Reviewed by:
Assoc Prof James St John - MBBS, MD, FRCP, FRACP, AGAF
Dr Lara Lipton - MBBS, PhD and FRACP
Dr Suzanne Kosmider - MBBS, FRACP
Mr Benjamin Thomson, MBBS FRACS, Consultant Hepatobiliary Surgeon, Peter MacCallum Cancer Centre and Royal Melbourne Hospital
Taken from: 
Pancreatic cancer booklet (2.1MB)
Doctors and other health professionals you may see
How pancreatic cancer is diagnosed
Computerised tomography (CT) scan
Magnetic resonance imaging (MRI)
Positron emission tomography (PET) scan
You may not realise that you have pancreatic cancer until the cancer is big enough to touch and affect organs nearby. The symptoms can be minor at first.
The most common symptoms of pancreatic cancer are jaundice, itch, a gnawing pain in the abdomen, loss of appetite, nausea and weight loss.
If the cancer blocks the bile duct, bile will build up in the blood, causing jaundice. This will cause the skin and the whites of the eyes to become yellowish and may make your skin very itchy. Jaundice also can cause dark urine and pale bowel motions (faeces).
Some pancreatic cancers can cause severe back pain.
Diabetes is a symptom in 10-20% of people with pancreatic cancer. This is because the cancer stops the pancreas from making insulin properly.
If the cancer has spread, signs can include pain from liver enlargement, and swelling in the abdomen due to fluid build-up or bowel obstruction.
Other illnesses (including benign cysts and tumours) can cause symptoms like those described above, and should always be checked by a doctor.
Your doctor will examine you and refer you for tests to see if you have cancer. This can be a worrying and tiring time, especially if you need to have several tests.
If the tests show you have or may have cancer, your doctor will refer you to a specialist, who will examine you and may ask you to have more tests. If you have cancer, one or more specialists will advise you about treatment options.
You should expect to be cared for by a team of health professionals from the relevant major fields (see following list). Ideally, all tests and treatment should be available at your hospital, however this may not be possible.
Specialists and other health professionals who care for people with pancreatic cancer include:
The common tests for pancreatic cancer are described on the following pages. You won't have all of them. These tests will tell your doctors if you have pancreatic cancer. They will also tell whether it is still confined to the pancreas and therefore able to be removed. When the tests are done, your doctor will tell you what they have learned about your cancer, and suggest the best treatment for you.
Before referring you for tests, your doctor will take a full medical history and examine you.
Blood tests check how well the liver and kidneys are working and provide a full blood count.
Pancreatic cancer often sends a protein (Ca 19.9) into the blood. This can be measured. It is not used to diagnose pancreatic cancer, but it can give your doctor important information about the cancer and its response to treatment.
A CT scan is a type of x-ray that takes many pictures of your organs and other structures, including the pancreas and other structures (including any tumours) in your abdomen. These are put together to build up a three-dimensional picture of your body.
CT scans are usually done at a hospital or a radiology clinic. It usually takes 30 to 40 minutes to complete this painless test. You will be asked not to have a meal before the scan. However, you will be asked to both drink and have an injection of a liquid dye. This dye makes your organs appear white on the scans that are taken, so anything unusual will show more clearly. The injection of dye can cause some people to feel hot. You will be asked to lie on a table. This is moved into the CT scanner, which is large and round like a doughnut. Most people are able to go home as soon as their scan is over.
This test is like a CT scan, but it uses magnetism instead of x-rays to build up pictures of organs in your abdomen, including your pancreas and other organs nearby. Like a CT scan, MRI is painless, and the magnetism is harmless.
You will be asked to lie on a table inside a large metal tube, which is open at both ends. The tube makes some people feel claustrophobic (afraid of being in a small space). You can usually take someone into the room with you to keep you company. The machine can be quite noisy. The test may take up to an hour.
Because the scanner uses a large magnet, if you have a pacemaker or have other metal objects in your body it may not be safe to have an MRI scan. Speak to your doctor or the staff at the MRI scanner if you are not sure.
In this test, sound waves are used to create a picture of your pancreas and the area around it, including your liver.
You will uncover your abdomen and lie on a table. Once you are comfortable, a gel will be spread on the skin over the area being scanned.
A small device called a ‘transducer' will be moved across your abdomen. It makes sound waves and receives echoes. A computer makes a picture of the echoes produced when the sound waves meet something dense, like an organ or a tumour. An ultrasound scan can show if a cancer is present, and how large it is.
The test is painless and takes 15 to 20 minutes.
In this test, a thin, flexible ‘telescope' called an endoscope is put into your mouth then passed down your throat into your digestive system so that the doctor can examine you inside. The procedure is called ERCP, or endoscopic retrograde cholangio-pancreatography. Through the endoscope, the doctor can inject a liquid directly into the pancreatic duct and bile duct, allowing images of these organs to appear on x-ray pictures. The test can show blockages and inflammation in these ducts, and allow the doctor to judge whether these are due to cancer or other problems. The doctor is also able to take a tissue or fluid sample through the endoscope to help with the diagnosis.
You will be asked not to eat or drink anything for a period of time before the test. You will be given a sedative and a local anaesthetic to make you as comfortable as possible during this test. You may even fall asleep. After the test, because of the sedative, you should not drive or operate machinery until the next day.
This test has some risks, including infection, bleeding and pancreatitis. A small number of people who have the test are affected. Your doctor will explain the risks before asking you to consent to the procedure.
In this test, the endoscope also has an ultrasound probe attached. This allows better views of the pancreas than other tests. It also allows the doctor to try to remove a sample of tissue from the pancreas (biopsy) for checking under a microscope.
This test looks at how tissue in the body is behaving.
If a PET scan is recommended, you will have an injection with a glucose solution containing a very small amount of radioactive material. The scanner can ‘see' the radioactive substance. Cancerous cells show up as ‘hot spots': areas where the glucose is being taken up.
A laparoscope is an instrument that is used to look inside the abdomen. It is like an endoscope, but goes into your abdomen through a small cut near your belly button.
You will be asked not to eat or drink for eight hours beforehand. You will have a general anaesthetic, and the doctor will make a small cut and guide the laparoscope around inside your body through a tube. The doctor can put other instruments inside your body through other small cuts (about 1 cm each) and take tissue samples if necessary. This procedure is useful to see if a cancer has spread to other sites in the abdomen. It may be done just before surgery.
You will have stitches where the cuts were made and may feel sore while you heal. You must ask for pain relief if you need it-don't put up with pain when you don't have to.
There is a small risk of infection or damage to an internal organ with laparoscopy. Your doctor will explain the risks before asking you to sign the consent form.
A biopsy may also be done.
In this procedure, a sample of tissue will be taken from the tumour in the pancreas and sent to a laboratory to be looked at under a microscope. Normally, the sample is taken by inserting a very fine needle into the pancreas. The doctor guides the needle by watching its path on an ultrasound or CT picture of your abdomen. Biopsy can also be performed by endoscopic ultrasound.
You may have either a local or a general anaesthetic.
The tests described on previous pages can show whether you have cancer in your pancreas. In many cases they also show if the disease has spread. The cancer may have spread into blood vessels or lymph nodes near the pancreas, or into organs further away, like the liver or the lungs. This is called metastasis. The tests you have help your doctors ‘stage' the disease so they can work out the best treatment for you.
The most common staging system used for pancreatic cancer is known as the ‘TNM system' (T = tumour, N = lymph nodes, M = metastases).
Doctors combine this information to determine the stage of the cancer, from Stage 1 (I) to Stage 4 (IV). For example, a pancreatic cancer staged as T1, N0, M0 (cancer contained within the pancreas, no spread to lymph nodes, no metastasis) is a Stage 1 pancreatic cancer.
Ask your doctor to explain the stage of your cancer in a way you can understand. This will help you to choose the best treatment for your situation.
