Page last updated: April 2024
The information on this webpage was adapted from Understanding Pancreatic Cancer - A guide for people with cancer, their families and friends (2024 edition). This webpage was last updated in April 2024.
Expert content reviewers:
This information was developed based on clinical practice guidelines, and with the help of a range of health professionals and people affected by cervical cancer:
- Prof Lorraine Chantrill, Honorary Clinical Professor, University of Wollongong, and Head of Department, Medical Oncology, Illawarra Shoalhaven Local Health District, NSW
- Karen Baker, Consumer
- Michelle Denham, 13 11 20 Consultant, Cancer Council WA
- Prof Anthony J Gill, Surgical Pathologist, Royal North Shore Hospital and The University of Sydney, NSW
- A/Prof Koroush Haghighi, Liver, Pancreas and Upper Gastrointestinal Surgeon, Prince of Wales and St Vincent’s Hospitals, NSW
- Dr Meredith Johnston, Radiation Oncologist, Liverpool and Campbelltown Hospitals, NSW
- Dr Brett Knowles, Hepato-Pancreato-Biliary and General Surgeon, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, and St Vincent’s Hospital, VIC
- Rachael Mackie, Upper GI – Clinical Nurse Consultant, Peter MacCallum Cancer Centre, VIC
- Prof Jennifer Philip, Chair of Palliative Care, University of Melbourne, and Palliative Medicine Physician, St Vincent’s Hospital, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, VIC
- Lucy Pollerd, Social Worker, Peter MacCallum Cancer Centre, VIC
- Rose Rocca, Senior Clinical Dietitian – Upper GI, Peter MacCallum Cancer Centre, VIC
- Stefanie Simnadis, Clinical Dietitian, St John of God Subiaco Hospital, WA
If your doctor thinks you may have pancreatic cancer, you will need some tests to confirm the diagnosis. Sometimes you may also have tests to check for gene changes in the cancer.
The tests you have will depend on the symptoms, type and stage of the cancer. You will not have all the tests described below.
Your guide to best cancer care
A lot can happen in a hurry when you’re diagnosed with cancer. The guide to best cancer care for pancreatic cancer can help you make sense of what should happen.
It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.
Read the guide
Blood tests
You are likely to have blood tests to check your general health and see how well your liver and kidneys are working. Some blood tests look for proteins produced by cancer cells. These proteins are known as tumour markers.
Tumour markers
Many people with pancreatic cancer have higher levels of the tumour markers CA 19-9 (carbohydrate antigen) and CEA (carcinoembryonic antigen) in their bloodstream. On their own, however, these tumour markers can’t be used to diagnose.
This is because some people with pancreatic cancer have normal levels of these markers, and other conditions can also raise the levels of these markers in the bloodstream. It is normal for the levels of these tumour markers to go up and down.
Your doctor will look for sharp increases and overall patterns. Raised levels can tell your doctor more about the cancer and, after diagnosis, can also show how well the treatment is working.
Imaging scans
Imaging scans are tests that create pictures of the inside of the body. Different scans can provide different details about the cancer.
Types of imaging tests
Before having scans, tell the doctor if you have any allergies or have had a reaction to dyes during previous scans. You should also let them know if you have diabetes or kidney disease or are pregnant or breastfeeding.
You will usually have at least one of the following scans during diagnosis and treatment:
- CT scan – most people suspected of having pancreatic cancer will have a CT (computerised tomography) scan. This scan uses x-ray beams to take many pictures of the inside of your body and then compiles them into one detailed, cross-sectional picture.
- Endoscopic scans – can show blockages or inflammation in the common bile duct, stomach and duodenum. For these scans, you will have an endoscopy, and there are two main types - an endoscopic ultrasound (EUS) and an endoscopic retrograde cholangiopancreatography (ERCP). During an endoscopic scan, the doctor can also take a tissue or fluid sample (biopsy) to help with the diagnosis.
- MRI and MRCP scans – an MRI (magnetic resonance imaging) scan uses a powerful magnet and radio waves to create detailed cross-sectional pictures of the pancreas and nearby organs. An MRCP (magnetic resonance cholangiopancreatography) scan is a different type of MRI scan that produces more detailed images and can be used to check the common bile duct for a blockage. MRIs for pancreatic cancer are not always covered by Medicare.
- PET–CT scan – doctors sometimes use a PET (positron emission tomography) scan combined with a CT scan to help work out if the pancreatic cancer has spread or how it is responding to treatment. PET–CT scans are specialised tests. They are not available in every hospital and may not be covered by Medicare.
Talk to your medical team for more information on each test, including what you may have to pay.
Molecular and genetic testing
Some people are born with a gene change that increases their risk of cancer (an inherited faulty gene), but most gene changes that cause cancer build up during a person’s lifetime (acquired gene changes).
In some circumstances, your doctors may recommend extra tests to look for acquired gene changes (molecular tests) or inherited gene changes (genetic tests).
Learn more
Molecular testing
If you have pancreatic cancer, you may be offered extra tests on the biopsy sample known as molecular or genomic testing.
This looks for gene changes and other features in the cancer cells that may help your doctors decide which treatments to recommend.
Molecular testing for pancreatic cancer is not covered by Medicare and can be expensive, so check what costs are involved and how helpful it would be.
If you are having molecular testing as part of a clinical trial, the costs may be covered.
Genetic testing
Your doctor may suspect you have developed pancreatic cancer because you have inherited a faulty gene – for example, because other members of your family have also had pancreatic cancer.
In this case, they may refer you to a family cancer clinic for genetic counselling and extra tests.
These tests are known as genetic or germline tests. The results may help your doctor work out what treatment to recommend and can also provide important information for your blood relatives.
Genetic counselling can help you understand what tests are available to you and what the results mean for you and your family. Medicare may cover the costs of genetic tests – check this with your treatment team.
Tissue sampling
If imaging scans show there is a tumour in the pancreas, your doctor may remove a sample of cells or tissue from the tumour (biopsy).
This is the main way to confirm if the tumour is cancer and to work out exactly what type of cancer it is. A specialist doctor called a pathologist will examine the sample under a microscope to check for signs of cancer.
Sometimes, the results are not clear and a second biopsy is needed.
A biopsy can be taken in different ways, including:
- with a needle – a sample of cells may be collected with a fine needle (fine needle biopsy), or a tissue sample may be collected with a larger needle (core biopsy). A fine needle or core biopsy can be done during an endoscopic procedure. Another method is to insert the needle through the skin of the abdomen, using an ultrasound or CT scan for guidance.
- during keyhole surgery – also called a laparoscopy or minimally invasive surgery, a laparoscopy is sometimes used to look inside the abdomen to see if the cancer has spread to other parts of the body. It can also be done to take tissue samples before any further surgery.
- during surgery to remove the tumour – if you are having a larger operation to remove the tumour, your surgeon may take the tissue sample at that time.
“I asked the surgeon what caused it, and he said, ‘We don’t know, Phil.’ He got me to focus on what had to be done and to just get on with it. It’s easy to say now that you need to get on the front foot and work with your treatment team, but the diagnosis is a terrific blow.” Phil
Staging pancreatic cancer
The test results will show what type of pancreatic cancer it is, where in the pancreas it is, and whether it has spread. This is called staging, and it helps your doctors work out the best treatment options for your situation.
The TNM system
Pancreatic cancer is commonly staged using the TNM (Tumour-Nodes-Metastasis) system, with each letter given a number that shows how advanced the cancer is:
- T stands for Tumour and refers to the size of the tumour or how close it is to major blood vessels. It will be given a score of T0–4. The higher the number, the more advanced the cancer is.
- N stands for Nodes and refers to whether the cancer has spread to lymph nodes. N0 means the cancer has not spread to nearby lymph nodes; N1 means the cancer has spread to 1–3 nodes, N2 means the cancer has spread to 4 or more lymph nodes.
- M stands for Metastasis. M0 means the cancer has not spread to other parts of the body; M1 means it has.
The TNM scores are combined to work out the overall stage of the cancer, from stage 1 to stage 4.
If you need help to understand staging, ask someone in your treatment team to explain it in a way that makes sense to you. You can also call 13 11 20 for information and support.
Stages of pancreatic cancer
- Stage 1 – cancer is small and found only in the pancreas.
- Stage 2 – cancer is large but has not spread outside the pancreas, or it is small and has spread to a few nearby lymph nodes.
- Stage 3 – cancer has grown into nearby major blood vessels or into a lot of nearby lymph nodes.
- Stage 4 – cancer has spread to more distant parts of the body, such as the liver, lungs or lining of the abdomen. There may or may not be cancer in the lymph nodes.
Stage 1–2 cancers are considered early pancreatic cancer. They may also be called resectable, which means surgery to remove the cancer may be an option if you are well enough. About 20% of pancreatic cancers are stage 1–2 when first diagnosed.
Some stage 3 cancers are borderline resectable cancers, which means surgery to remove the cancer may be an option if other treatment can shrink the cancer first.
Other stage 3 cancers are called locally advanced, which means that surgery cannot remove the cancer, but treatments can relieve symptoms. About 30% of pancreatic cancers are stage 3 when first diagnosed.
Stage 4 cancer is called metastatic cancer. Surgery cannot remove the cancer, but treatments can relieve symptoms. About 50% of pancreatic cancers are stage 4 when first diagnosed.
Prognosis
Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of the disease.
To work out your prognosis, your doctor will consider:
- test results
- the type, stage and location of the cancer
- how the cancer responds to initial treatment
- your medical history
- your age and general health.
As symptoms can be vague or go unnoticed, most pancreatic cancers are not found until they are advanced, which usually means treatment cannot remove all the cancer.
If the cancer is diagnosed at an early stage and can be surgically removed, the prognosis may be better.
It is important to know that although the statistics for pancreatic cancer can be frightening, they are an average and may not apply to your situation.
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