Diagnosing a pancreatic tumor can be difficult. The symptoms are not always obvious and usually develop gradually. Pain, indigestion, and other symptoms of pancreatic cancer could indicate other problems, such as a stomach ulcer or gallbladder disease, and diagnosis is not always straightforward. Pancreatic cancer is usually diagnosed with tests and procedures that produce pictures of the pancreas and the area around it. Doctors use the following tests to diagnose pancreatic cancer and determine if it has spread. These tests do not normally require a hospital stay.
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No single blood test can diagnose pancreatic cancer. Some blood tests measure the levels of proteins made by cancer cells, known as tumor markers. Doctors may order tests on the levels of tumor markers like carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA). These blood tests may be useful when pancreatic cancer is suspected and to monitor the cancer, but neither CA19-9 nor CEA is useful when screening for pancreatic cancer.
Doctors also use blood tests to evaluate the function of the liver and other organs related to the pancreas, which can be affected by pancreatic cancer. For example, abnormal liver enzymes may suggest that the cancer has spread to the liver.
This diagnostic test uses an X-ray machine and a computer to create detailed pictures of the body, including 3-D images, to show the pancreas, the tumor, and whether the tumor has spread. CT scans also can be used to guide a needle into a mass if a biopsy is needed. As part of your CT scan, you may be asked to drink oral contrast or have an IV (intravenous) line for injection of a contrast dye. Contrast dye makes your organs more visible on the X-ray film. The CT scan is the primary test used to determine whether the tumor can be surgically removed.
You will lie on a padded table, and the technologist will make sure you are positioned correctly. Once you are positioned, do not move. Movement can cause the scan to blur, just as movement blurs photos from a regular camera. The technologist will leave the room and watch you from a booth outside while the scanner takes several pictures. You may talk to the staff through a speaker; however, do not move your body. You may be asked to hold your breath at different times during the procedure to minimize motion. The total amount of time for your CT scan, including preparation, is about two to three hours.
Ultrasound uses sound waves to form a picture on a small television screen. From the picture, the doctor can see the size of the pancreas, and may also be able to see a tumor. For ultrasound, the technician moves a wand across the abdomen. The wand produces sound waves and records them as they bounce back.
New technology makes it possible to use an ultrasound probe on the end of a flexible tube called an endoscope that can be passed into the stomach and duodenum (the first section of the small intestine). This is called an endoscopic ultrasound (EUS). It can get closer to the pancreas than an ultrasound done from outside the body. During endoscopic ultrasound, the doctor may remove a tissue sample. Surgical instruments, called biopsy forceps, biopsy needles, or brushes, may be inserted through the endoscope to collect a sample of tissue for further testing (biopsy). Then, a pathologist will study the tissue under a microscope to look for abnormal cells.
A person undergoing EUS is sedated before the procedure begins. After the patient is asleep, the doctor inserts the endoscope into the patient's mouth. The doctor views the inside of the intestinal tract on a television monitor and the ultrasound image on another monitor. The procedure usually takes 30 to 90 minutes and the patient usually can go home the same day of the procedure.
Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used to X-ray the ducts that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreatic cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice, a condition in which the skin or whites of the eyes have a yellow discoloration. An endoscope (a thin, lighted tube) is gently guided through the mouth, esophagus, and stomach into the first part of the small intestine. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic duct and the bile duct. A dye is injected through the catheter into the ducts and an X-ray is taken. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube, known as a stent, may be left in place to keep the duct open.
If an abnormal growth is seen, surgical instruments called biopsy forceps or brushes may be inserted through the endoscope to collect a sample of the tissue for further testing (biopsy). Then, a pathologist will study the tissue under a microscope to look for abnormal cells.
Your throat may be numbed with an anesthetic spray, gargle, or lozenge to relax your gag reflex and make it easier to insert the endoscope. The local anesthetic usually tastes slightly bitter and will make your tongue and throat feel numb and swollen. Before the procedure begins, an intravenous (IV) line will be placed in a vein in your arm. To help you relax, you will receive pain medicine and a sedative through the IV. You may notice a brief, sharp burning or stinging sensation when the IV is started in your arm. You may also receive an antibiotic through the IV to help prevent infection.
An ERCP usually takes between 30 and 60 minutes; afterwards you will be observed in a recovery room for one to two hours. You may need to stay overnight if your doctor places a stent during the procedure. Otherwise, you will be allowed to go home after the procedure. Unless you are staying in the hospital, you will need to have someone drive you home after the procedure. You will not be allowed to drive or to return to work for 24 hours.
Biopsy is the removal of a tissue sample so that it can be viewed under a microscope by a specially trained doctor to check for signs of cancer. There are several ways to do a biopsy for pancreatic cancer. A fine needle may be inserted into the pancreas during an X-ray or ultrasound to remove cells. Tissue may also be removed during a laparoscopy (a surgical incision made in the wall of the abdomen—see the next section.
Laparoscopy is a surgical procedure that uses a thin, lighted tube called a laparoscope inserted through an incision in the abdominal wall to examine the abdominal organs. Tissue samples can be collected for biopsy through the scope. If needed, other instruments, such as surgical scissors, can be inserted through additional incisions.
In many cases laparoscopy can eliminate the need for a more extensive operation that would require a larger incision in the abdomen. Laparoscopy can be less risky, less stressful, and less costly than more extensive surgeries and can often be done without requiring an overnight stay in the hospital.
Laparoscopy is not performed to diagnose pancreatic cancer, but it may be used to look for evidence that the cancer has spread to other organs, such as the intestines, liver, lymph nodes, and stomach. This procedure is performed in the operating room while the patient is under general anesthesia.
A PET scan is a test that uses a special type of camera or scanner and a form of sugar that contains a radioactive atom. This sugar is injected into a vein in the patient's body. The camera rotates around the patient's body and records the sugar as it moves through the body and collects in organs. The camera's recordings are made into pictures on a computer. Cancer cells show up brighter in the pictures because they are more active and absorb more sugar than normal cells.
The PET scanner, which is shaped like a giant doughnut, moves around the patient. The scanned pictures are sent to a computer screen so that the doctor can see them. The scans are done over a period of time to make a series of picture. It is important to lie still while each scan is being done. The test takes one to three hours.
You will not feel the PET scan, nor does it cause any pain. The table you lie on may feel hard and the room may be cool. Tell your doctor if you are having pain or do not feel well.
Magnetic Resonance Imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. For an MRI, the area of the body being studied is placed inside a special machine that is a strong magnet. Information from an MRI can be saved and stored on a computer for more study. Photographs or films of certain views can also be made. In some cases, a contrast material may be used during the MRI to show pictures of organs or structures more clearly. Contrast material, or contrast dye, is a substance used to make specific organs or types of tissue more visible. Common contrast material includes iodine and barium.
During the test you will lie on your back on a table that is part of the MRI scanner. The table will slide into the space that contains the magnet. Inside the scanner you will hear a fan and feel air moving. You may also hear tapping noises as the MRI scans are taken. It is very important to hold completely still while the scan is being done. You may be asked to hold your breath for short periods of time. You may be alone in the room; however a technologist will watch you through a window. You will be able to talk through a two-way speaker.
If contrast material is needed, the technologist will give it to you through an intravenous (IV) line in your arm. The material may be given over one to two minutes. Then more scans are taken.
You will have no pain from the test. The table you lie on may feel hard and the room may be cool. An MRI test usually takes 30 minutes to two hours.
Last reviewed on 10/13/09
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