If pancreatic cancer is suspected, several tests can be run to confirm the diagnosis and assess the situation:
History & Physical
The first step in any diagnoses for pancreatic cancer involves your doctor asking questions about your medical history and performing a physical exam in the office. Questions may focus on:
- The location, severity, and duration of pain
- Any unintentional weight loss
- Your energy level
- The color of your urine and stool
Your doctor may also ask about your parents, siblings, and children to learn if there are any inherited conditions that may be causing your symptoms.
The physical examination will focus on your abdomen. Your doctor will:
- Check for masses or fluid buildup in the areas near your pancreas, stomach, liver, and gallbladder
- Check your skin and eyes for signs of yellowing
- Check for swollen lymph nodes above the collarbone and other locations in the body
A history and physical exam alone are not enough to make a diagnosis of pancreatic cancer, but the information gathered will help your doctor better understand your individual situation.
Currently, there is no simple lab test that exists solely to diagnose early pancreatic cancer. However, there are certain blood tests that can support a diagnosis or help your doctor determine treatment if other evidence of cancer is found.
- Liver Function Test: The liver function test will look at your bilirubin. If there is a tumor blocking your bile duct, the bilirubin levels in your blood may increase. The normal range of bilirubin levels is between .3 and 1.3 mg/dL (milligrams per deciliter).
- CA 19-9: CA 19-9 is a tumor marker commonly associated with pancreatic cancer. The normal range of CA 19-9 is between 0 and 37 U/mL (units/milliliter), but people with pancreatic cancer often have higher levels. Not every pancreatic cancer will cause elevated levels of CA 19-9, and some non-cancerous conditions (like pancreatitis and jaundice) can cause high levels of CA 19-9. This means that a diagnosis cannot be based on CA 19-9 alone.
- Carcinoembryonic Antigen (CEA): CEA is another tumor marker associated with pancreatic cancer. The normal amount of CEA in non-smokers is less than 2.5 ng/mL (nanograms per milliliter), and in smokers, less than 5.0 ng/mL.
Once a diagnosis has been established, CA 19-9 can be used to monitor the condition. Your doctor may take a baseline CA 19-9 level before surgery or before beginning a cycle of chemotherapy. If your levels decrease, that typically indicates the treatment is working. If your levels rise, that can mean a recurrence of your cancer or that you are no longer responding to your current treatment plan.
Like CA 19-9, CEA is best used to monitor progress and treatment response, rather than to establish a diagnosis. Keep in mind that chemotherapy and radiation therapy can cause a temporary rise in CEA levels due to increased CEA release by tumor cells that are being destroyed.
These tests allow you and your doctor to see what’s going on in your pancreas and the surrounding organs. They help diagnose tumors and also monitor their growth over time. These tests include:
- CT Scan: a series of high-resolution x-rays used to give a 3-D look at the body
- MRI: a 3-D look at the body using radio waves and magnets
- MRCP: an MRI that focuses on the pancreas and bile ducts
- PET Scan: a scan specifically designed to identify cancers
Other imaging tests require the insertion of a small, thin device called an endoscope, which is passed through the mouth and into your abdomen:
- Endoscopic Ultrasound (EUS): an ultrasound probe at the tip of the endoscope creates an image of the pancreas and surrounding tissue using sound waves
- Endoscopic Retrograde Cholangiopancreatography (ERCP): used to look at the bile and pancreatic ducts. Dye is injected through the endoscope and then an x-ray is taken.
Looking directly at a piece of a tumor under a microscope allows for the most accurate diagnosis of cancer. To gather that piece of tumor, a biopsy is performed. Your doctor may use any of the following biopsy methods, depending on your unique situation.
- Fine Needle Aspiration (FNA): the most common biopsy procedure due to its safety and the reliability of its results. There are two ways to perform an FNA biopsy of the pancreas, either through the skin (percutaneously) or Endoscopic Ultrasound (EUS)-guided. When the percutaneous approach is used, a local anesthetic is applied to the skin and a long thin needle is inserted through the abdominal wall and into the pancreas. In FNA with EUS guidance, live ultrasound images are used to guide needle placement through the endoscope directly into the suspicious mass. The EUS-guided approach is painless for the patient and produces the most accurate results.
- Brush Biopsy: a small brush is inserted through the endoscope during an ERCP procedure and directly into your bile duct or pancreatic duct. Cells rub off onto the brush and can be examined using a microscope.
- Laparoscopy: a procedure in which a small camera attached to a thin, lighted tube is inserted directly into the abdominal cavity through a small incision. It is performed under general anesthesia. This means the patient is completely asleep during the procedure. By manipulating the camera, the doctor can directly view and biopsy the pancreas and its surrounding organs.
Once pancreatic cancer is diagnosed, it is important to determine the correct clinical stage of the disease referring to whether, and how far, the cancer has spread in the pancreas and throughout the body. Determining the correct stage enables a team of physicians to create the best treatment plan to extend survival and maintain quality of life. Learn more about the Stages of Pancreatic Cancer.
If you or someone you care for is dealing with a pancreatic condition, the Pancreas Center is here for you. Whether you need a diagnosis, treatment, or a second opinion, we have an entire team of experts ready to help.
Call us at (212) 305-9467 or use our online form to get in touch today.
To keep learning about pancreatic cancer:
- Pancreatic Cysts
- Chemotherapy for Pancreatic Cancer
- Endoscopic Treatment for Pancreatic Disease
- Non-Invasive Tests for Pancreatic Cancer
- Palliative Procedures
- Surgery for Pancreatic Cancer
- Whipple Procedure (Pancreaticoduodenectomy)
- Total Pancreatectomy with Autologous Islet Cell Transplantation
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