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How is pancreatic cancer diagnosed?

The tests you have will depend on the symptoms, type and stage of pancreatic cancer.

You will not have all the tests described. Some are only used to detect pancreatic NETs.

You are likely to have blood tests to check your general health and see how well your liver and kidneys are working.

Some blood tests look for proteins produced by cancer cells. These proteins are called tumour markers.

If your doctor suspects you have pancreatic NETs, you may have a blood test to check for high levels of certain hormones and a tumour marker called CgA (chromogranin-A).

Tests that create pictures of the inside of the body are known as imaging scans. Different scans can provide different details about the
cancer. You will usually have at least one of the following scans during diagnosis and treatment.

Ultrasound
An ultrasound uses soundwaves to create a picture of the inside of your body. An ultrasound of your abdomen will show the pancreas and the surrounding area, including your liver. It can show if a tumour is present and its size.

CT scan
Most people suspected of having pancreatic cancer will have a CT (computerised tomography) scan. This scan uses x-ray beams to create detailed, cross-sectional pictures of the inside of your body.

MRI and MRCP scans
An MRI (magnetic resonance imaging) scan uses a powerful magnet and radio waves to create detailed cross-sectional pictures of the pancreas and nearby organs. An MRCP (magnetic resonance cholangiopancreatography) is a different type of MRI scan that produces more detailed images and can be used to check the common bile duct for a blockage (obstruction).

Endoscopic scans
Endoscopic scans can show blockages or inflammation in the common bile duct, stomach and duodenum. They are done using an endoscope, a long, flexible tube with a light and small camera on the end, that is passed down your throat into your digestive tract. This is also called an endoscopy.

During these scans, the doctor can also take a tissue or fluid sample to help with the diagnosis. This is called a biopsy.

There are two main types of endoscopic scans:

  • EUS – An EUS (endoscopic ultrasound) uses an endoscope with an ultrasound probe (transducer) attached. The transducer makes soundwaves that create detailed pictures of the pancreas and ducts. This helps to locate small tumours and shows if the cancer has spread into nearby tissue.
  • ERCP – The endoscopic scan known as an ERCP (endoscopic retrograde cholangiopancreatography) is used to take an x-ray of the common bile duct and pancreatic duct. The doctor uses the endoscope to guide a catheter into the bile duct and insert a small amount of dye. The x-ray images show blockages or narrowing that might be caused by cancer. ERCP may also be used to put a thin plastic or metal tube (stent) into the bile duct to keep it open.

PET–CT scan
A PET (positron emission tomography) scan combined with a CT scan is a specialised imaging test.

Fluorodeoxyglucose (FDG)
This substance is commonly used in PET scans. Some cancer cells may show up brighter on the scan because they take up more glucose solution than normal cells do. This scan can help doctors work out whether pancreatic cancer has spread or how it is responding to treatment.

68-Gallium DOTATATE (GaTate)
For most pancreatic NETs, the radioactive material used in a PET scan is 68-Gallium DOTATATE. This scan can help show the exact position of pancreatic NETS and may show tumours that don’t appear on other scans. It may also be used to help work out whether a pancreatic NET has spread. For some pancreatic NETs, an FDG-PET is used instead of or as well as this test.

If imaging scans show there is a tumour in the pancreas, your doctor may remove a sample of cells or tissue from the tumour (biopsy).

Fine needle or core biopsy
A fine needle biopsy removes some cells from the pancreas, while a core biopsy uses a thicker needle to remove a sample of tissue. This is done during an endoscopy or endoscopic ultrasound.

Laparoscopy
A laparoscopy, also called keyhole surgery, is sometimes used to look inside the abdomen to see if the cancer has spread to other parts of the body. It can also be done to take tissue samples before any further surgery. This procedure is done under general anaesthetic.

A laparoscopy is done with an instrument called a laparoscope, which is a long tube with a light and camera attached. The doctor will guide the laparoscope through a small cut near your belly button so they can see the inside of your body.