Diagnosing Pancreatic Cancer
There are several tests that may be conducted if a person is concerned that they may have Pancreatic Cancer. Usually when people are worried, they speak to their GP, who may organise blood tests or conduct a physical examination to feel for any swollen or painful areas and look for signs of jaundice.
Sometimes GPs do not suspect cancer, but if a patient feels strongly they would like further investigations (for example if they have a family history of Pancreatic Cancer). Given how difficult this cancer is to detect in the early stages, Dr Andy Gaya believes that early non-invasive testing may be prudent and recommends two approaches:
It is important to note that there is no 100% accurate screening test, and whilst negative screening tests are reassuring there can sometimes be “false negatives” which is why screening tests are repeated every few years.
When a patient has been referred to hospital by their GP for suspected Pancreatic Cancer, a series of tests and procedures are organised to confirm the presence and/or location of cancer, to assess its stage and guide treatment decisions. Here is a summary of the key diagnostics for pancreatic cancer:
- Blood Tests can check for specific substances in the blood that might indicate pancreatic cancer. For example, the CA19-9 blood test is a tumour marker that is often elevated in pancreatic cancer, and a raised amylase or lipase level can indicate pancreatic inflammation.
- Imaging Tests are critical for visualising the pancreas and surrounding areas, helping to identify tumours and determine the extent of the disease.
- Computed Tomography (CT) Scan is an imaging test that takes about 5 minutes and provides detailed cross-sectional images of the body. The patients is given an injection of iodine contrast before the procedure to make the area ‘light up’ for the scan
- Magnetic Resonance Imaging (MRI) is a longer, quite noisy scan (up to 45 mins). Some people feel claustrophobic in MRI scanners, but it offers more detailed images of soft tissues in the body and can be particularly useful for examining the pancreas and bile ducts. However, people with things like a pacemaker, surgical clips, metal fragments or implants in their body may not be able to have an MRI
- Endoscopic Ultrasound (EUS) uses an endoscope (camera down the throat) fitted with an ultrasound probe to produce images of the pancreas from inside the abdomen. It can also be used to take biopsy samples. The ‘camera down the throat’ is passed through the food pipe and stomach of a sedated patient and the procedure takes 20-40 minutes
- Positron Emission Tomography (PET) scan is a more cancer specific scan. It involves injecting radioactive sugar into the blood. Cancer absorbs the radioactive sugar and “light ups” much more clearly on a PET scan. About 25% of the time a PET scan will pick up additional areas of cancer not seen on a more simplistic CT scan
A person with pancreatic cancer may also need a small procedure to aid diagnosis and assess cancer spread, such as:
- Endoscopic Retrograde Cholangiopancreatography (ERCP) – a 45-minute procedure to examine the pancreatic and bile ducts. It involves the insertion of an endoscope (camera down the throat) where a dye is then injected into the ducts and X-rays are taken. It shows blockages/abnormalities (the patient is sedated) and blockages can be relieved by placing a metallic stent through the obstruction, allowing liver drainage to be restored.
- Laparoscopy is a surgical procedure using small incisions and a camera to look directly at the pancreas and other abdominal organs. This can help determine the extent of the cancer and whether it is operable. This is rarely performed for pancreatic cancer.
Biopsy
A biopsy is the removal of a small amount of tissue for examination under a microscope. It is the only definitive way to diagnose pancreatic cancer (cancer is a tissue diagnosis). Biopsies can be performed using a needle (fine needle biopsy) during an endoscopy or through the skin during laparoscopy.
These tests not only diagnose the cancer, but help doctors find out the type of Pancreatic Cancer a patient has and determine the stage of the cancer.
