Checking for pancreatic cancer, may include blood tests, a CT scan and other imaging tests, endoscopic tests and tissue sampling (biopsy). The diagnostic tests for pancreatic cancer you have depend on the symptoms, type and stage of the cancer.
Learn more about:
- Blood tests
- Scans (imaging tests)
- Tissue sampling
- Video: Cancer and common diagnostic tests
Blood tests are used together with other test results to diagnose pancreatic cancer. You are likely to have blood tests to check your general health and how well your liver and kidneys are working.
Some blood tests look for particular markers of pancreatic cancer. Many people with pancreatic cancer have higher levels of the markers CA19-9 (carbohydrate associated antigen) and CEA (carcinoembryonic antigen). Other conditions can also raise the level of these markers, and some people with pancreatic cancer have normal levels, so these markers can’t be used to diagnose pancreatic cancer on their own. However, they may tell your doctor more about the cancer and how it is responding to treatment.
It is normal for the levels of these markers to go up and down a bit, but your doctor will look for sharp increases and overall patterns.
Scans (imaging tests)
Tests that create images of the inside of the body are known as scans. Different scans can provide different details about the cancer. Depending on your individual situation, you may need only one or several types of scans. You are likely to have scans during the process of diagnosis, as well as throughout and after treatment.
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.
A CT (computerised tomography) scan uses x-rays to take many pictures of the inside of your body and then compiles them into one detailed, cross-sectional picture.
CT scans are usually done at a hospital or a radiology clinic. Before the scan, dye is injected into a vein to help make the pictures clearer. This may cause you to feel hot throughout your body and may give you a strange taste in your mouth. These sensations are temporary and usually go away in a few minutes.
The CT scanner is large and round like a doughnut. You will lie on a table that moves in and out of the scanner. It takes about 30 minutes to set up the machine, but the CT scan itself takes only 5–10 minutes.
The dye used in a CT or MRI scan can cause allergies. If you have had an allergic reaction to iodine or dyes during a previous scan, let your medical team know beforehand. You should also tell them if you are diabetic, have kidney function problems or are pregnant.
MRI and MRCP scans
An MRI (magnetic resonance imaging) scan uses magnetic waves to build up detailed cross-sectional pictures of the pancreas and nearby organs. An MRCP (magnetic resonance cholangiopancreatography) is a type of MRI scan that produces more detailed images and can be used to check the common bile duct for blockage (obstruction).
Before an MRI scan, you may be asked not to eat or drink for a few hours. You may also be given an injection of dye to highlight the organs in your body.
You may not be able to have an MRI if you have a pacemaker or another iron-based metallic object in your body, because the scan may damage these devices. However, some newer pacemakers are MRI-compatible.
An MRI takes about an hour and you will be able to go home when it is over. The test is painless, but some people feel anxious lying in such a confined space. If you think this will be a problem, let the doctor or nurse know beforehand, as there are medicines that can help you relax. During the test, the machine makes a series of bangs and clicks and can be quite noisy, but you will usually be given earplugs or headphones.
MRIs for pancreatic cancer are not always covered by Medicare, so check with your treatment team about whether you will need to pay for these tests.
Endoscopic scans can show blockages or inflammation in the common bile duct, stomach and duodenum. They are done using an endoscope, which is a thin, flexible tube with a light and a camera that is passed down your throat into your digestive system. This is also called an endoscopy. It will usually be performed by a specialist called a gastroenterologist.
You will be asked not to eat or drink for several 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.
An endoscopic scan to investigate pancreatic cancer has some risks, including infection, bleeding and inflammation of the pancreas (pancreatitis). Your doctor will explain these risks before asking you to 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) performs an x-ray of the common bile duct and/or 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 duct to keep it open.
An FDG-PET scan is a specialised imaging test that can help doctors work out whether a pancreatic cancer has spread or how it is responding to treatment. It involves the injection of a very small amount of radioactive substance called fluorodeoxyglucose (FDG) to highlight tumours in the body during the positron emission tomography (PET) scan. It may take several hours to prepare for and complete this scan.
An FDG-PET scan is not available in every hospital and may not be covered by Medicare, so talk to your medical team for more information.
While imaging scans can show the presence and location of a tumour in the pancreas, the main way to confirm that it is cancer is by testing a sample of cells or tissue taken from the tumour (biopsy). This sample can also be tested to help your doctor 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).
Fine needle or core biopsy
This method uses a needle to remove a sample from an organ for examination under a microscope. It is done during an endoscopy or endoscopic ultrasound (see pages 19–20). A fine needle biopsy removes some cells, while a core biopsy uses a thicker needle to remove a sample of tissue.
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.
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 performed with an instrument called a laparoscope, which is a long tube with a light and camera attached. It is done under general anaesthetic, so you will be asked not to eat or drink for six hours beforehand.
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.
If you take blood-thinning medicines or are a diabetic, let your doctor or nurse know before the laparoscopy.
Video: Cancer and common diagnostic tests
Learn more about what cancer is, how it spreads, and what primary and secondary cancers are. You can also find out about the tests that are commonly used to diagnose cancer, including CT/CAT scans, PET scans & MRI scans.