Imaging scans for pancreatic cancer
Imaging scans are tests that create pictures of the inside of the body. Different scans can provide different details about the cancer.
You will usually have at least one of the following scans during diagnosis and treatment.
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Most people suspected of having pancreatic cancer will have a CT (computerised tomography) scan. This scan uses x-ray beams to take many pictures of the inside of your body and then compiles them into one detailed, cross-sectional picture.
A CT scan is usually done at a hospital or a radiology clinic. Before the scan, a liquid dye (called contrast) will be injected into a vein to help make the pictures clearer. The dye travels through your bloodstream to the pancreas and nearby organs and helps show up any abnormal areas. This may cause you to feel hot all over, may give you a strange taste in your mouth and you could feel as if you need to pass urine (pee). These reactions are temporary and usually go away in a few minutes, but tell the team if you feel unwell.
The CT scanner is large and round like a doughnut. You will need to lie still on an examination 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.
Endoscopic scans can show blockages or inflammation in the common bile duct, stomach and duodenum. For these scans, you will have an endoscopy, a procedure that is usually done as day surgery by a specialist doctor called a gastroenterologist. The doctor passes a long, flexible tube with a light and small camera on the end (endoscope) down your throat into your digestive tract. 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 tube 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.
During an endoscopic scan, the doctor can also take a tissue or fluid sample (biopsy) to help with the diagnosis.
You will be asked not to eat or drink (fast) for six hours before an endoscopic scan. The doctor will give you medicine to help you relax and feel as comfortable as possible. Because of this medicine, 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 complications are not common. Your doctor will explain the risks before asking you to agree (consent) to the procedure.
In some cases, you may also have another type of scan such as an MRI or MRCP scan. 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) scan 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 (contrast) 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.
Doctors sometimes use a PET (positron emission tomography) scan combined with a CT scan to help work out if the pancreatic cancer has spread or how it is responding to treatment.
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, usually a glucose solution called fluorodeoxyglucose (FDG). Some cancer cells will show up brighter on the scan because they take up more of this solution than normal cells do.
PET–CT scans are specialised tests. They are not available in every hospital and may not be covered by Medicare, so talk to your medical team for more information.
Before having scans, tell the doctor if you have any allergies or have had a reaction to dyes during previous scans. You should also let them know if you have diabetes or kidney disease or are pregnant or breastfeeding.
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Dr Benjamin Loveday, Hepato-Pancreato-Biliary (HPB) Surgeon, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, VIC; Dr Katherine Allsopp, Palliative Medicine Physician, Crown Princess Mary Cancer Centre, Westmead Hospital, NSW; Hollie Bevans, Senior Dietitian, Radiotherapy and Oncology, Western Health, VIC; Dr Lorraine Chantrill, Head of Department Medical Oncology, Illawarra Shoalhaven Local Health District, NSW; Amanda Maxwell, Consumer; Prof Michael Michael, Medical Oncologist, Lower and Upper GI Oncology Service, Co-Chair Neuroendocrine Unit, Peter MacCallum Cancer Centre and University of Melbourne, VIC; Dr Andrew Oar, Radiation Oncologist, Icon Cancer Centre, Gold Coast University Hospital, QLD; Meg Rogers, Nurse Consultant Upper GI/NET Service, Peter MacCallum Cancer Centre, VIC; Ady Sipthorpe, 13 11 20 Consultant, Cancer Council WA.
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