Diagnosis of Pancreatic Cancer

Pancreatic cancer causes non-specific symptoms. If you have symptoms suggestive of pancreatic cancer or some other significant problem, your doctor will take a detailed history, perform physical examination and recommend tests. There may be no significant findings or abnormalities on physical examination in people with pancreatic cancer.

Some of the tests that are helpful in diagnosing pancreatic cancer are as follows.

Abdominal ultrasound: Ultrasound is a painless and non-invasive test that uses high-frequency sound waves to produce a picture of the inside of your body. When an abdominal ultrasound is done, a trained doctor may look at the images that are formed and detect normal and abnormal structures. The test is done if you have abdominal pain and jaundice. It can help to detect gallstones, hepatitis and other conditions that can present with symptom like pancreatic cancer. If any abnormality or growth is noted in the pancreas, other imaging studies, such as CT scan or MRI scan will be done to obtain more information.

Computed tomography (CT) scan: Abdominal CT scan is a painless and non-invasive test, which provides good visual detail of the abdomen. It can show small tumours and other lesions in the abdomen that may not be seen on an abdominal ultrasound. During CT scan, a series of detailed pictures of abdomen are taken. A computer then combines these pictures into images for a trained doctor to examine the images for abnormalities (such as cancerous growth, infection or any other pathology). CT scan is useful to stage the tumour (i.e. determine the extent of spread and size of tumour). Staging of tumour is important to decide the treatment approach.

Biopsy: This is a confirmatory test to diagnose if the suspected growth or mass is cancerous. Tissue sample from the mass or growth is taken and sent for examination. The tissue sample is examined by a pathologist (a doctor who specialises in diagnosing diseases by looking at cells and tissues under a microscope) for cancerous changes. Biopsy of pancreatic cancer can be performed in the following ways:

• Percutaneous biopsy: Sample from pancreas is taken by inserting a needle through the skin into the pancreas (using an ultrasound or CT scan to guide the needle into the growth).
• Endoscopic biopsy: A gastroenterologist uses a special medical instrument called endoscope (it is a thin, flexible tube that has a light and camera at one end) to perform this procedure. The endoscope is inserted through the mouth, into the stomach and into the duodenum to take sample from the growth in pancreas.

CA 19-9 test: This is a blood test, which measures the level of a tumour marker in the body called CA 19-9. CA 19-9 is produced by many types of cancer including pancreatic cancer. The level of this antigen is elevated in 80% of people with pancreatic cancer. In people with elevated levels of CA 19-9 in pancreatic cancer, serial follow-up of its level can be done to monitor response to treatment and detect risk of recurrence.