Pancreatic cancer is a cancer that begins in the pancreas, which is the organ that lies behind the lower part of the stomach. This type of cancer is really difficult to diagnose and it is often detected late. In most cases, by the time this cancer is detected, it has already spread rapidly and thus the prognosis is poor.
There are several cancer diagnostic tests your doctor or specialist might advise if pancreatic cancer is suspected. You may be asked to get the following tests done:
Testing for cancer
A Blood test is one of the basic tests to diagnose any disease or illness.
If you have jaundice, your blood will have high levels of bilirubin. Bilirubin is a pigment, excess of which gives your skin and eyes yellowish color. During Jaundice your bilirubin levels are more than 2.5mg/dl. Your blood test will help your doctor understand how bad your jaundice is. A tumor in the pancreas can cause the narrowing of the bile duct and block the bile flowing from the gall bladder to the small intestine. The blockage of the bile duct causes a buildup of bilirubin. Thus jaundice and pancreatic cancer are connected.
Evaluation of total blood cell count is also advised. Your blood is composed of red blood cells, white blood cells and platelets. Excess destruction of your red blood cells also leads to jaundice. Your total blood count will help your doctor understand the cause of jaundice.
Testing for CA19-9
CA19-9 is a tumor marker. The presence of it may indicate cancer; however CA19-9 may be present in your blood even if you don’t have cancer. There are a lot of other conditions which may prompt the presence of CA19-9. Thus, the presence of pancreatic cancer should not be diagnosed based on this test alone.
This test assesses your organs. This will help your doctor understand the size of pancreas and the condition of surrounding structures. During an ultrasound:
- You are asked to lie down flat.
- A gel is applied over your tummy.
- An instrument is moved over your tummy for five to 30 minutes. It will take images of your internal organs.
Computerized tomography/CT scan
If you have jaundice and other symptoms of pancreatic cancer, you may be asked to get a CT scan done immediately. This test gives a 3-dimensional image of your organs. In addition to your stomach area, your chest and region below the pelvis may be scanned to know if pancreatic cancer has spread to other organs (metastasis). Before you undergo this test, you will need to drink a liquid which contains a dye. You will also be given an injection. These will help your organs and blood vessels show up clearly on the scan. During a CT scan you will be asked to lie down straight, on your back, on a couch. The scanner is of the shape of a tunnel. Your couch will move into it and a few X- rays will be taken. This test will take around 30 minutes and is not painful.
CT - positron emission tomography
Sometimes a CT scan may be combined with positron emission tomography. This test will help your doctor check how the cancer is progressing and how it’s responding to treatment. During this test a dye is injected. After about 90 minutes a scan is complete.
Somatostatin receptor scintigraphy (SRS)
This helps you detect pancreatic cancer especially NETs or exocrine cancer. Here an octreotide, hormone-like substance, which is bound to a radioactive matter, is injected. This material attaches itself to tumor cells which help to detect the presence of cancerous cells. After few hours a camera is used to detect tumor.
Magnetic resonance imaging/MRI
This test will give you pictures of pancreas and surrounding structures in detail. It uses magnets and radio waves to detect the tumor. Here as well, you will be asked to lie down on a coach that enters a tunnel shaped scanner. You will be given headphones as this scanner is noisy.
Endoscopic ultrasound scan/EUS
This test will help your doctor understand which portion of pancreas has cancer and where exactly it has spread. During this test you will be given a spray to numb your throat and prevent coughing. Then you will be given an injection which will make you drowsy and relaxed. A thin tube which has light at the end of it is then inserted into your throat, then down to your stomach. It will take pictures of pancreas and surrounding organs. A fine needle may also be present in that tube. This will help your doctor pick few cells from pancreas for further examination.
An angiogram is a procedure that detects any blocked vessels. In this procedure a dye is injected. Then a catheter or tube is inserted into your blood vessels, mostly from your thighs. The catheter goes to your pancreas. X-rays are taken which show if there are any blocked blood vessels. It also shows the extent of the blockage. This helps your doctor assess if the tumor can be removed without causing damage to the major blood vessels.
In a biopsy a sample of tissues from the pancreas is taken. A biopsy is a sure way to confirm if you have pancreatic cancer. It may be taken during EUS as mentioned above. It may also be taken by laparoscopy. Laparoscopy is a procedure wherein your doctor is able to access your pancreas without making a large cut in the skin/body. This is also known as a keyhole surgery.
Magnetic resonance cholangio-pancreatography/MRCP
This test will help check if the pancreatic or bile duct is blocked. A dye will be injected to help your doctor get a clear picture of the blockage.
Diagnosing pancreatic cancer
An early diagnosis of this cancer is imperative to help you recover faster. If the diagnosis of pancreatic cancer is delayed, then it could in some cases lead to an early death. Several tests come together to help your doctor diagnose if you have pancreatic cancer and this is what makes all the difference.