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After a diagnosis is made, more tests may be needed 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 to 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 pancreatic cancer:
It will probably take several days for the results of your tests to be ready and this waiting period will obviously be an anxious time for you. It may help if you can talk things over with a relative or close friend. You may wish to ring our cancer support specialists or another support organisation| for emotional support.
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. Measuring the level of CA 19-9 can help to diagnose pancreatic cancer alongside other tests such as scans. It may also be used to monitor how the cancer responds to treatment.
About 1 in 4 people don't make CA 19-9, so a normal level on its own doesn't mean someone definitely doesn't have pancreatic cancer.
Ultrasound scans use sound waves to look at 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 to 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.
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.
Before the test, you are asked not to eat or drink anything for about six hours so that the stomach and small bowel (duodenum) are empty. You are given an injection to help you to relax (sedative) and some local anaesthetic is sprayed onto the back of your throat.
The doctor passes a thin flexible tube (endoscope) down your throat, into your stomach and then into your duodenum (the first part of the small bowel). 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 though, as you shouldn't drive for 24 hours after having a sedative.
A CT scan takes a series of x-rays, which builds up a three-dimensional picture of the inside of the body. The scan takes about 10–30 minutes and is painless. CT scans use a small amount of radiation, which is very unlikely to harm you and won't harm anyone you come into contact with. You will be asked not to eat or drink for a few hours before the scan.
Illustration of a person having a CT scan
View a large version of the illustration of a person having a CT scan|
CT scans can 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.
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 will probably be able to go home as soon as the scan is over.
Some hospitals use low-dose spiral CT scans. A CT scanning machine rotates rapidly around the body, taking more than 100 pictures in sequence. This only takes a few minutes and is quicker than a standard CT scan. Spiral CT scans are quite new and you might have to travel to a specialist hospital to have one.
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, bone pins, etc. 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 (see above) or an ERCP (see below). 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.
An ERCP may be done to unblock a bile duct. It is also sometimes used to take a sample of cells (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 small bowel (duodenum) are empty.
You are given an injection to make you feel relaxed and sleepy (sedative). The doctor will then pass a thin flexible tube called an endoscope into your mouth, down into your stomach and then into the first part of the small bowel (the duodenum). They then put a small brush down the endoscope and take samples of cells (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.
This is a combination of a CT scan and a PET scan. PET scans use low-dose radiation to measure the activity of cells in different parts of the body. PET/CT scans give more detailed information about the part of the body being scanned. They are a new type of scan and you may have to travel to a specialist centre to have one.
You are asked not to eat for several hours before the scan, although you may be able to drink. You will then have an injection of a mildly radioactive substance into a vein, usually in your arm. The radiation dose is very small. You will then need to wait for an hour or more. The scan itself usually takes 30–90 minutes. You should be able to go home when the scan is over.
This may be done if other tests haven't confirmed a diagnosis of pancreatic cancer or if an operation 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 area of the pancreas and see whether an operation will be possible.
The doctor makes a small cut (about 2cm/1inch) in the skin and muscle near the navel (belly button) and carefully inserts 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 sample of tissue (biopsy) to be looked at under a microscope. Sometimes 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.
This is an operation to look inside the abdomen and is done under a general anaesthetic. It may be done if other tests don’t give a definite diagnosis. But, it’s rare for a laparotomy to be 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.
Content last reviewed: 1 December 2010
Next planned review: 2013
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