How cancer of the pancreas 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:

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

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.

Diagnosing cancer of the pancreas

If you have symptoms, you usually begin by seeing your GP. They will examine you and look at your eyes and the colour of your skin. This is to check for jaundice (yellowing of the skin and whites of the eyes). They may test your urine (pee) for bile and take some blood samples. They may also examine your tummy (abdomen) for swelling in the liver area. They will ask if you have noticed any changes in your poo (stools) or weight.

If your GP thinks cancer could be causing your symptoms, they will refer you to hospital. At hospital you will have tests and get specialist advice and treatment. GPs have guidelines that help them know when to refer people to a specialist.

If you are aged 60 or older, your doctor may refer you urgently. They may arrange an urgent CT scan or ultrasound within 2 weeks.

If you are aged 40 or older and have jaundice, you should see a specialist within 2 weeks.

Sometimes, people are diagnosed with pancreatic cancer after being admitted to hospital because a symptom is making them unwell.

What is pancreatic cancer?

Abdominal surgeon Charles Imber talks about symptoms and treatments for pancreatic cancer in our video.

About our cancer information videos

What is pancreatic cancer?

Abdominal surgeon Charles Imber talks about symptoms and treatments for pancreatic cancer in our video.

About our cancer information videos


At the hospital

The doctor will ask about your general health and any previous medical problems. They will then examine you and talk to you about the tests you need.

To diagnose you, doctors often use information from several tests, along with your symptoms and medical history. Sometimes other medical conditions can give similar results. This makes it difficult to confirm whether cancer is the cause.

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


Blood tests

You will need to give blood samples to check your general health. They will also show how well your liver and kidneys are working.

Your doctor might also test for tumour markers. These are chemicals that can show up in the bloodstream. Many pancreatic cancers produce a tumour marker called CA 19-9. But some people who have pancreatic cancer do not have raised levels of CA 19-9. So if you have a normal level of CA 19-9, you could still have pancreatic cancer. Also, other conditions, such as jaundice that has not been caused by cancer, may cause high levels of CA 19-9. Doctors will consider these things when looking at the test results.

Doctors may measure your level of CA 19-9 during treatment and follow-up. This is to see how the pancreatic cancer is responding to treatment.


Ultrasound scan

Ultrasound scans use sound waves to make a picture of internal organs, like the pancreas and liver. This test does not hurt and only takes a few minutes. You will have the scan in the hospital scanning department. Usually, you should not eat or drink anything for a few hours before the test.

You will lie comfortably on your back. A gel is spread on the skin over the area that will be scanned. A small device that makes sound waves is passed over the area. The computer then uses the sound waves to make a picture of the area.


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 to 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.

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 is 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.

Someone having a CT scan

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos


Biopsy

Taking a small piece of tissue or a sample of cells from a tumour is called a biopsy. A biopsy may happen during an EUS or an ERCP (see below for more information). The biopsy is then looked at under a microscope.

To get a sample of cells, the doctor might insert a needle through the skin and into the tumour. 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 guide the needle through the skin and into the tumour. This is to take (aspirate) a sample of cells. They are able to guide the needle using images from an ultrasound or CT scan.

The doctor will send the sample of cells to a laboratory to test for cancer. To help make an accurate diagnosis, they sometimes repeat the biopsy.


Endoscopic ultrasound (EUS)

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

You should not eat or drink anything for about 6 hours before the test. This is so your stomach and duodenum are empty. The duodenum is the first part of the small bowel. Your doctor or nurse will give you an injection to help you relax (a sedative). They will also spray local anaesthetic on to the back of your throat.

The doctor passes a thin, flexible tube (an endoscope) down your throat, into your stomach and then into your duodenum. An ultrasound probe is attached to the end of the endoscope. The probe produces 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. This is because you should not drive for 24 hours after having a sedative.


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 is safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips or bone pins, etc.

You should also tell your doctor if you have 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 is likely that you will not be able to have an MRI scan. In this situation, another type of scan can be used. Before the scan, you will be asked to remove any metal belongings including jewellery.

Some people are given an injection of dye into a vein in the arm, which does not 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 will lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It is also noisy, but you will be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.


MRCP

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, but is not available in every hospital. You will have to lie still inside the MRI scanner for around 30 minutes. The scan shows any narrowing or blockages in the pancreatic ducts or bile ducts. But the scan cannot take biopsies.


ERCP

For this test, the doctor passes a thin, flexible tube called an endoscope into your mouth. This goes down into your stomach and into the first part of the small bowel (duodenum). It allows the doctor to look at the pancreas and take a biopsy from a tumour. An ERCP can also unblock the bile duct.

You should not eat or drink anything for 6 hours before the procedure. This is so your stomach and duodenum are empty. The doctor or nurse will give you a sedative to make you feel relaxed and sleepy. They will also use a local anaesthetic spray to numb your throat. Sometimes, doctors do this test under general anaesthetic (while you are asleep).

Your doctor will look down the endoscope. This helps them find the openings where the bile duct and the pancreatic duct drain into the duodenum. This area is called the ampulla of Vater. They can inject a dye into these ducts that will show on x-rays. This helps them find any abnormalities or blockages.

If there are any abnormal areas, the doctor will take a biopsy. They will then send the biopsy to the laboratory to be examined under a microscope. They may put a small brush down the endoscope and take biopsies from the tumour. They will then send the brush with the cells on it 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


Laparoscopy

If other tests have not confirmed a diagnosis of pancreatic cancer, you may have a laparoscopy. You may also have this if you are going to have surgery to remove the cancer. It is a small operation that allows doctors to look at the pancreas and other organs in the tummy. They can see whether an operation to remove the cancer is possible. You will have a laparoscopy under general anaesthetic. This means you will have a short stay in hospital.

The doctor makes a small cut (incision) near the belly button. They then insert a thin tube (called a laparoscope) into your tummy. It has a tiny camera and light on the end, so doctors can look at the pancreas and surrounding tissues. They may also take a biopsy to look at in a laboratory, under a microscope.

To make it easier to see the pancreas, the doctor will pump gas into the abdomen. The gas can cause uncomfortable wind and shoulder pains for several days afterwards. Walking around or sipping peppermint water can help give you relief. After the laparoscopy, you will have one or two stitches in your abdomen.


Laparotomy

If a laparoscopy is not suitable for you, a surgeon may do a laparotomy. You might need this if other tests have not given a diagnosis. But it is rarely needed, as most people can have a laparoscopy.

A laparotomy is an operation to look inside the tummy. It happens under general anaesthetic. The surgeon makes a larger cut into your tummy, so they can see the pancreas.


PET-CT scan

This is a combination of a CT scan, which takes a series of x-rays to build up a three-dimensional picture, and a positron emission tomography (PET) scan. A PET scan uses 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. You may have to travel to a specialist centre to have one. You cannot eat for six hours before the scan, although you may be able to drink. A mildly radioactive substance is injected into a vein, usually in your arm. The radiation dose used is very small. You will wait for at least an hour before you have the scan. It usually takes 30 to 90 minutes. You should be able to go home after the scan.


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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