How is pancreatic cancer diagnosed?
A number of tests may be performed to investigate symptoms of pancreatic cancer and confirm a diagnosis. The more common tests include:
- physical examination
- imaging tests, including
- computed tomography (CT) scans
- magnetic resonance imaging (MRI) scans
- ultrasound tests, including endoscopic ultrasound, which uses an ultrasound probe on the tip of an endoscope (a tube that is passed through the nose or mouth into the digestive tract)
- cholangiopancreatography, which uses X-rays or MRI of the pancreatic ducts and bile ducts
- somatostatin receptor scintigraphy, which uses a radioactive substance attached to a hormone-like substance that is injected into the body (for endocrine cancers)
- positron emission tomography (PET) scans
- angiography, an X-ray that looks at blood vessels
- blood tests for liver function, tumour markers or pancreatic hormones
- laparoscopy, a surgical procedure to look at the organs in the abdomen using a thin tube with a light on the end
- biopsy, where a small sample of tissue is removed to be examined under a microscope.
Other types of laboratory tests are used to diagnose specific types of functional pancreatic neuroendocrine tumours.
Staging
If you are diagnosed with pancreatic cancer, you might have more tests to determine the stage of the disease and whether the cancer has spread to other parts of the body. Knowing the stage of the disease helps your medical team plan the best treatment for you.
Pancreatic cancer is divided into 5 stages:
- Stage 0: the cancer is confined to the top layers of pancreatic duct cells and has not invaded deeper tissues; it has not spread outside the pancreas.
- Stage I: the cancer is confined to the pancreas; it has not spread to nearby lymph nodes or distant sites. The tumour is
- 2 cm across or smaller (stage IA); OR
- larger than 2 cm across (stage IB).
- Stage II:
- the cancer has spread to nearby tissue and organs, but has not spread to nearby lymph nodes or distant sites (stage IIA); OR
- the cancer has spread to nearby lymph nodes and may have spread to nearby tissue and organs, but has not spread to distant sites (stage IIB).
- Stage III: the cancer has spread into nearby major blood vessels or nerves. It may have spread to nearby lymph nodes, but has not spread to distant sites.
- Stage IV: the cancer has spread to distant sites, such as the liver, lung and peritoneal cavity.
Some doctors classify pancreatic cancer on the basis of imaging tests into 4 main groups:
- Resectable: the cancer has not spread outside the pancreas and appears to be easily treated with surgery.
- Borderline resectable: the cancer has not spread outside the pancreas (or it has grown to a small extent into nearby blood vessels), but it is uncertain whether it can be completely removed using surgery.
- Locally advanced (unresectable): the cancer has spread outside the pancreas to nearby blood vessels or other tissues, and cannot be removed by surgery.
- Metastatic (widespread): the cancer has spread outside the pancreas to distant organs and tissues, such as the abdomen, liver, lungs, bone or brain.
For pancreatic neuroendocrine tumours, treatment is based on the extent of spread of the cancer, rather than a standard staging system.
American Cancer Society (2015). Pancreatic cancer http://www.cancer.org/cancer/pancreaticcancer/detailedguide/index.
National Comprehensive Cancer Network (2014). NCCN guidelines for patients: pancreatic cancer, version 1.2014 http://www.nccn.org/patients/guidelines/pancreatic/index.html.
National Cancer Institute (2015). Pancreatic neuroendocrine tumors (islet cell tumors) treatment (PDQ®) http://www.cancer.gov/cancertopics/pdq/treatment/isletcell/Patient, patient version.
National Cancer Institute (2015). Pancreatic cancer treatment (PDQ®) http://www.cancer.gov/cancertopics/pdq/treatment/pancreatic/Patient, patient version.
National Cancer Institute (2015). Pancreatic cancer treatment (PDQ®) http://www.cancer.gov/cancertopics/pdq/treatment/pancreatic/Patient, patient version.
National Cancer Institute (2015). Pancreatic neuroendocrine tumors (islet cell tumors) treatment (PDQ®) http://www.cancer.gov/cancertopics/pdq/treatment/isletcell/Patient, patient version.