How pancreatic cancer is diagnosed
It can sometimes be difficult to diagnose pancreatic cancer as the symptoms may be similar to those caused by other, more common conditions.
Your GP will normally look at your eyes and the colour of your skin to check for jaundice, test your urine for bile and take a blood sample if needed. They may also examine your tummy (abdomen) to feel for any sweling in the area of the liver.
Your GP will refer you to hospital for tests and for specialist advice and treatment. At the hospital, the specialist will ask about your general health and any previous medical problems, and then examine you. You may have a blood test and a chest x-ray to check your general health.
To help make the diagnosis, you'll probably have a number of tests. If you are diagnosed with pancreatic cancer you may need more tests to find out about the size and position of the cancer, and whether it has spread to other parts of the body.
The results will help your doctor decide on the best treatment for you.
While tests are useful, no single test can tell the whole story. Even the most modern scans can’t always pick up tiny areas of cancer. Occasionally, other medical conditions can cause similar results, making it difficult to decide what is and isn’t cancer. Doctors often have to piece together information from different tests and examinations, along with your symptoms and medical history, and then put all this information in context.
The following tests are often used to diagnose cancer of the pancreas.
Ultrasound scans use sound waves to show internal organs such as the pancreas and the liver. You’ll usually be asked not to eat or drink anything for a few hours before the test.
Once you are lying comfortably on your back, a gel is spread on the skin over the area to be scanned. A small device that produces sound waves is passed over the area. The sound waves are then converted into a picture by a computer. This test only takes a few minutes.
An ultrasound can also be used to guide a biopsy, in which tissue is taken to be examined under a microscope.
CT (computerised tomography) scan
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A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body.
The scan takes 10–30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with.
You will be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.
You’ll probably be able to go home as soon as the scan is over.
CT scans can also be used to guide a biopsy, in which a small amount of tissue is taken to be examined under a microscope. A biopsy involves an overnight stay in hospital, but you’ll be told if this is planned.
Endoscopic ultrasound (EUS)
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An endoscopic ultrasound (EUS) may be done to measure the size of the tumour and to see whether it has spread to tissues nearby. It can also be used to take samples of tissue (biopsies) from the tumour.
You’ll be asked not to eat or drink anything for about six hours before the test, so that the stomach and duodenum are empty. You are given an injection to help you to relax
(a sedative) and some local anaesthetic is sprayed on to the back of your throat.
The doctor passes a thin flexible tube called an endoscope down your throat, into your stomach and then into your duodenum. An ultrasound probe is put down the endoscope to produce a picture of the pancreas and other organs on a screen.
Most people are ready to go home a couple of hours after their test. It’s a good idea to arrange for someone to collect you from the hospital as you shouldn’t drive for 24 hours after a sedative.
MRI (magnetic resonance imaging) scan
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This test uses magnetism to build up a detailed picture of areas of your body.
The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it’s safe for you. The checklist asks about any metal implants you may have, for example a pacemaker, surgical clips, or bone pins.
You should also tell your doctor if you’ve ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body it’s likely that you won’t be able to have an MRI scan. In this situation another type of scan can be used.
Before the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm, which doesn’t usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly.
During the test you’ll lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It’s painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It’s also noisy, but you’ll be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.
A biopsy is a small piece of tissue or a sample of cells that is taken from the tumour to be looked at under a microscope.
A biopsy may be taken during an EUS or an ERCP. Alternatively, the doctor may insert a needle through the skin into the tumour to get a sample of cells. This is called a percutaneous biopsy. The doctor injects a local anaesthetic into the skin to numb the area first. They then use images from an ultrasound or CT scan to guide the needle through the skin and into the tumour to withdraw a sample of cells.
ERCP (endoscopic retrograde cholangiopancreatography)
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An ERCP may be carried out to drain a bile duct to treat jaundice. It is also sometimes used to take a biopsy from the tumour.
You’ll be asked not to eat or drink anything for six hours before the procedure, so that your stomach and duodenum are empty.
You’re given an injection to make you feel relaxed and sleepy. After this the doctor passes a thin flexible tube called an endoscope into your mouth, down into your stomach and then into the duodenum. They then put a small brush down the endoscope and take biopsies from the tumour. The brush with the cells on it is sent to a laboratory to be tested for cancer.
To treat a blocked bile duct, the doctor injects a dye into the bile duct to help them see where the narrowing is. They then stretch the narrowed area of the duct and put a tube called a stent in through the endoscope. The stent holds the duct open and lets bile drain.
Many pancreatic cancers produce a substance called CA 19-9, which can be measured in the blood. CA 19-9 is known as a tumour marker
Some people who have pancreatic cancer don’t have raised levels of CA 19-9, so a normal level on its own doesn’t mean someone definitely doesn’t have pancreatic cancer.
Measuring the level of CA 19-9 isn’t very useful for diagnosing pancreatic cancer but it may be useful for monitoring how the cancer responds to treatment and during follow-up.
This may be done if other tests haven’t confirmed a diagnosis of pancreatic cancer or if surgery to remove the cancer is planned. It involves a small operation, done under a general anaesthetic, and will mean a short stay in hospital. It allows the doctor to look at the pancreas to see whether an operation to remove the cancer is possible.
Under a general anaesthetic the doctor makes a small cut (about 2cm/1in) in the skin and muscle near the belly button. They then insert a thin tube with a tiny camera and light on the end, called a laparoscope, into your abdomen. The doctor uses the laparoscope to look at the pancreas and surrounding tissues. They may also take a biopsy to be looked at under a microscope. Gas is pumped into the abdomen to make it easier to see the pancreas. The gas won’t harm you and gradually goes away after the laparoscopy.
If a laparoscopy isn’t suitable for you, your surgeon may carry out a laparotomy.
This is an operation to look inside the abdomen and is done under a general anaesthetic. The surgeon makes a larger cut (incision) in your abdomen so that they can see the pancreas.
It may be done if other tests don’t give a definite diagnosis, but it’s rarely needed as most people can have a laparoscopy.
ERCP, biopsy and laparoscopy can cause problems for some people. Your specialist should discuss any possible risks with you before you have any of these procedures.
Waiting for test results
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Waiting for test results can be a difficult time. It may take from a few days to a couple of weeks for the results of your tests to be ready. You may find it helpful to talk with your partner, family or a close friend. You can also talk things over with one of our cancer support specialists. Or, you may want to search for other useful organisations that can offer support too.