It is important to note that pancreatic cancer is not just one disease. There are many types of pancreatic tumours, each with its own unique prognosis and treatment recommendations. In the diagnosis of pancreatic cancer, the doctor may conduct the following tests:
Medical History and Physical Examination
A series of tests may be necessary to make a definite diagnosis. The doctor will first start by asking about the patient’s medical history and any physical complaints or symptoms, specifically recent weight loss, pain and changes in appetite, bowel patterns or skin colour. The doctor will then complete a thorough physical exam, which will include palpation and observation of the chest and abdomen.
Blood specimens may be collected and less commonly, urine or stool samples may also be asked for. Of particular interest to the doctor is the level of bilirubin and liver enzymes in a patient’s blood, which measures liver and pancreas function.
Another blood test commonly performed is CA19-9 (carbohydrate antigen 19-9). CA19-9 is referred to as a ‘tumour marker’ which is a chemical substance in the body that may be found at higher levels if cancer is present. An elevated CA19-9 test by itself is not used to make the diagnosis of pancreatic cancer, as it can be elevated in a variety of other conditions, such as pancreatitis or cirrhosis of the liver, and some people with pancreatic cancer do not show this marker at all. CA 19-9 however can be used as a tool to help evaluate the effectiveness of a cancer therapy by comparing the levels before and during treatment.
Ultrasound uses a machine that emits high-frequency sound waves to create images of the organs inside the body. An abdominal ultrasound examines the liver, gallbladder, spleen, pancreas and kidneys, and can help identify abnormal structures or tissue.
Computed Tomography (CT) Scan:
This is a non-invasive method of examining internal organs that captures a series of thin x-ray images of the inside of the body. CT scans can help detect tumours and determine whether it has spread to other parts of the body, such as the liver.
There are different types of CT scans and special techniques that can be done to create more detailed images of the pancreas. Some places offer a three-dimensional CT scan, often referred to as a ‘spiral’ or ‘helical’ scan, which creates extremely detailed images of the pancreas and nearby blood vessels and structures to help determine treatment decisions.
Endoscopic Ultrasound (EUS)
This is a procedure that allows a specially trained doctor, typically a gastroenterologist, to view the oesophagus, stomach and the first portion of the small intestine, as well as adjacent organs including the liver and pancreas. While the patient sleeps, a thin flexible tube called an endoscope is passed through the mouth into the stomach and small intestine. At the end of the tube is an ultrasound probe that emits sound waves that create images of the abdominal organs.
If unusual masses are detected, the doctor may collect a specimen of tissue at the time of the procedure during a biopsy. The use of EUS can decrease the likelihood that a patient will need to go to the operating room for surgery.
Endoscopic Retrograde Cholangiopancreatography (ERCP)
This procedure uses an endoscope – a long, flexible, lighted tube connected to a computer and TV monitor. The doctor guides the endoscope through the patient’s stomach and into the small intestine. ERCP combines two imaging techniques: ‘endoscopy’ the direct visualisation of internal structures and ‘fluoroscopy’ a live action x-ray method. These two techniques allow the doctor to view images of the liver, gall bladder and pancreas ducts, which can help detect a narrowed or blocked duct.
Further tests, such as a biopsy, can pinpoint the cause of a narrowed or blocked duct. If a duct is narrowed or blocked by a tumour, a plastic or metallic stent can be placed across the blockage. The stent is designed to expand and reopen the duct to allow bile juices to flow freely.
Magnetic Resonance Cholangiopancreatography (MRCP)
MRCP uses radio waves and a powerful magnet linked to a computer to visualise the biliary and pancreatic ducts in a non-invasive manner. These pictures can show the difference between normal and diseased tissue and can also detect bile duct obstruction.
MRCP may be performed in patients who cannot have an Endoscopic Retrograde Cholangiopancreatography (ERCP) or may also prevent unnecessary invasive procedures.
Biopsy: A biopsy allows a doctor to collect a small amount of tissue. A pathologist then uses a microscope to examine the tissue and identify the types of cells collected.
Tissue can be collected at the time of an endoscopic ultrasound or endoscopic retrograde cholangiopancreatography. A biopsy can also be performed under the guidance of a CT scan. If necessary, a biopsy can be performed at the time of abdominal open surgery.
There are two methods frequently used to collect tissue for a biopsy. A Fine Needle Aspiration (FNA) utilises a very narrow needle. A core needle biopsy uses a larger needle. Both methods have advantages and risks.
If cancer is suspected to have spread, or metastasised, it is preferable to biopsy the tumour than the pancreas itself. A specially trained doctor can then determine the best method to use. It is also important to note that if all of your other test results suggest cancer, you may not need a biopsy before you have treatment.