Your doctor will ask you about your symptoms, and medical and family history. The abdomen and surrounding areas will carefully examined. Your doctor may recommend different tests in order to identify tumors and confirm diagnosis.
Suspicion of Pancreatic Cancer
If you are having symptoms or your doctor detects abnormalities, you may need further testing. Tests can help confirm a cancer diagnosis or another condition, such as pancreatitis. Tests may include:
A number of blood tests may be performed, although they cannot be used to definitively diagnose pancreatic cancer. The tests may show some of the changes that occur during pancreatic cancer, such as elevated levels of the enzymes amylase and lipase, increased bilirubin, elevated glucose, and changes in liver function tests. These changes can occur in other conditions as well.
Specific blood tests for pancreatic cancer include tumor markers (CA 19-9, CA 72-4, and also human chorionic gonadotropin [hCG]). These tests are useful in predicting prognosis and identifying relapse after surgical resection.
Imaging tests may be used to look for the presence of tumors. They can also help assess their size and location. Some tests use contrast material to highlight structures so images are more clear and detailed. Imaging tests may include:
- Dual phase helical CT scan—The scan can show the interior of the pancreas in detail, allowing a tumor to be diagnosed in approximately 98% of the time. CT is also very useful for diagnosing the spread of cancer beyond the pancreas.
- Endoscopic ultrasound—A thin, lighted tube (endoscope) is passed down the throat, through your stomach, and into your intestine.
- MRI scan
- Endoscopic retrograde cholangiopancreatography (ERCP)
- PET scan
During laparoscopy, tiny incisions are made in the abdomen, and a small fiberoptic tube with a lighted tip (a laparoscope) is inserted. The scope can be used to look at the pancreas, the surrounding tissues, the liver, and the wall of the abdomen for the presence of tumor. Laparoscopy is useful for both diagnosing pancreatic cancer and determining whether the cancer has spread outside of the pancreas.
Diagnosis of Pancreatic Cancer
During a biopsy, suspicious tissue is removed so it can be examined under a microscope. The tissue sample may be obtained during an ERCP exam, laparoscopy, or through fine needle aspiration (FNA). A tiny needle is inserted directly through the skin of the abdomen and into the pancreas in order to withdraw a sample of pancreatic tissue. Some researchers believe that FNA should not be performed unless the tumor is inoperable because the cancer cells may accidentally be spread along the track of the needle. If an abnormality is seen in another organ (such as the liver), a biopsy of that abnormality may be done instead.
A biopsy is the only way to confirm a diagnosis.
Cytology is the study of cells. The cytology of cancer cells differs significantly from normal cells, and doctors use the unique cellular features seen on biopsy samples to determine the diagnosis and assess the prognosis of a cancer.
The first thing that cytology studies will do is determine what type of pancreatic cell the cancer involves. Exocrine cells are much more commonly involved in pancreatic cancer than endocrine cells. Cytology will also try to determine the degree of abnormality and aggressiveness of the cancer cells.
Staging of Pancreatic Cancer
The physical exam, combined with blood, imaging, and biopsy test results will determine the stage of the cancer. Staging is used to identify where and how far the cancer has spread. It is also used to guide your treatment plan. Treatment and outcomes depend on several factors, such as location, tumor size, stage, and overall health.
A common system used for staging is called the TNM system. This system characterizes 3 aspects of pancreatic cancer: information about the tumor (T), the lymph nodes (N), and the presence of distant metastasis (M). As with grading, the higher numbers reflect a greater degree of abnormality and spread.
The T stages are as follows:
- TX: Tumor cannot be evaluated.
- T0: There is no evidence of tumor.
- Tis: There is minimal tumor without invasion (in situ).
- T1: Pancreatic tumor measures 2 centimeters (cm) or less and has not spread outside of the pancreas.
- T2: Pancreatic tumor is greater than 2 cm, but has not spread outside of the pancreas.
- T3: The pancreatic tumor extends beyond the pancreas but does not involve the superior mesenteric artery or the vessels of the celiac axis, both of which are located in the abdomen.
- T4: The pancreatic tumor extends beyond the pancreas and involves the superior mesenteric artery or vessels of the celiac axis.
The N stages are as follows:
- NX: Nodes cannot be evaluated.
- N0: There are no cancer cells in the regional lymph nodes.
- N1: There are cancer cells in lymph nodes surrounding the pancreas.
The M stages are as follows:
- MX: Presence of metastasis cannot be evaluated.
- M0: There are no distant metastasis.
- M1: There are distant metastasis, such as to distant lymph nodes, liver, lungs, and/or brain.
Once the T, N, and M categories have been determined, the information is grouped together to determine your stage. The groupings are as follows:
T, N, and M Classifications
T1, N0, M0
T2, N0, M0
T3, N0, M0
T1, T2, or T3; N1; M0
T4; N0 or N1; MO
T1, T2, T3, or T4; N0 or N1; M1
Another method of staging addresses whether the original pancreatic tumor can be surgically removed or not. Most doctors believe that tumors that have invaded major blood vessels (T4 or Stage III) cannot be removed. Therefore, this method of staging utilizes information about blood vessel invasion. This system has 3 designations:
- Resectable pancreatic cancer—Visible tumors can be removed.
- Locally advanced or unresectable pancreatic cancer—The cancer has spread to neighboring tissues or invaded into blood vessels. The cancer cannot be removed by surgery. However, no distant spread has been diagnosed.
- Metastatic—The cancer has been found in distant sites and it has spread well beyond the pancreas.
Prognosis is a forecast of the probable course and/or outcome of a disease or condition. Prognosis is most often expressed as the percentage of patients who are expected to survive over 5 or 10 years. Cancer prognosis is an inexact process. This is because the predictions are based on the experience of large groups of patients with cancer in various stages. Using this information to predict the future of an individual patient is always imperfect and often flawed, but it is the only method available.
Pancreatic cancer is often relatively advanced at the time that it is diagnosed. As a result, the number of patients who survive for 5 years or more after diagnosis is very small, perhaps as low as 5%. About 21% of all patients diagnosed with pancreatic cancer survive for a year after diagnosis. Also, being overweight or obese can further reduce your chance of survival.
- Reviewer: Mohei Abouzied, MD
- Review Date: 09/2016 -
- Update Date: 09/17/2014 -