Diagnosis is the process of finding the underlying cause of a health problem. If cancer is suspected, the healthcare team will confirm if it is present or not, and what type of cancer it is. The process of diagnosis may seem long and frustrating, but it is important for the doctor to rule out other possible reasons for a health problem before making a cancer diagnosis.
Diagnostic tests for pancreatic cancer are usually done when:
- the symptoms of pancreatic cancer are present
- the doctor suspects pancreatic cancer after talking with a person about their health and completing a physical examination
Many of the same tests used to initially diagnose cancer are also used to determine the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment. Tests may include the following.
Medical history and physical examination
The medical history is a record of present symptoms, risk factors and all the medical events and problems a person has had in the past. The medical history of a person's family may also help the doctor to diagnose pancreatic cancer.
In taking a medical history, the doctor will ask questions about:
- a personal history of
- smoking tobacco
- chronic pancreatitis
- diabetes
- occupational exposure to chemicals
- inherited syndromes
- a family history of
- pancreatic cancer
- inherited syndromes
- signs and symptoms
A physical examination allows the doctor to look for any signs of pancreatic cancer. During a physical examination, the doctor may:
- check the skin and whites of the eyes for jaundice
- feel the abdomen for an enlarged liver or spleen
- check the legs for swelling
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Complete blood count
A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to:
- show how well the bone marrow and certain organs are functioning – may indicate areas needing further investigation
- provide a baseline by which to compare future blood counts during and after treatment
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Blood chemistry tests
Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can also be used to detect abnormalities. They are used to measure liver function and include:
- bilirubin
- alkaline phosphatase
- lactic dehydrogenase (LDH)
- alanine aminotransferase (ALT)
- aspartate transaminase (AST)
- amylase
An increased level of any of these may indicate:
- a blockage in the common bile duct or pancreatic duct
- pancreatitis – inflammation or infection of the pancreas
- spread of pancreatic cancer to the liver
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Tumour marker tests
Tumour markers are substances – usually proteins – in the blood that may indicate the presence of pancreatic cancer. Tumour marker tests are used to check a person's response to cancer treatment, but they can also be used to diagnose pancreatic cancer.
The tumour markers that may be measured are:
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Computed tomography (CT) scan
A CT scan uses special x-ray equipment to make 3-dimensional and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures. A CT scan is the most common imaging test for pancreatic cancer. It is used to:
- locate tumours
- show if the tumour can be completely removed by surgery
- show spread of the cancer to nearby organs and tissues
- guide a fine needle aspiration biopsy to obtain tissue samples
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Ultrasound
Ultrasound uses high-frequency sound waves to make images of structures in the body. It is used to:
- find tumours
- help tell some types of tumours apart from others
- guide a fine needle aspiration biopsy to obtain tissue samples
Endoscopic ultrasound
An endoscopic ultrasound (EUS) is a newer procedure that is similar to an ERCP (endoscopic retrograde cholangiopancreatography). It is more accurate than an abdominal ultrasound in diagnosing pancreatic cancer.
- An endoscope is passed down the throat, through the esophagus and stomach, and into the duodenum (first part of the small intestine).
- An ultrasound probe is passed down the endoscope and is pointed toward the pancreas.
- An ultrasound scan is taken of the pancreas and nearby organs.
The scan gives a very accurate picture and is good for finding small tumours.
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Magnetic resonance imaging (MRI)
MRI uses powerful magnetic forces and radio-frequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-dimensional pictures. It may be used to:
- locate tumours
- show spread of the cancer to other organs and tissues
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Endoscopic retrograde cholangiopancreatography (ERCP)
ERCP allows a doctor to examine the ducts that drain the pancreas, liver and gallbladder by using a flexible tube with a light and lens on the end (an endoscope). A dye is injected into the ducts to make them show up clearly on an x-ray. X-rays are taken as soon as the dye is injected. ERCP is used to:
- find a tumour that may be causing a blockage in a bile duct or pancreatic duct
- take a biopsy
- show spread of the cancer to nearby organs and tissues
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Laparoscopy
A laparoscopy is an operation in which a flexible, lighted tube (an endoscope) is inserted through a small incision in the abdomen. It is used to:
- view the pancreas and surrounding areas
- take a biopsy
- avoid more extensive abdominal surgery if the cancer has spread
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Biopsy
During a biopsy, tissues or cells are removed from the body so they can be tested in a laboratory. The pathology report from the laboratory will confirm whether or not cancer cells are present in the sample. The biopsy that could be used for pancreatic cancer is a fine needle aspiration (FNA).
An FNA uses a thin needle and a syringe to remove a small amount of fluid or cells. An FNA of the pancreas can be done through the skin with CT or ultrasound guidance, or it can be done during ERCP.
A biopsy of the liver may be done to confirm liver metastases.
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Upper gastrointestinal (GI) series
An upper GI series is also called a barium swallow. It is an x-ray of the upper GI tract, including the lower half of the esophagus, the stomach and the first part of the small intestine (duodenum), which surrounds the pancreas. It can show if the pancreatic cancer has spread to the duodenum.
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Chest x-ray
An x-ray uses small doses of radiation to make an image of the body’s structures on film. A chest x-ray may be done to find out if pancreatic cancer has spread to the lungs.
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Positron emission tomography (PET) scan
A PET scan uses radioactive materials (radiopharmaceuticals) to detect changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3-dimensional colour images of the area being scanned. It may be used to:
- locate tumours
- show spread of the cancer to other organs and tissues
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See a list of questions to ask your doctor about diagnostic tests.