Pancreatic cancer may go undetected until it's advanced. By the time symptoms occur, diagnosing pancreatic cancer is usually relatively straightforward. Unfortunately, a cure is rarely possible at that point.
(This section focuses on pancreatic adenocarcinoma, which account for more than 95% of pancreatic cancer. Other forms of pancreatic cancer are mentioned at the end.)
Diagnosing pancreatic cancer usually happens when someone comes to the doctor after experiencing weeks or months of symptoms. Pancreatic cancer symptoms frequently include abdominal pain, weight loss, itching, or jaundice (yellow skin). A doctor then embarks on a search for the cause, using the tools of the trade:
- By taking a medical history, a doctor learns the story of the illness, such as the time of onset, nature and location of pain, smoking history, and other medical problems.
- During a physical exam, a doctor might feel a mass in the abdomen and notice swollen lymph nodes in the neck, jaundiced skin, or weight loss.
- Lab tests may show evidence that bile flow is being blocked, or other abnormalities.
Based on a person's exam, lab tests, and description of symptoms, a doctor often orders an imaging test:
- Computed tomography (CT scan): A scanner takes multiple X-ray pictures, and a computer reconstructs them into detailed images of the inside of the abdomen. A CT scan helps doctors make a pancreatic cancer diagnosis.
- Magnetic resonance imaging (MRI): Using magnetic waves, a scanner creates detailed images of the abdomen, in particular the area around the pancreas, liver, and gallbladder.
- Ultrasound: Harmless sound waves reflected off organs in the belly create images, potentially helping doctors make a pancreatic cancer diagnosis.
- Positron emission tomography (PET scan): Radioactive glucose injected into the veins is absorbed by cancer cells. PET scans may help determine the degree of pancreatic cancer spread.
If imaging studies detect a mass in the pancreas, a pancreatic cancer diagnosis is likely, but not definite. Only a biopsy -- taking actual tissue from the mass -- can diagnose pancreatic cancer. Biopsies can be performed in several ways:
- Percutaneous needle biopsy: Under imaging guidance, a radiologist inserts a needle into the mass, capturing some tissue. This procedure is also called a fine needle aspiration (FNA).
- Endoscopic retrograde cholangiopancreatography (ERCP): A flexible tube with a camera and other tools on its end (endoscope) is put through the mouth to the small intestine, near the pancreas. ERCP can collect images from the area, as well as take a small biopsy with a brush.
- Endoscopic ultrasound: Similar to ERCP, an endoscope is placed near the pancreas. An ultrasound probe on the endoscope locates the mass, and a needle on the endoscope plucks some tissue from the mass.
- Laparoscopy is a surgical procedure that uses several small incisions. Using laparoscopy, a surgeon can collect tissue for biopsy, as well as see inside the abdomen to determine if pancreatic cancer has spread. However, laparoscopy has higher risks than other biopsy approaches.
If pancreatic cancer seems very likely, and the tumor appears removable by surgery, doctors may recommend surgery without a biopsy.
Early Detection of Pancreatic Cancer
Treating pancreatic cancer is challenging when it's discovered at an advanced stage, as is usually the case. Researchers are seeking methods of early detection, but so far none has proved useful. These methods include:
Blood tests. Certain substances, such as carcinoembryonic antigen (CEA) and CA 19-9, are elevated in people with pancreatic cancer. However, blood tests don't allow for early detection of pancreatic cancer, because these levels may not rise until pancreatic cancer is advanced, if at all. These tests also may produce a false positive result.
Endoscopic ultrasound. Some families have multiple members affected by pancreatic cancer. The American Cancer Society says that up to 10% of pancreatic cancers may be caused by inherited DNA changes. Studies are ongoing to see if aggressive screening with endoscopic ultrasound works for early detection of pancreatic cancer in healthy family members. Early results are promising. However, endoscopy is an invasive procedure, so its use is only justified in people already at high risk for pancreatic cancer.
Pancreatic Neuroendocrine Cancers
Pancreatic neuroendocrine tumors arise from a separate group of hormone-producing cells in the pancreas. Like adenocarcinoma, islet cell cancers are generally diagnosed with imaging and biopsy. These types of tumors may cause no symptoms or symptoms related to hormones secreted by the tumor.