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How is pancreatic cancer diagnosed?

If your doctor thinks you may have pancreatic cancer, you will need some tests to confirm the diagnosis. These may include blood tests, imaging scans, endoscopic tests and tissue sampling (biopsy).

The tests you have will depend on the symptoms, type and stage of pancreatic cancer. You will not have all the tests described below. 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. Many people with pancreatic cancer have higher levels of the markers CA19-9 (carbohydrate antigen) and CEA (carcinoembryonic antigen). Other conditions can also raise the levels of these markers in the bloodstream, and some people with pancreatic cancer have normal levels.

The levels of tumour markers can’t be used to diagnose pancreatic cancer on their own, but they may tell your doctor more about the cancer and how well the treatment is working. It is normal for the levels of these markers to go up and down a bit. Your doctor will look for sharp increases and overall patterns.

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.

You will lie on your back for the procedure. A gel will be spread onto your abdomen and a small device called a transducer will be moved  across the area. The transducer creates soundwaves that echo when they meet something solid, such as an organ or tumour. A computer turns these echoes into pictures. The ultrasound is painless and takes about 15–20 minutes.

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.

A CT scan is usually done at a hospital or a radiology clinic. Before the scan, a liquid dye called contrast is injected into a vein to help make the pictures clearer. This may cause you to feel hot all over and may give you a strange taste in your mouth. These reactions are temporary and usually go away in a few minutes.

The CT scanner is large and round like a doughnut. You will need to lie still on a table while the scanner moves around you. The scan itself is painless and takes only a few minutes, but the preparation can take 10–30 minutes.

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).

An MRI or MRCP takes about an hour and you will be able to go home when it is over. Before the scan, you may be asked not to eat or drink (fast) for a few hours. You may also be given an injection of dye to highlight the organs in your body.

During the scan, you will lie on a treatment table that slides into a large metal tube that is open at both ends. The noisy, narrow machine makes some people feel anxious or claustrophobic. If you think you will be distressed, mention this beforehand to your doctor or nurse. You may be given medicine to help you relax, and you will usually be offered headphones or earplugs. Also let the doctor or nurse know if you have a pacemaker or any other metallic object in your body, as this can interfere with the scan.

MRIs for pancreatic cancer are not always covered by Medicare. If this test is recommended, check with your treatment team what you will have to pay.

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. It will usually be done as day surgery by a specialist called a gastroenterologist.

You will be asked not to eat or drink (fast) for six hours before an endoscopy. The doctor will give you a sedative so you are as relaxed and  comfortable as possible. Because of the sedative, you shouldn’t drive or operate machinery until the next day.

Having an endoscopic scan has some risks, including infection, bleeding and inflammation of the pancreas (pancreatitis). These risks are uncommon. Your doctor will explain these risks before asking you to agree (consent) to the procedure.

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 endoscope is passed through your mouth into the small bowel. 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. It may take several hours to prepare for and complete a PET–CT scan. Before the scan you will be injected with a small amount of radioactive material to highlight tumours in the body. The radioactive material may be either:

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.

These specialised PET scans are not available in every hospital and may not be covered by Medicare, so talk to your medical team for more information.

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). This is the main way to confirm if the tumour is cancer and to work out exactly what type of pancreatic cancer it is.

The sample may be collected with a needle (fine needle or core biopsy) or during keyhole surgery (laparoscopy). If you are having surgery to remove the tumour, your doctor may take the tissue sample at the same time. A pathologist will examine the sample under a microscope to check for signs of cancer.

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.

An ultrasound or CT scan can help the doctor guide the needle through the abdomen and into the pancreas. You will be awake during the procedure, but you will be given a local anaesthetic so you do not feel any pain.

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, so you will be asked not to eat or drink (fast) for six hours beforehand. If you take blood-thinning medicines or are diabetic, let your doctor or nurse know before the laparoscopy as they may need to adjust your medicines in the days leading up to the procedure.

A laparoscopy is done with an instrument called a laparoscope, which is a long tube with a light and camera attached. The camera projects images onto a TV screen so the doctor can see the inside of your body. The doctor will guide the laparoscope through a small cut near your belly button. The doctor can insert other instruments through other small cuts to take the biopsy.

You will have stitches where the cuts were made. You may feel sore while you heal, so you will be given pain-relieving medicine during and after the operation, and to take at home. There is a small risk of infection or damage to an organ with a laparoscopy. Your doctor will explain the risks before asking you to agree to the operation.

This information is reviewed by

This information was last reviewed February 2020 by the following expert content reviewers: Dr Lorraine Chantrill, Head of Department, Medical Oncology, Illawarra Shoalhaven Local Health District, NSW; Marion Bamblett, Nurse Unit Manager, Cancer Centre, Fiona Stanley Hospital, WA; Prof Katherine Clark, Clinical Director of Palliative Care, Northern Sydney Local Health District Cancer and Palliative Care Network, and Conjoint Professor, Northern Clinical School, The University of Sydney, NSW; Lynda Dunstone, Consumer; Kate Graham, Accredited Practising Dietitian – Upper GI Dietitian, Peter MacCallum Cancer Centre, VIC; Dr Gina Hesselberg, Radiation Oncologist, St George Hospital Cancer Centre, NSW; Dr Marni Nenke, Endocrinologist and Mary Overton Early Career Research Fellow, Royal Adelaide Hospital, SA; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; A/Prof Nicholas O’Rourke, Head of Hepatobiliary Surgery, Royal Brisbane Hospital and The University of Queensland, QLD; Rose Rocca, Senior Clinical Dietitian – Upper GI, Peter MacCallum Cancer Centre, VIC; Gail Smith, Consumer.