Pancreatic Cancer Diagnosis

Various blood tests are used to check your blood count, liver and kidney function and your general health. Blood tests can also check for tumour markers. These are chemical substances produced by cancers that may be present in the bloodstream. For example, pancreatic cancer is often linked to a tumour marker called CA19-9. Not all pancreatic cancers produce this marker, and it may also occur with some other illnesses that are not cancer.

Blood samples are usually examined in a laboratory within a day or two. Sometimes samples must be sent away for analysis, and it can take several days to get the results.

Blood tests are used together with other test results to make a diagnosis.

Ultrasound scans use sound waves to create a picture of what your body looks like inside. A probe is passed over the outside of your abdomen, and the images are collected on a screen – usually an outline of the liver, pancreas, gall bladder and bile ducts.

A CT scan uses X-rays to build up a three-dimensional picture of the pancreas and the other organs around it. It is common practice to scan your chest and pelvic area to check for any signs of cancer outside the pancreas. A CT scan can also be used to guide the needle during a biopsy that is performed in some cases. The biopsy procedure involves a tissue sample being taken for examination under a microscope.

An MRI scan uses radio waves and magnets to take pictures of organs and structures inside the body by measuring their energy. Like a CT scan, an MRI photographs the organs several times, while a patient lies on a table. A computer creates a 3D image that doctors can use to help diagnose and monitor pancreatic cancer.

A PET scan is a test where a small amount of radioactive substance is injected into a vein. On the scans, the injected substance shows areas where the cells are more active in the body. The scan works by highlighting where growing cells, such as cancer cells, use glucose for energy and growth faster than other non-cancerous cells. A PET scan may indicate whether a mass is cancerous and has spread. It can also help your healthcare team develop the right treatment plan, including whether surgery is possible.

This scan combines a CT scan with a PET scan. As mentioned above, a PET uses a small amount of radioactive material to scan for cancerous cells, and a CT is a type of X-ray. Combining the two scans into one has been shown to be extremely sensitive in detecting small tumours that are undetectable by other imaging procedures or CT alone. The images and information gained from a PET-CT scan can be used to determine what kind of surgery, radiation therapy and/or chemotherapy is most likely to be successful in treating the cancer.

Like the EUS, the ERCP is a procedure that involves the use of an endoscope. Additionally, the ERCP takes X-rays during the procedure. During an ERCP scan, dye is injected through the tube directly into the opening of the pancreatic duct (the ampulla of Vater) so that any blockages will be seen on the X-ray. While the endoscope is in place, the doctor may also take tissue samples for biopsy. If there is a blockage in your bile duct, the doctor may insert a small tube (called a stent) into the duct.

Another type of ultrasound – called an endoscopic ultrasound (EUS) – is a procedure that uses sound waves to take pictures of the pancreas, bile duct and digestive tract from within the body. This type of ultrasound is usually performed by a specialist gastroenterologist and involves an endoscope, which is a thin tube, entering a patient’s mouth and being guided down through the stomach and into the first part of the small intestine (duodenum). An EUS can help a doctor see a pancreatic tumour’s location and size, check whether the cancer has spread to other nearby areas of the body, or take a biopsy/tumour sample for examination. The images provided by this internal ultrasound have been shown to be helpful in diagnosing and staging pancreatic cancer.

In some circumstances a biopsy is performed as part of the investigations to be certain about your diagnosis. Tissue samples for examination under a microscope can be taken during an EUS, ERCP or laparoscopy, or through your skin with local anaesthetic and guided by CT. A biopsy may not be performed in certain cases when surgical removal is planned upfront. In cases when surgery is not planned at the beginning, you will need to have a biopsy before starting chemotherapy or taking part in a clinical trial, to obtain a definite cancer diagnosis.

The MRCP scan is a different type of MRI scan that is sometimes used to give clearer pictures of the bile and pancreatic ducts. It can also show if there are any blockages in the bile and pancreatic ducts. An MRCP can happen at the same time as an MRI.

This is a small operation done under general anaesthetic by a surgeon. A long tube with a camera at one end is inserted through a small cut in your abdomen so that the doctor can examine your organs internally. Other small cuts may be made so instruments can be inserted to help with the examination. This test can help to clarify whether a tumour has spread to other regions and can be removed by surgery. Sometimes an ultrasound probe (laparoscopic ultrasound) is also used to help identify suspicious areas and take a biopsy. This test may or may not be performed depending on your surgeon’s practices and the results of other tests.