How do you diagnose pancreatic cancer?

The symptoms listed above may suggest diagnosis and occasionally there may be a lump to feel in the abdomen. But further tests are needed to make a diagnosis of pancreatic cancer.

• Blood tests can identify the presence of jaundice and low blood count (anaemia). There are proteins in the blood which can be abnormal in pancreatic cancer, these are called tumour markers. CA19.9 is the one used for pancreatic cancer, and the level in the blood may be (but not always) raised in patients with pancreatic cancer.

• Ultrasound scan.This may be the first test to be done, especially if the patient is jaundiced.This uses sound waves to look at organs inside the abdomen. Gel is applied to the abdomen and then a hand held probe is moved over this area.This type of scan is useful but must not be relied on as the only test for pancreatic cancer.
  

• CT (computer tomography) scan. This is the best initial way to diagnose pancreatic cancer and should always be used if pancreatic cancer is suspected.These scanners, which are like a ring or ‘doughnut’, use x-rays to build up a three dimensional picture of the body.A patient is given an injection and a drink to have before the scan, and then passes through the ‘doughnut’.The scan can identify a pancreatic cancer in a high number of cases and also show whether it has spread outside of the pancreas. Other scans such as MRI (magnetic resonance imaging) scans may be used as well.

• EUS (endoluminal ultrasound) involves a thin flexible tube (endoscope) being passed through the mouth down the gullet, stomach and duodenum and is carried out under local anaesthetic. At the end of the scope is an ultrasound probe and scans can be taken of the pancreas.A biopsy (small sample of tissue for examination under a microscope) of the pancreas can also be taken to help with the diagnosis.This technique can help to diagnose very small cancers.

• ERCP (endoscopic retrograde cholangiopancreatography) involves a thin flexible tube (endoscope) being passed through the mouth down the gullet, stomach and duodenum and is carried out under local anaesthetic.This is used in jaundiced patients (in whom tumour is blocking the bile duct) to place a plastic tube (stent) into the bile duct, past the pancreatic cancer to allow the bile to flow into the duodenum again.This will allow the jaundice to get better. Biopsy/ brushings can be taken to help diagnosis. Brushings may pick up cancer cells as another way of confirming the diagnosis.

• PTC (percutaneous transhepatic cholangiography) involves passing a very thin tube through the skin, into the liver to the bile duct.This is done under local or general anaesthetic and is used for patients who cannot have ERCP and need their jaundice to be treated.

• Biopsy can be done at EUS, ERCP or using a needle through the skin using CT scan guidance.The last one should only be done for patients who are not having surgery to remove the cancer.