Understanding Pancreatic Cancer: The Diagnosis
The first step in diagnosing pancreatic cancer is to do a physical exam. Your doctor will focus mostly on your abdominal area (belly). In particular, the doctor will be looking for swelling of the lymph nodes or liver. He or she will also check the white part of your eyes for a yellow color. This condition is called jaundice and can be a symptom of pancreatic cancer. Keep in mind that it can also be caused by other non-cancerous conditions.
Once the physical exam is done, your doctor will probably want you to have one or more imaging tests done. These might include:
CT scan (CAT scan or computed tomography): This type of X-ray takes pictures of different angles of your pancreas and other organs in the abdomen. Before the X-ray, you will have to drink 1 to 2 pints of liquid dye. This helps outline your esophagus and intestines. If it’s difficult for you to swallow, you may instead get an IV (intravenous) line. The contrast dye can be delivered through the IV.
CT scans show your pancreas clearly. CT scans also show:
- the organs near your pancreas
- nearby lymph nodes
- distant organs where cancer might have spread
You may experience a warm feeling and some redness from the injection. This may be uncomfortable, but it is not painful. You will have to lie very still on a table. This table will slide in and out of the scanner. A CT scan takes longer than a regular X-ray. Some people complain that they feel restless and confined. There are newer CT scanners in many hospitals and clinics that are faster and less confining.
The CT scan can help locate the cancer and determine how big it is. Your doctor also uses a CT scan to decide whether surgery is a good option.
MRI (magnetic resonance imaging): MRI scans are similar to CT scans except that they use radio waves and strong magnets to take pictures. MRIs are a little more uncomfortable than CT scans, because they involve an enclosed space. They also take longer. An MRI usually takes about an hour.
PET scan (positron emission tomography): This scan requires a special radioactive sugar to be injected in your vein. The cancerous tissues then take up the sugar. That enables a scanner to easily see those areas. PET scans are useful for finding cancer that has spread.
PET/CT scan: This test combines the 2 types of scans. This combination is a better way to find the tumor. Your doctor may recommend this test if the cancer has spread beyond your pancreas and can’t be surgically removed. A combination PET/CT scan is also helpful in determining the stage of cancer.
Ultrasound: This test uses sound waves to make pictures of the inside of your body. A computer then combines the pictures to produce a detailed image. An ultrasound can help identify what kind of tumor is in your pancreas. To take an ultrasound of your abdomen, a wand called a transducer is moved around on your skin.
An endoscopic ultrasound (EUS) is the best way to look for pancreatic cancer. In this test, the wand is on the end of a long tube. This tube is put through the nose or mouth into the stomach. This produces a very good picture. An endoscopic ultrasound is better than CT scans for seeing small tumors. You will be given a sedative or anesthesia to make you sleepy or relaxed before you have an endoscopic ultrasound.
ERCP (endoscopic retrograde cholangiopancreatography): As with an ultrasound, you will be given medicine to make you sleepy and relaxed. Then a thin, flexible tube will be passed down the throat to reach into the small intestine. Your doctor will be able to see through the end of the tube. He or she can find where your common bile duct opens into your small intestine.
Next a small amount of contrast dye is pushed through the tube into the ducts. This dye outlines your bile ducts on X-rays. The pictures can reveal blocked ducts. These blockages may be a sign of pancreatic cancer. At the same time, your doctor can insert a small brush through the tube. This will remove cells so they can be examined under a microscope looking for cancer cells.
ERCP is also used to place a small tube into the bile duct to keep it open if a nearby tumor is pressing on it. This tube is called a stent.
Magnetic Resonance Cholangiopancreatography (MRCP): MRCP is a special type of magnetic resonance imaging (MRI). An MRCP is less invasive than an ERCP, but it shows a similar picture. A MRCP shows the pancreatic and bile ducts.
Angiography: This type of X-ray looks at blood vessels. It can identify blood flow that is blocked or slowed. Often a tumor is causing such a blockage. Angiography also reveals abnormal blood vessels. This helps your doctor decide if the cancer can be surgically removed.
Many patients say that angiography is uncomfortable. This is because a small tube called a catheter has to be put into the artery that leads to the pancreas. Typically the catheter is inserted into an artery in the inner thigh. From there it is threaded up to your pancreas. You will be given a local anesthetic to numb the area before the catheter is inserted. Then the dye is put in through the catheter. This dye outlines all the blood vessels so that clear X-rays can be taken.
Blood tests: Your doctor may run certain blood tests to help diagnose pancreatic cancer. These tests will also help you and your doctor decide on the best treatment plan. The tumor markers CA19-9 and CEA in your blood can indicate pancreatic cancer. In addition, blood tests for liver, kidney and bone marrow function help your doctor decide if you are able to go through the stress of surgery.
Biopsy: A biopsy is a fairly common surgical procedure. During a biopsy, the doctor removes a sample of tissue from the tumor. The sample is examined under the microscope to check for cancer cells.
There are several different types of biopsies:
- Fine needle aspiration (FNA) biopsy: This is most commonly used for detecting pancreatic cancer. In this test, the doctor puts a thin needle through your skin. The needle then extends into your pancreas, and small pieces of tissue are removed. Sometimes this is done at the same time as a CT scan or ultrasound.
- Laparoscopy: In this biopsy, you will be given drugs to make you sleepy. Then the surgeon makes tiny cuts and inserts small, thin, instruments into your abdomen. These are like telescopes. One is connected to a video screen. The surgeon can look to see the size of the tumor and whether it has spread. A tissue sample can also be taken at the same time.