

Find out more about physical exams.

A CBC measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to show how well the bone marrow and certain organs are functioning. It is also used to provide a baseline that your doctors can use to compare blood counts during and after treatment.

Find out more about a complete blood count (CBC)..

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can help find abnormalities. Blood chemistry tests may be used to measure the following chemicals:

• bilirubin
• alkaline phosphatase
• lactic dehydrogenase (LDH)
• alanine aminotransferase (ALT)
• aspartate transaminase (AST)
• amylase

An increased level of any of these chemicals may indicate:

• a blockage in the common bile duct or pancreatic duct
• pancreatitis (inflammation or infection of the pancreas)
• pancreatic cancer has spread to the liver

Find out more about blood chemistry tests.

Tumour markers are substances found in the blood, tissues or fluids removed from the body. An abnormal amount of a tumour marker may mean that a person has pancreatic cancer.

Tumour marker tests are generally used to check your response to cancer treatment. They can also be used to diagnose pancreatic cancer. These tests are not sensitive or specific enough to be used to screen for pancreatic cancer.

The following tumour markers may be measured for pancreatic cancer.

Carbohydrate antigen 19-9 (CA19-9) is a protein found in very small amounts on the surface of certain cancer cells. The level of CA19-9 is higher than normal in 70% to 80% of people with pancreatic cancer. Find out more about carbohydrate antigen 19-9 (CA19-9).

Carcinoembryonic antigen (CEA) is a protein normally found in the tissue of a developing fetus. Levels of CEA in the blood decrease after birth. The level of CEA is higher than normal in about 50% of people with pancreatic cancer. Find out more about carcinoembryonic antigen (CEA).

Find about more about tumour marker tests.

A computed tomography (CT) scan uses special x-ray equipment to make 3-D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan is the most common imaging test for pancreatic cancer. It is used to:

• find tumours
• find out the size of the tumour
• find out if the tumour can be completely removed with surgery
• find out if the cancer has spread to nearby organs and tissues
• guide a fine needle aspiration (FNA) biopsy to get tissue samples

Find out more about CT scans.

An ultrasound uses high-frequency sound waves to make images of parts of the body. It is used to:

• find tumours
• help tell different types of tumours apart
• guide a fine needle aspiration (FNA) biopsy to get tissue samples

An abdominal ultrasound may be one of the first tests done if you have unexplained abdominal pain. It can also be used to look at the liver.

An endoscopic ultrasound (EUS) is a newer procedure that can diagnose pancreatic cancer more accurately than an abdominal ultrasound. An endoscope is a thin, tube-like instrument with a light and lens on the end. During an EUS, the doctor passes an endoscope down the throat, through the esophagus and stomach, and into the duodenum (first part of the small intestine). The doctor then passes an ultrasound probe down the endoscope and points it toward the pancreas. An ultrasound scan is taken of the pancreas and nearby organs.

An EUS creates a very accurate picture and is good for finding small tumours. Doctors can also collect a tissue sample for a biopsy during an EUS.

Find out more about ultrasounds.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-D pictures.

An MRI is used to find tumours and check to see if the cancer has spread to other organs and tissues.

Magnetic resonance cholangiopancreatography (MRCP) is a special type of MRI that produces detailed pictures of the liver, gallbladder, bile ducts, pancreas and pancreatic duct.

Find out more about MRIs.

An ERCP is similar to an endoscopic ultrasound. It is a procedure that uses an endoscope (a thin, tube-like instrument with a light and lens on the end) and x-rays to examine the ducts that drain the pancreas, liver and gallbladder. A dye is injected into the ducts to make them show up clearly on an x-ray. X-rays are taken as soon as the dye is injected.

ERCP is used to:

• find a tumour that may be causing a blockage in the bile duct or pancreatic duct
• collect a sample for biopsy
• place a tube (stent) to relieve the blockage of the bile duct

Find out more about ERCP.

A laparoscopy is a procedure in which an endoscope (a thin, tube-like instrument with a light and lens on the end) is passed through a small cut (incision) in the abdomen. Using a laparoscopy can help avoid the need for more extensive abdominal surgery.

Laparoscopy is used to:

• look at the pancreas and surrounding areas
• collect a tissue sample for a biopsy

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from the pathologist will show whether or not cancer cells are found in the sample.

Fine needle aspiration (FNA) is the type of biopsy used to collect a sample from the pancreas. An FNA uses a thin needle and a syringe to remove a small amount of fluid or cells.

An FNA of the pancreas can be done through the skin. The doctor uses a CT scan or an ultrasound to guide the needle to the tumour. An FNA can be done during a laparoscopy, an EUS or an ERCP.

An FNA may also be used to collect samples from the liver to see if cancer has spread to the liver.

Find out more about biopsies and FNA.

A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3-D colour images of the area being scanned.

A PET scan is used to:

• find tumours
• find out if cancer has spread to other organs and tissues

Find out more about PET scans.

A PTC is an x-ray of the bile ducts and liver. The doctor inserts a thin needle through the skin into the bile duct area. A contrast medium, or special dye, is injected into the bile ducts. The dye outlines the structure of the bile ducts and liver on the x-ray.

A PTC may be used to find out if there is a blockage in the bile duct. Doctors may also use a PTC to guide them as they place a stent to open a blocked bile duct.

To make the decisions that are right for you, ask your healthcare team questions about a diagnosis.