How pancreatic cancer is diagnosed

To make a diagnosis, doctors often use information from several tests, along with your symptoms and medical history. You usually begin by seeing your GP. They will normally examine you, test your urine and take some blood samples. They will then refer you to hospital for tests.

At the hospital, a specialist doctor will ask about your general health and any previous medical problems. They will examine you and organise some tests and scans.

These may include:

  • an ultrasound scan
  • an endoscopic ultrasound (EUS)
  • a CT (computerised tomography) scan
  • an MRI (magnetic resonance imaging) scan
  • an MRCP (magnetic resonance cholangiopancreatography)
  • an ERCP (endoscopic retrograde cholangiopancreatography)
  • a biopsy
  • a laparoscopy
  • a laparotomy
  • blood tests.

It may take from a few days to a couple of weeks for the results to be ready. Waiting for test results can be a difficult time.

How cancer of the pancreas is diagnosed

Usually, you begin by seeing your GP. 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 some blood samples. They may examine your tummy (abdomen) to feel for any swelling in the area of the liver. They will also ask if you have noticed any changes in your bowel habits or in your weight.

Your GP will then refer you to hospital for tests and for specialist advice and treatment. If you are aged 60 or older and have symptoms, your doctor may arrange a referral and an urgent CT scan or ultrasound. If you are aged 40 or older and have jaundice, you should be seen at the hospital within two weeks.

At the hospital, a specialist doctor will ask about your general health and any previous medical problems. They will then examine you and organise some tests and scans.


Tests

To make a diagnosis, doctors often use information from several tests, along with your symptoms and medical history. Occasionally, other medical conditions can cause similar results, making it difficult to decide what is and isn’t cancer. 

If you are diagnosed with pancreatic cancer, you may need more tests. These are to find out the size and position of the cancer, and whether it has spread to other parts of the body.

Other tests, such as blood tests and chest x-rays, will look at your general health and fitness. All these results will help when your doctor looks at the best treatment for you.

The following tests are often used to test for suspected cancer of the pancreas:


Ultrasound scan

Ultrasound scans use sound waves to show internal organs such as the pancreas and the liver. You will 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 where a small sample of tissue is taken to be examined under a microscope (see below).


Endoscopic ultrasound (EUS)

If there is a tumour, your doctor may do an endoscopic ultrasound (EUS) to measure its size and to see whether it has spread. They may also take samples of tissue (biopsies) from the tumour during the EUS.

You will be asked not to eat or drink anything for about six hours before the test, so that your stomach and duodenum are empty. Your doctor or nurse will give you an injection to help you to relax (a sedative). They will also spray some local anaesthetic 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 this test. It is a good idea to arrange for someone to collect you from the hospital as you shouldn’t drive for 24 hours after a sedative.


CT (computerised tomography) scan

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.

CT scan
CT scan

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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.


MRI scan

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, such as 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.


MRCP (magnetic resonance cholangiopancreatography)

This test uses magnetic and radio waves to get a detailed picture of your pancreas, bile ducts and liver. It is a type of MRI scan (see above) but isn’t available in every hospital. You will have to lie very still inside the MRI scanner for around 30 minutes. The scan shows any narrowing or blockages in the pancreatic ducts or bile ducts but can’t be used to take biopsies.


ERCP (endoscopic retrograde cholangiopancreatography)

Doctors may carry out an ERCP to put a stent in a blocked bile duct. A stent is a flexible plastic or metal tube, which holds a blocked duct open and allows it to drain. This is a treatment for jaundice. They may also use an ERCP to take a biopsy from a tumour (see below).

You will be asked not to eat or drink anything for six hours before the procedure, so that your stomach and duodenum are empty.

The doctor or nurse will give you 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.

It’s not nice, the thought of having a tube down your throat. But it was not unpleasant at all.

Phil


Biopsy

A biopsy is a small piece of tissue or a sample of cells that is taken from a tumour to be looked at under a microscope.

A biopsy may be taken during an EUS or an ERCP (see above). Sometimes, the doctor inserts a needle through the skin into the tumour to get a sample of cells. This is called a percutaneous biopsy or fine needle aspirate (FNA). 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 take (aspirate) a sample of cells. The sample is then sent to a laboratory to be tested for cancer.


Laparoscopy

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 is a small operation that allows the doctors to look at the pancreas and other organs in the tummy. They can see whether an operation to remove the cancer is possible. A laparoscopy is done under a general anaesthetic. It will mean a short stay in hospital.

The doctor makes a small cut near the belly button. They then insert a thin tube with a tiny camera and light on the end, called a laparoscope, into your tummy. 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 can cause uncomfortable wind and/or shoulder pains for several days afterwards. The pain is often eased by walking about or taking sips of peppermint water. After the laparoscopy, you will have one or two stitches in your abdomen.


Laparotomy

If a laparoscopy isn’t suitable, your surgeon may carry out a laparotomy. This may be done if other tests don’t give a definite diagnosis, but it’s rarely needed as most people can have a laparoscopy.

A laparotomy is an operation to look inside the tummy and is done under a general anaesthetic. The surgeon makes a larger cut (incision) in your tummy so that they can see the pancreas.

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.


Blood tests

Many pancreatic cancers produce a substance called CA 19-9. This is called a tumour marker and can be measured in the blood. But some people who have pancreatic cancer don’t have raised levels of CA 19-9. And a normal level of CA 19-9 does not mean that someone definitely doesn’t have pancreatic cancer. Also, a high level may be caused by other conditions such as jaundice. Doctors will consider these things when they are looking at the test results.

Doctors may measure the level of CA 19-9 to see how a pancreatic cancer responds to treatment and during follow-up.

You may also have other blood samples taken to check your general health and how well your liver and kidneys are working.


Waiting for test results

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. Your specialist nurse or one of the organisations listed on our database, can also provide support. You can also talk things over with one of our cancer support specialists on 0808 808 00 00.

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