Diagnosing and Staging Pancreatic Cancer

Diagnosing and Staging Pancreatic Cancer

Learn about the tests used to diagnose and stage cancer of the pancreas.

How is cancer of the pancreas diagnosed?

There are no screening tests for pancreatic cancer like a mammogram screening for breast cancer or colonoscopy for colon cancer.

However, about 10 percent of all pancreatic cancers can be linked genetically. If there is a very strong family history of pancreatic cancer, your doctor may suggest genetic testing. Some early pancreatic tumors have also been found using a technique called endoscopic ultrasound. Because this type of test has risks, it is reserved for people who are at an extremely high risk for getting pancreatic cancer.

Early cancer of the pancreas usually has no symptoms. As the cancer becomes more advanced, symptoms appear. Unfortunately, pancreatic cancer is often advanced when it is found.

If pancreatic cancer is suspected after taking a medical history, your doctor will perform a physical exam.The doctor will check to see if there is any swelling or tenderness in the abdomen or the lymph nodes. He or she also will check for jaundice, or yellowing of the skin or eyes.

Depending on the results of the history and physical exam, some of the following tests may be ordered:

Radiology or x-ray tests

  • Ultrasound. This test uses sound waves to get an image of organs inside the body. A special type of ultrasound called an endoscopic ultrasound is one of the best ways to find a small tumor in the pancreas. This test is done by inserting a thin, flexible tube into the stomach. Medicine is given to make you sleepy and to prevent discomfort. An ultrasound probe is attached to the endoscope. This test can also be used to get a biopsy of a tumor in the pancreas.
  • Computed tomography (CT) scan. A CT scan is a series of detailed images of areas inside the body. A computer linked to an x-ray machine makes the images of the organs, lymph nodes, and surrounding tissues. Sometimes a dye is injected to help see the pancreas more clearly. A CT scan may help guide a biopsy needle into a tumor.
  • Magnetic resonance imaging (MRI). An MRI uses a magnet linked to a computer to make a detailed picture of specific areas inside the body. An MRI uses magnetic fields and radio waves instead of radiation. This test is sometimes used to check the pancreas for tumors, though CT scans are usually preferred.
  • Angiography. Dye is injected into a vein to check the blood flow into the pancreas. It can be used to check if a tumor has invaded into surrounding blood vessels. This can help doctors decide what type of treatment may be most effective.
  • Endoscopic retrograde cholangiopancreatography (ERCP). An ERCP is done by inserting a thin, flexible tube past the stomach into the first part of the small intestine. Medicine is given to make you sleepy and to prevent discomfort. Looking through this special tube, the doctor can see the ducts that lead out of the liver and pancreas to be sure that they are open. If these are narrowed by a tumor, a thin stent or small tube can be inserted to help keep them open.
  • Percutaneous transhepatic cholangiography (PTC). Dye is injected into the liver through the skin. X-ray pictures are then taken. PTC can show if the bile ducts are blocked by tumor or other problem.
  • Positron emission tomography (PET) scan. Sugar that contains a small amount of radioactivity is injected into a vein. Cancer cells grow quickly and use more glucose or sugar for energy than normal cells. Thus, these cancer cells will take up more of the radioactive sugar. A scan is then done to detect radiation, and these cancer cells will “light up” on the scan. The PET scan is helpful to check and see if a small mass is cancerous or if the cancer has spread to other parts of the body.

Blood tests

There is not a specific blood test to diagnose pancreatic cancer. But, there are several blood tests that are sometimes used to look for other factors that might point to cancer.

  • Bilirubin. This test checks to see if bilirubin from the liver is building up in the blood. This may happen in liver disease or if the bile flow is blocked by a tumor.
  • Carcinoembryonic antigen (CEA) and CA 19-9. These are tumor markers that are sometimes elevated in people who have cancer. They are not specific for cancer of the pancreas, though.

Biopsy

The only sure way to know if cancer is present is to get a biopsy, or sample of the tumor, and look at it under a microscope. One way a biopsy can be done is with a thin needle inserted through the skin into the pancreas while using CT scan or ultrasound images as a guide. This test is called a fine needle aspiration (FNA).

Another way to get a sample of the tumor is by surgery. This may be done using a laparoscope or an open procedure, depending on the size and location of the tumor.

How is cancer of the pancreas staged?

Staging is the process that doctors use to see how advanced a cancer is. Staging is done by first measuring the size of the tumor or tumors. Then different tests may be done to see if the cancer has spread to any lymph nodes or other parts of the body. Staging is important to help determine the best treatment plan.

The basic stages of pancreatic cancer are:

  • Stage I. The tumor has not spread from the pancreas.
  • Stage II. The cancer has not spread into any large blood vessels or distant sites, but it may have spread to nearby lymph nodes.
  • Stage III. The cancer has spread into nearby large blood vessels. It has possibly spread to nearby lymph nodes, but it has not spread to distant parts of the body.
  • Stage IV. The cancer has spread to distant parts of the body.
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