Diagnosing pancreatic cancer

Saturday 1 February, 2014

Download PDF Order FREE booklet

On this page: Blood tests | Imaging tests | Tissue sampling | Staging pancreatic cancer | Prognosis | Key points


To confirm the diagnosis of pancreatic cancer, your doctor will take a full medical history and you will have several tests. Some tests will help the doctor determine if cancer has spread to other parts of your body. This is called staging.

You will not have all the tests described in this booklet. Some tests are only used to detect neuroendocrine tumours.

Blood tests

Blood tests can check how well your liver and kidneys are working and provide a full blood count. However, blood tests alone are not used to diagnose pancreatic cancer.

  • Pancreatic cancer may make a tumour marker called CA19-9, which is a substance that shows up in the blood of some cancer types. Measuring the level of CA19-9 may give your doctor information about the cancer. It’s also useful for checking how the cancer is responding to treatment.
  • PNETs may produce high levels of certain hormones, which can also be detected in the blood.

Imaging tests

Ultrasound

An ultrasound uses soundwaves to create a picture of your pancreas and the surrounding area, including your liver. It can show if a tumour is present and its size.

You will lie on your back for the procedure. A gel will be spread onto your abdomen and a small device called a transducer will be moved across the area. The transducer creates soundwaves that echo when they meet something solid, such as an organ or tumour. A computer turns these echoes into pictures.

The ultrasound is painless and takes about 15–20 minutes

CT scan

A CT (computerised tomography) scan is a type of x-ray that takes pictures of several organs at the same time. These pictures are put together to create a three-dimensional picture of your body. CT scans are usually done at a hospital or a radiology clinic.

You will be asked not to eat (fast) for a few hours before the scan. You may be given some liquid dye to drink or have dye injected into your veins before the scan. This makes your organs appear clearly in the pictures. The dye may make you feel flushed for a few minutes.

You will lie on an examination table that is moved into the CT scanner, which is large and round like a doughnut. This takes about 15–45 minutes. Most people are able to go home as soon as the scan is over.

Some people who have a CT or MRI scan are allergic to the dye injection. If you are allergic to iodine, fish or dyes, it is important tell the person doing the CT or MRI scan in advance.

MRI and MRCP scans

An MRI (magnetic resonance imaging) scan uses magnetic waves to build up detailed cross-sectional pictures of the pancreas and nearby organs. An MRCP (magnetic resonance cholangiopancreatography) is a type of MRI scan that produces more detailed images and can be used to check the common bile duct for blockage (obstruction).

Before the MRI scan, you may be asked not to eat or drink for a few hours. You may also be given an injection of dye to highlight the organs in your body.

You will then lie on an examination table inside a large metal tube that is open at both ends. The tube makes some people feel claustrophobic. It can also be noisy. If you are uncomfortable, let the person performing the scan know. They can give you an eye cover to help you relax and earplugs to reduce the noise level. If you are claustrophobic and think you will need sedation with medication to complete the scan, this should be discussed with your doctor when booking your scan.

The MRI scan takes 30–90 minutes. Most people are able to go home as soon as it’s over.

If you have a pacemaker or other metallic object in your body, you can’t have an MRI scan due to the effect of the magnet.

Endoscopy

An endoscopy can show blockages or inflammation in the bile ducts, stomach and duodenum. It is done using an endoscope, which is a thin, flexible tube with a light and a camera that is passed down your throat into your digestive system.

During an endoscopy, the doctor can also take a tissue or fluid sample to help with the diagnosis. This part of the procedure is called a biopsy.

You will be asked not to eat or drink for several hours before an endoscopy. The doctor will give you a sedative so you are as relaxed and comfortable as possible. Because of the sedative, you shouldn’t drive or operate machinery until the next day.

An endoscopy has some risks, including infection, bleeding and inflammation of the pancreas (pancreatitis). Your doctor will explain these risks before asking you to consent to the procedure.

Endoscopic ultrasound

An endoscopic ultrasound (EUS) uses an endoscope with an ultrasound probe (transducer) attached.

The endoscope is passed through your mouth into the small bowel. The transducer makes soundwaves that create detailed pictures of the pancreas and ducts. This helps to locate small tumours and shows any local spread of cancer. The doctor may take tissue samples of the pancreas (biopsy).

Scintigraphy

Scintigraphy is an imaging method that uses a mild dose of a radioactive substance to show where tumours may be in the body. Some of these scans are less common, and their role in managing pancreatic cancer is still being evaluated.

Somatostatin receptor scintigraphy (SRS) scan

Most PNET cells have hormone receptors for somatostatin. In the SRS scan, a radioactive drug that is similar to somatostatin is injected into your body. Over the course of a day, the drug travels to the tumour and attaches itself to the receptors. The scan will show doctors where the drug has attached, highlighting the tumour.

It may take several hours to prepare for and complete a SRS scan. Talk to your medical team for more information.

Tissue sampling

Fine needle biopsy

A biopsy means removing cells or tissue samples from an organ for examination under a microscope.

This procedure may be done during an endoscopy or endoscopic ultrasound. A fine needle is usually used to remove the cells.

An ultrasound or CT scan can help the doctor guide the needle through the abdomen and into the pancreas. You will have a local anaesthetic for the biopsy so you are not in pain, but you will be awake during the procedure.

Laparoscopy

This procedure is done to look inside the abdomen to see if a tumour has spread to other parts of the body. It can also be done to take tissue samples before another type of surgery.

A laparoscopy, sometimes called keyhole surgery, is done with an instrument called a laparoscope, which is a long tube with a light and camera attached.

You will be asked not to eat or drink for six hours beforehand. After giving you a general anaesthetic, the doctor will make a small cut near your belly button and guide the laparoscope inside your body through a tube. The doctor can put other instruments inside your body through other small cuts (about 0.5–1cm each) to take the biopsy.

You will have stitches where the cuts were made, and you may feel sore while you heal. To help control the pain, you will be given medication during and after the operation, and to take home.

There is a small risk of infection or damage to an organ. Your doctor will explain the risks before asking you to agree to the procedure. If you are in pain during or after the procedure, you will be given medication.

If you take blood-thinning medicines or are a diabetic, let your doctor or nurse know before the laparoscopy.

Staging pancreatic cancer

The test results will help your doctors assign a stage to describe how far the cancer has spread. The most common staging system used for pancreatic cancer is the TNM system. In this system, letters are assigned numbers to describe the cancer.

TNM system
T
(Tumour)
1–4
Indicates the size and depth of tumour invasion into the pancreas and nearby tissues. T1 is a maller tumour; T4 is a larger tumour that has nvaded the major arteries nearby
N
(Nodes)
0–3
Shows if the cancer has spread to nearby lymph odes. N0 means that the cancer has not spread o the lymph nodes; N1 means there is cancer in the local lymph nodes.
M
(Metastasis)
0–1
Shows if the cancer has spread to other parts of the body. M0 means that the cancer has not spread; M1 means that the cancer has spread away from the area around the pancreas, to more distant parts of the body (e.g. the liver).

Your doctor may also just use numbers to describe the stage:

  • Stage 1
    Cancer is found only in the pancreas. This is sometimes called early-stage disease.
  • Stage 2
    Cancer has either spread to lymph nodes or structures near the pancreas (such as the small bowel or common bile duct), or is large but has not spread to neighbouring organs.
  • Stage 3
    Cancer has grown into nearby major arteries. There may or may not be cancer in the lymph nodes.
  • Stage 4
    The cancer has spread to other organs, such as the liver, lungs or lining of the abdomen.

Ask your doctor to explain the stage in a way that will help you understand the best treatment options for your situation.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of your disease. Your prognosis will depend on the stage of the cancer, the location of the tumour and other factors such as your age, fitness and medical history.

In general, the earlier cancer is diagnosed, the better the prognosis. This is because the cancer may not have spread beyond the pancreas and treatment can start earlier. However, pancreatic cancers – especially exocrine tumours – are usually not found until they are advanced because symptoms can be vague or go unnoticed.

For people who have PNETs, functioning tumours may have better outcomes than non-functioning tumours.

Advanced cancer is more difficult to treat successfully, but palliative treatment can relieve various symptoms and help to improve quality of life.

Key points

  • You will have several tests to confirm the diagnosis.
  • Blood tests can show how your liver and kidneys are working, and provide a full blood count.
  • During an ultrasound, gel is spread over your abdomen and a scanner creates pictures of your organs.
  • CT and MRI scans involve an injection of dye into your body, followed by a scan. Some people have a type of MRI called a MRCP. This produces more detailed images.
  • During an endoscopy, a tube with a light and camera is passed into your digestive system.
  • An ultrasound probe may be used during an endoscopy. This is called an endoscopic ultrasound (EUS).
  • Scintigraphy is an imaging method that uses a mild dose of a radioactive substance to show where tumours may be in the body.
  • A biopsy means removing cells or tissue samples from an organ for examination under a microscope. This may be done during an endoscopy or endoscopic ultrasound.
  • A biopsy can also be done during a surgical procedure called a laparoscopy, when the surgeon makes small cuts in your abdomen to access the pancreas.
  • The cancer is assigned a stage to describe how much cancer there is and where it has spread.
  • You may wish to talk to your doctor about your prognosis. This is the expected outcome of your disease

Reviewed by: A/Prof Val Usatoff, Head of Unit, Upper GI/HPB Surgery, Western Hospital, A/Prof of Surgery, The University of Melbourne, Adj Senior Lecturer, Monash University, HPB Surgeon, Alfred Hospital, Deputy Medical Director and HPB Surgeon, Cabrini Hospital and Founding Councillor and Treasurer, Australian and New Zealand HPB Association; Merran Findlay, Acting Cancer Services Development Manager, Senior Oncology Dietitian, Royal Prince Alfred Hospital, NSW; Suzanne Kavanagh, Consumer; Rachelle Ryan, Senior Dietitian Clinical Educator, Royal Prince Alfred Hospital, NSW; Janny Wagenaar, Nurse, Cancer Council Tasmania.
Updated: 01 Feb, 2014