How is Pancreatic Cancer Diagnosed?

If you are experiencing symptoms that your doctor suspects might be pancreatic cancer, you may be recommended to undergo various tests and scans. They will determine whether the cause is indeed cancer or perhaps a different underlying issue(s).

Wondering how is pancreatic cancer diagnosed? There are several imaging technologies that your doctor may use depending on individual circumstances.

Computerized tomography (CT)

Computerized tomography, also known as CT, is a diagnostic imaging technology that utilizes x-rays and computer technology to create detailed images of the inside of the body. CT scans are commonly used in the diagnosis of pancreatic cancer.

They are useful in visualizing the pancreas and detecting the spread of pancreatic cancer to nearby structures, such as the liver or nearby lymph nodes. If you have been advised to undergo a CT scan, there is no need to fret as it is generally a painless procedure.

Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) is an advanced imaging test that provides a highly detailed, non-invasive look at organs and tissues inside the body. It uses powerful magnets and radio waves to create three-dimensional images.

Magnetic resonance cholangiopancreatography (MRCP) is a special type of MRI that focuses specifically on the pancreatic and bile ducts. It gives doctors clear pictures of these ducts without the need for more invasive procedures.

Although CT scans are more commonly used to diagnose pancreatic cancer because they are faster and widely available, MRI (including MRCP) may be recommended for people who cannot undergo CT scans. MRI can also be used along with CT if it is still unclear whether surgery is possible.

Pancreatic ultrasound

Ultrasound is an imaging test that uses high-frequency sound waves to create images of certain organs, such as the pancreas. There are two types of ultrasound typically used when diagnosing pancreatic cancer: abdominal ultrasound and endoscopic ultrasound.

During an abdominal ultrasound, a wand-like instrument called a transducer is moved over the skin on and around the abdominal area. It is often used first when the cause for abdominal symptoms is unclear. It can miss very small growths, and the results depend a lot on how skilled the person doing the test is. Also, it can be hard to tell the difference between cancer and other conditions, like inflammation of the pancreas. As such, an abdominal ultrasound is usually just the first step. Doctors often order other tests afterward to get more accurate information.

During an endoscopic ultrasound (EUS), the doctor uses a thin, flexible tube called an endoscope. At the tip of this tube is a tiny ultrasound probe that makes detailed pictures of the inside of your body. The tube is gently passed through your mouth and into your stomach and small intestine, so the probe can get very close to the pancreas, liver, and other nearby organs.

By placing the probe closer to these organs than in a regular abdominal ultrasound, the pictures are much clearer and more accurate. This helps doctors spot small tumors or other problems that might be missed on a regular ultrasound.

EUS can also do more than just take pictures. It can help guide a tiny needle to take a small sample of tissue, called a biopsy, from a tumor or lump. The biopsy is then looked at under a microscope to find out if it’s cancer or another condition.

Endoscopic retrograde cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that uses both an endoscope and x-rays to look at the bile ducts and pancreatic ducts.

The doctor passes a thin, flexible tube (endoscope) through the mouth, down the esophagus and stomach, and into the first part of the small intestine. A smaller tube (catheter) is then guided through the endoscope so that a special dye can be injected into the ducts. The dye makes the ducts show up clearly on x-rays, helping doctors see if there are blockages or narrowing caused by a tumor.

In addition to diagnosis, ERCP can also be used for treatment. For example, if the bile duct is blocked, the doctor may place a small tube called a stent to help keep it open and allow bile to drain properly.

Percutaneous transhepatic cholangiography (PTC)

Percutaneous transhepatic cholangiography (PTC) is another way to examine the bile ducts when ERCP is not possible or has not worked. Instead of going through the mouth, the doctor places a thin needle directly through the skin of the belly into a bile duct inside the liver. A contrast dye is injected, and x-rays are taken as the dye flows through the ducts. As this approach is more invasive, PTC is usually done only if ERCP cannot be performed.

Positron emission tomography (PET)

PET stands for positron emission tomography. It is a combination of nuclear medicine and biochemical analysis. It uses a radioactive tracer injected into the body to measure the metabolic activity of the cells in body tissues. Three-dimensional visual images are produced, allowing doctors to detect the possible spread of cancer.

Although PET can be useful for detecting cancer in many parts of the body, it is not commonly used for pancreatic cancer. Other imaging methods, such as CT or MRI, are usually preferred for diagnosis and treatment planning.

Your doctor may request for certain tests in the process of diagnosing pancreatic cancer.

Common tests include:

• Liver function tests
• Tumor marker tests
• Urine test
• Complete blood count
• Chemistry panel (metabolic profile or blood chemistry profile)

Learn more: How to Test for Pancreatic Cancer

A pancreatic biopsy is a procedure where a small sample of the tumor is removed and observed under a microscope. It is generally needed to confirm a diagnosis. There are several types of biopsies that your doctor may perform depending on different circumstances.

Percutaneous biopsy

In a percutaneous biopsy, a thin, hollow needle is inserted through the skin to remove a small piece of the tumor. This process is known as fine needle aspiration (FNA) and is a common technique used to remove small samples from a tumor. Ultrasound or CT may be used to guide the needle.

Endoscopic biopsy

In an endoscopic biopsy, an endoscope is inserted through the mouth, down the esophagus and stomach, and into the small intestine near the pancreas. Using ultrasound for guidance, a fine needle is inserted through the endoscope to remove a sample from the tumor or bile or pancreatic ducts.

Pancreatic biopsy through EUSIn an endoscopic biopsy, the doctor uses the procedure called endoscopic ultrasound (EUS). A thin, flexible tube with an ultrasound probe at its tip is passed through the mouth, down the esophagus and stomach, and into the small intestine near the pancreas. The ultrasound creates detailed images that help guide the doctor. 

Using this guidance, a fine needle can be passed through the endoscope to take a small sample from the tumor or from the bile or pancreatic ducts. The tissue sample is then examined under a microscope to confirm whether cancer or another condition is present.

Pancreatic biopsy through ERCP In some cases, doctors collect tissue samples using ERCP. A thin, flexible tube called an endoscope is passed through the mouth, down the esophagus and stomach, and into the first part of the small intestine. A small tube (catheter) is then guided into the bile or pancreatic ducts.

Through this catheter, the doctor can use a tiny brush or biopsy needle to collect cells or tissue from a tumor or from areas that look abnormal. These samples are then examined under a microscope to check for cancer or other conditions.

Surgical biopsy

In a surgical biopsy, the biopsy is done during a small operation, typically a laparoscopy, to remove a sample from the tumor. However, this is rarely performed and is usually much less common than a percutaneous biopsy or an endoscopic biopsy.

Most of the time, doctors try to take a tissue sample using EUS first. If that doesn’t work, they may use ERCP. Only rarely do they take a sample through the skin, and even less often do they need surgery to get one.