MD Anderson has the most advanced and accurate technology available to diagnose pancreatic cancer, including endoscopic ultrasound. Our highly skilled pathologists, diagnostic radiologists and specially trained technicians are able to pinpoint the exact extent of the disease, improving your chances for successful treatment.
Pancreatic cancer often can be challenging to diagnose. Symptoms usually do not appear in the early stages, and if they do they may be mistaken for signs of another condition. Also, the pancreas is deep inside the body, behind several other organs. This makes it difficult to feel or see without proper equipment. Several medical tests usually are required to find and stage (determine extent of disease) pancreatic cancer. Accurate diagnosis and staging are important because they help your doctors choose the best type of treatment.
Pancreatic Cancer Diagnostic Tests
If you have symptoms that may signal pancreatic cancer, your doctor examine you and ask you questions about your health; your lifestyle, including smoking habits; and your family medical history. One or more of the following tests may be used to find out if you have pancreatic cancer and if it has spread. These tests also may be used to find out if treatment is working.
Imaging tests, which may include:
- CT or CAT (computed axial tomography) scans: This is the primary test used to determine the stage of pancreatic cancer
- PET (positron emission tomography) scans
- MRI (magnetic resonance imaging) scans
- Angiography: A type of X-ray that looks at blood vessels
Endoscopic ultrasound (EUS): A special endoscope with an ultrasound probe and a small needle at the end is placed through the mouth and esophagus and into the first part of the small intestine. The doctor views the pancreas on a video screen. Surgical instruments, called biopsy forceps or brushes, may be inserted through the endoscope to remove tissue to examine under a microscope.
Endoscopic retrograde cholangiopancreatography (ERCP): This test for pancreatic cancer X-rays the ducts that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. An endoscope is put 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 ducts. A dye is injected through the catheter, and an X-ray is taken. If the ducts are blocked by a tumor, a fine tube (stent) may be inserted into the duct to unblock it. The stent may be left in place to keep the duct open.
Blood tests: No single blood test can diagnose pancreatic cancer. Some blood tests, known as tumor markers, measure the levels of proteins made by cancer cells. Known tumor markers for pancreatic cancer include carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA). Blood tests also can evaluate the function of the liver and other organs that may be affected by a pancreatic tumor.
Biopsy: This is the removal of a small piece of tissue to view under a microscope. The ways to do a biopsy for pancreatic cancer include the following.
CT-guided Fine Needle Aspiration (FNA): A CT scan helps the doctor find the tumor and guide a small needle through the skin and abdomen into the pancreas.
Laparoscopy: This test is done in the operating room under general anesthesia. An endoscope is guided through a very small cut in the abdomen. This lets the surgeon view the pancreas and find out if the cancer has spread. Tissue samples also can be taken.
Laparoscopy is not used to diagnose pancreatic cancer. It may be used to find out if the cancer has spread to other organs, such as the intestines, liver, lymph nodes and stomach.
If you are diagnosed with pancreatic cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer. Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.
Did You Know?
MD Anderson has a nationally recognized research program with clinical trials of new treatments for pancreatic cancer.
(source: National Cancer Institute)
Stage 0: Cancer is found only in the lining of the pancreas. Stage 0 also is called carcinoma in situ.
Stage I: Cancer has formed and is in the pancreas only.
- Stage IA: The tumor is 2 centimeters or smaller
- Stage IB: The tumor is larger than 2 centimeters
Stage II: Cancer may have spread to nearby tissue and organs, and lymph nodes near the pancreas.
- Stage IIA: Cancer has spread to nearby tissue and organs but has not spread to nearby lymph nodes
- Stage IIB: Cancer has spread to nearby lymph nodes and may have spread to nearby tissue and organs
Stage III: Cancer has spread to the major blood vessels near the pancreas and may have spread to nearby lymph nodes.
Stage IV: Cancer may be of any size and has spread to distant organs, such as the liver, lung and peritoneal cavity. It also may have spread to organs and tissues near the pancreas or to lymph nodes.
Doctors also may use the following terms to talk about how far pancreatic cancer has spread:
Resectable: Cancer is in the pancreas and can be removed surgically.
Locally advanced (unresectable): Pancreatic cancer has spread to tissue and blood vessels around the pancreas but not to other parts of the body. It cannot be removed entirely by surgery. Surgery may be done to help symptoms or other problems.
Metastatic: Pancreatic cancer has spread to other parts of the body. Surgery is done only to relieve symptoms or other problems.