How is Pancreatic Cancer Diagnosed?
July 23, 2018
It’s frightening when you hear the word “cancer,” although more people than ever are living rich, productive lives after a cancer diagnosis. It usually takes a number of tests to determine whether a person has cancer, particularly pancreatic cancer. Sometimes certain symptoms or a family history of cancer of the pancreas raises concerns and prompts a doctor to look for suspicious signs on clinical exam. Pancreatic cancer symptoms that merit further investigation include new onset diabetes particularly with sudden weight loss, pain in the upper abdominal region that often radiates to the back, yellowing (jaundice) of the skin or eyes, blood clots, bloating, fatigue, decreased appetite, and incessant itching.
The first approach for suspicious symptoms is always contacting your family practitioner for a physical exam. Red flags on exam that might alert a doctor that a more detailed evaluation is needed include swelling in the abdominal region or enlargement of the liver. Doctors also look for swollen lymph nodes that might suggest spread of cancer into the lymph system. A family history of cancer is definitely a red flag to further explore the possibility of pancreatic cancer, particularly if the patient has multiple risk factors of pancreas cancer.
Based on the findings, your doctor may order a variety of lab tests to rule out other possible causes for the symptoms, although there isn’t a blood test that’s diagnostic for pancreatic cancer. What’s more helpful are imaging studies.
If your doctor is concerned about the possibility of a pancreatic tumor, he or she would likely order an imaging study, most commonly a CT scan. This type of scan uses radiation to visualize the pancreas in depth using horizontal or axial slices that provide much more detail than a standard x-ray. Sometimes contrast, given intravenously or by mouth, is used to visualize areas of concern more clearly. MRI, a study that uses magnetic and radio waves is used instead of a CT scan, although CT scanning usually is the preferred test.
The advantage of CT and MRI imaging is both are non-invasive. Two other invasive tests are sometimes used to examine the pancreas and bile ducts and to take a tissue sample. One test called an ERCP involves passage of a small scope into your stomach and upper intestine. Once the scope is in place, a dye is injected into the bile ducts and pancreas and x-rays are taken.
Another test doctors sometimes use to image the pancreas is called an endoscopic ultrasound. Under sedation, a probe with an ultrasound transducer attached is passed into the mouth and guided carefully through the digestive tract to the small intestine. Once positioned correctly, sound waves are used to outline the head, body and tail of the pancreas. The benefit of ERCP and endoscopic ultrasound is you can take a biopsy, or small sample of tissue, if an abnormal area is seen. In addition, endoscopic ultrasound has a detection rate of between 99% and 100%.
The Final Step: Biopsy
In most cases, a biopsy, a sample of tissue from a suspicious area, will be needed to confirm the diagnosis of pancreatic cancer. Doctor perform biopsies in a number of ways. As mentioned, a small tissue sample can be taken during ERCP or endoscopic ultrasound. Another option is to do a biopsy through the skin by inserting a special needle into the abdominal cavity and taking up a few cells. Another less common way is to do a laparoscopic biopsy. Under sedation, an abdominal incision is made and a camera inserted to look for areas that look abnormal. A suspicious area can be biopsied and the tissue sent to the lab for confirmation.
The Bottom Line
Signs and symptoms of pancreatic cancer are often vague and can mimic typical symptoms of less serious illness such as acid reflux. It’s crucial to note that by the time symptoms become more pronounced, the disease is already advanced. As you can see, diagnosing pancreatic cancer involves a number of steps and often more than one study. Once the diagnosis is confirmed, the next step is staging and determining a treatment plan.
American Cancer Society. “Pancreatic Cancer”
Medscape.com. “Pancreatic Cancer Workup”