Diagnosis

There is no standard diagnostic test for pancreatic cancer, and the diagnosis can be difficult to make. Most people with pancreatic cancer first present to their primary-care physician complaining of nonspecific symptoms. These complaints trigger an evaluation often including a physical examination (usually normal), blood tests, X-rays, and often, an ultrasound.

It is important to note that the best initial imaging test when there is concern for pancreatic cancer (PC) is contrast-enhanced computed tomography (CT), and not ultrasound. The pancreas is often not well seen and in fact partially obscured on ultrasound. It is entirely visualized on CT, offering a chance to detect earlier stage disease and reducing need of subsequent tests. Ultimately, a tissue biopsy is the only way to make the diagnosis with certainty.

Imaging Tests

CT Scan

CT Scan is one of the most common and best imaging procedures performed when an individual is suspected of having pancreatic cancer. This is accepted as the most appropriate initial imaging test when there is concern for pancreatic cancer. The images are often used to determine whether the tumour can be surgically removed. A contrast dye may be given both orally and injected into a vein to show small tumours of the pancreas and whether the cancer has spread.

MRI

Magnetic Resonance Imaging (MRI) is able to view internal structures and organs without using ionizing radiation (compared tto use of X-rays in CT). An MRI is often used to confirm a suspected pancreatic cancer from CT scan or to better characterize the tumour.

EUS

Endoscopic Ultrasound (EUS) is a test in which the doctor passes a thin, flexible lighted tube through the patient’s mouth and stomach, down into the first part of the small intestine. At the tip of the endoscope is an ultrasound device that makes sound waves and images. The doctor can obtain images of the pancreas and surrounding organs and tissues from inside the stomach and small intestine.

ERCP

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a test in which the doctor passes an endoscope through the patient’s mouth and stomach, down into the first part of the small intestine. The doctor then slips a smaller tube (catheter) through the endoscope into the bile ducts and pancreatic ducts. After injecting dye through the catheter into the ducts, the doctor takes x-ray pictures. The x-rays can show whether the ducts are narrowed or blocked by a tumour or other condition. In addition to guiding bile duct biopsies, ERCP can be used to relieve bile duct blockages caused by the tumour by guiding placement of a stent.

FNA

Fine-Needle Aspiration (FNA) is a type of biopsy where a doctor uses a long, thin needle to obtain tissue specimen to confirm a diagnosis. This can be guided by ERCP, CT, or EUS imaging methods to allow the doctor to view the position of the needle to ensure that the needle is in the tumour. General anaesthesia is not required, but local anesthesia may be provided.

Non-Imaging Tests

Tumor
Marker

In addition to radiologic tests, suspicion of a pancreatic cancer can arise from the elevation of a “tumour marker,” a blood test which can be abnormally high in people with pancreatic cancer. The tumour marker most commonly associated with pancreatic cancer is called the CA 19-9. It is often released into the bloodstream by pancreatic cancer cells and may be elevated in patients newly found to have the disease. Unfortunately, the CA 19-9 test is not specific for pancreatic cancer. Despite ongoing research to diagnose pancreatic cancer earlier, no specific proven or accepted blood test has been developed to screen for this cancer.

Surgical Resectability

Resectable

This type of pancreatic cancer can be surgically removed. A tumour may lie within the pancreas or extend beyond it, but there is no involvement of the critical arteries or veins in the area. There is no evidence of any spread to areas outside of the pancreas. Approximately 10% to 20% of patients are diagnosed at this stage.

Unresectable

Locally advanced and unresectable: This type is still confined to the area around the pancreas, but cannot be surgically removed because there is involvement of the critical arteries or veins, or the tumour directly extends to surrounding organs. There is no evidence of spread to any distant areas of the body. Approximately 35% to 40% of patients are diagnosed at this stage.

Metastatic

The tumour has spread beyond the area of the pancreas and involves other organs, such as the liver or distant areas of the abdomen. Approximately 45% to 55% of patients are diagnosed at this stage.

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