What Tests Help My Doctor Find Pancreatic Cancer?
If you’re having pancreatic-cancer-like symptoms, your doctor will want to know why. Your doctor is likely to ask you questions about the following things.
Family history of cancer
Lifestyle habits, such as what you eat and whether you smoke
Exposure to other risk factors, such as working with pesticides
In addition to asking you questions, your doctor may do a physical exam. He or she may check for jaundice, which is a yellowing of the skin and eyes. Your doctor may also feel your abdomen (belly) for signs of abnormal fluid buildup, called ascites. Your doctor may also want you to have one or more of the following tests done to provide more information about your health. Why so many tests? The doctor can’t feel your pancreas during a physical exam. It is sometimes hard to view on an X-ray, too. These tests can help.
Computed tomography (CT) scan
A CT scan can show a tumor in the pancreas. It may also show if the cancer has spread or has blocked the bile ducts. CT scans take pictures from many angles with an X-ray beam. A computer combines these pictures, giving the doctor a detailed cross section picture of the pancreas.
To have the test, you lie still on a table as it slowly slides through the center of the CT scanner. Then the scanner directs a continuous beam of X-rays at your body.
A CT scan is painless. You may be asked to hold your breath for a short time one or more times during the scan. In some cases, you will be asked to drink a contrast medium before the scan. Then you may be asked not to eat anything until after a second set of pictures is taken. You may also get an injection of contrast dye into a vein in between the sets of pictures. The dye allows your doctor to better see certain tissues. Some people have a flushing reaction to the injection. Be sure to tell your doctor if you have a strong reaction to contrast material, such as hives or trouble breathing, or if you have had a reaction in the past.
Positron emission tomography (PET)
A PET scan may be done in combination with a CT scan. For this test, a radioactive substance, usually bound to a type of sugar, is injected through a vein before the body is scanned. The radioactive sugar substance collects in cancer cells, which will show up on images. This test is not as specific as CT scanning, and is never used alone to diagnose pancreatic cancer.
Endoscopic ultrasound (EUS)
This test can show tumors in your pancreas and bile ducts. It is better for spotting small tumors than a CT scan. Ultrasound uses sound waves that bounce off your pancreas. A computer creates an image from the bounced-back sound waves. During a standard ultrasound, the sound waves come from a wand-like instrument that is placed on your skin over the abdomen and aimed at the pancreas. For an endoscopic ultrasound, the image of the pancreas is taken from inside your body, which allows for a better picture.
For an EUS, the doctor uses a thin, lighted tube called an endoscope. He or she inserts it down your throat, through your esophagus, and into your stomach. This lets your doctor view your stomach and the first part of the small intestine. At the tip of the scope is an ultrasound device which bounces waves into the nearby area, including the pancreas, to make an image of it. During the test, if the doctor sees anything suspicious, he or she may take a sample of tissue, known as a biopsy.
Endoscopic retrograde cholangiopancreatography (ERCP)
This test is an X-ray image of the common bile duct and the pancreatic duct taken from inside your body. The doctor inserts a long, flexible tube called an endoscope down your throat. He or she passes the tube through your esophagus and stomach, then into your small intestine. The doctor slips a smaller tube through the larger tube into the bile duct and then the pancreatic duct. Then he or she injects dye through the tube into your common bile duct and pancreatic duct. The doctor then takes X-rays of the area to look for any areas that might indicate blockage by a tumor. If your doctor sees anything suspicious, he or she may take a tissue sample, known as a biopsy, and check it for cancer.
Magnetic resonance cholangiopancreatography (MRCP)
This test is similar to an ERCP except it uses an imaging test called magnetic resonance imaging (MRI) to help see what’s happening inside you instead of an endoscope. MRCP can show both the bile duct and the pancreatic duct without the use of an endoscope passed into the duct. This test uses magnets and radio waves to take pictures of your pancreas.
Percutaneous transhepatic cholangiography (PTC)
This is an X-ray image of the bile duct. The doctor puts a thin needle into your liver through the right side of your abdomen. He or she injects dye through the needle. The dye highlights blockages, which can then be seen in the X-ray. This test is only done if an ERCP cannot be done.
Giving a small sample of your blood for testing can give your doctor information about your overall health. While there is no specific test that finds pancreatic cancer, blood tests can show whether any jaundice is due to a blockage in the bile duct or to another cause, such as liver disease. If you have been diagnosed with pancreatic cancer, your doctor may give you a special blood test, called CA 19-9 to track the activity of pancreatic cancer cells.
The results of these tests may be enough to rule out or diagnose cancer. Or you may need more tests. To be sure you have cancer, the doctor may remove tissue from your pancreas. This is called a biopsy. The biopsy can be done during some of these tests, such as the EUS or ERCP. Or it may be done separately.