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Tests and diagnosis
By Mayo Clinic staffResearchers are studying ways to detect pancreatic cancer early. However, it isn't clear who should undergo screening and which screening tests may most reliably find pancreatic cancer in its earliest stages. Currently no standard screening exists for pancreatic cancer.
Diagnosing pancreatic cancer
If your doctor suspects pancreatic cancer, you may have one or more of the following tests to diagnose the cancer:
- Ultrasound. Ultrasound uses high-frequency sound waves to create moving images of your internal organs, including your pancreas. The ultrasound sensor (transducer) is placed on your upper abdomen to obtain images.
- Computerized tomography (CT) scan. CT scan uses X-ray images to help your doctor visualize your internal organs. In some cases you may receive an injection of dye into a vein in your arm to help highlight the areas your doctor wants to see.
- Magnetic resonance imaging (MRI). MRI uses a powerful magnetic field and radio waves to create images of your pancreas.
- Endoscopic retrograde cholangiopancreatography (ERCP). This procedure uses a dye to highlight the bile ducts in your pancreas. During ERCP, a thin, flexible tube (endoscope) is gently passed down your throat, through your stomach and into the upper part of your small intestine. Air is used to inflate your intestinal tract so that your doctor can more easily see the openings of your pancreatic and bile ducts. A dye is then injected into the ducts through a small hollow tube (catheter) that's passed through the endoscope. Finally, X-rays are taken of the ducts. A tissue or cell sample (biopsy) can be collected during ERCP.
- Endoscopic ultrasound (EUS). EUS uses an ultrasound device to make images of your pancreas from inside your abdomen. The ultrasound device is passed through an endoscope into your stomach in order to obtain the images. Your doctor may also collect a sample of cells (biopsy) during EUS.
- Percutaneous transhepatic cholangiography (PTC). PTC involves injecting a dye into your liver to highlight your bile ducts. Your doctor carefully inserts a thin needle into your liver and injects the dye into the bile ducts in your liver. A special X-ray machine (fluoroscope) tracks the dye as it moves through the ducts.
- Biopsy. During a biopsy, your doctor obtains a small sample of tissue from the pancreas for examination under a microscope. A biopsy sample can be obtained by inserting a needle through your skin and into your pancreas (fine-needle aspiration). Or it can be done using endoscopic ultrasound to guide special tools into your pancreas where a sample of cells can be obtained for testing.
Staging pancreatic cancer
Once a diagnosis of pancreatic cancer is confirmed, your doctor will work to determine the extent, or stage, of the cancer. Your cancer's stage helps determine what treatments are available to you. In order to determine the stage of your pancreatic cancer, your doctor may recommend:
- Laparoscopy. Laparoscopy uses a lighted tube with a video camera to explore your pancreas and surrounding tissue. The surgeon passes the laparoscope through an incision in your abdomen. The camera on the end of the scope transmits video to a screen in the operating room. This allows your doctor to look for signs cancer has spread within your abdomen.
- Chest X-ray. A chest X-ray helps your doctor look for signs that cancer has spread to your lungs.
- CT scan. CT scans allow your doctor to see your pancreas and assess whether the cancer has spread to nearby tissues, lymph nodes or other organs.
- MRI. MRI images may show if the cancer has spread beyond the pancreas.
- Positron emission tomography (PET) scan. PET scans use a radioactive tracer injected into a vein in order to help your doctor look for areas where cancer has spread beyond the pancreas. PET scans aren't typically used for pancreatic cancer, but they may offer another way to examine unusual areas found with a CT scan or MRI.
- Bone scan. Bone scans use radioactive tracers to look for evidence that cancer cells have spread to your bones.
- Blood test. Your doctor may test your blood for specific proteins (tumor markers) shed by pancreatic cancer cells. One tumor marker test used in pancreatic cancer is called CA19-9. Some research indicates that the more elevated your level of CA19-9 is, the more advanced the cancer. But the test isn't always reliable, and it isn't clear how best to use the CA19-9 test results. Some doctors measure your levels before, during and after treatment. Others use it to gauge your prognosis.
Stages of pancreatic cancer
The stages of pancreatic cancer can be expressed in different ways. One description of the stages uses three broad categories:
- Resectable. All the tumor nodules can be removed.
- Locally advanced. The tumor can no longer be removed with surgery because the cancer has spread to tissues around the pancreas or into the blood vessels.
- Metastatic. At this stage, the cancer has spread to distant organs, such as the lungs and liver.
Another description of the stages uses numerals:
- Stage I. Cancer is confined to the pancreas.
- Stage II. Cancer has spread beyond the pancreas to nearby tissues and organs and may have spread to the lymph nodes.
- Stage III. Cancer has spread beyond the pancreas to the major blood vessels around the pancreas and may have spread to the lymph nodes.
- Stage IV. Cancer has spread to distant sites beyond the pancreas, such as the liver, lungs and the lining that surrounds your abdominal organs (peritoneum).
