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Pancreatic cancer


Diagnosing pancreatic cancer

 

If your doctor thinks you may have pancreatic cancer, you will need some tests to confirm the diagnosis. These may include blood tests, CT, MRI and other imaging scans, endoscopic tests and tissue sampling (biopsy). 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.

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.

Many people with pancreatic cancer have higher levels of the tumour markers CA 19-9 (carbohydrate antigen) and CEA (carcinoembryonic antigen). Other conditions can also raise the levels of these markers in the bloodstream, while some people with pancreatic cancer have normal levels.

The levels of tumour markers can’t be used to diagnose pancreatic cancer on their own, but they may tell your doctor more about the cancer or how well the treatment is working. It is normal for the levels of these tumour markers to go up and down a little. Your doctor will look for sharp increases and overall patterns.

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 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 different types. 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 scan uses a powerful magnet and radio waves to create detailed cross-sectional pictures of the pancreas and nearby organs. An MRCP 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 (obstruction). MRIs for pancreatic cancer are not always covered by Medicare.
  • PET–CT scan doctors sometimes use a PET 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.

 

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).

More about genetic testing and counselling

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 or you may need to pay for them – 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.

A biopsy can be taken with a needle or during different types of surgical procedures.

  • 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 scan. Another method is to insert the needle through the skin of the abdomen, using an ultrasound or CT scan for guidance.
  • During a laparoscopy – also called keyhole 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.

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.

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. 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.

When pancreatic cancer is advanced, treatment will usually aim to control the cancer for as long as possible, relieve symptoms and improve quality of life. This is known as palliative treatment.

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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Understanding Pancreatic Cancer

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Expert content reviewers:

Dr Benjamin Loveday, Hepato-Pancreato-Biliary (HPB) Surgeon, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, VIC; Dr Katherine Allsopp, Palliative Medicine Physician, Crown Princess Mary Cancer Centre, Westmead Hospital, NSW; Hollie Bevans, Senior Dietitian, Radiotherapy and Oncology, Western Health, VIC; Dr Lorraine Chantrill, Head of Department Medical Oncology, Illawarra Shoalhaven Local Health District, NSW; Amanda Maxwell, Consumer; Prof Michael Michael, Medical Oncologist, Lower and Upper GI Oncology Service, Co-Chair Neuroendocrine Unit, Peter MacCallum Cancer Centre and University of Melbourne, VIC; Dr Andrew Oar, Radiation Oncologist, Icon Cancer Centre, Gold Coast University Hospital, QLD; Meg Rogers, Nurse Consultant Upper GI/NET Service, Peter MacCallum Cancer Centre, VIC; Ady Sipthorpe, 13 11 20 Consultant, Cancer Council WA. 

Page last updated:

The information on this webpage was adapted from Understanding Pancreatic Cancer - A guide for people with cancer, their families and friends (2022 edition). This webpage was last updated in May 2022.

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