Pancreatic cancer

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Diagnosis of pancreatic cancer

Diagnosing pancreatic cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for pancreatic cancer or other health problems.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as pancreatic cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of pancreatic cancer.

The following tests are commonly used to rule out or diagnose pancreatic cancer. Many of the same tests used to diagnose cancer are used to find out the stage, which is how far the cancer has progressed. Your doctor may also order other tests to check your general health and to help plan your treatment.

Health history and physical exam

Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. In taking a health history, your doctor will ask questions about:

  • symptoms that suggest pancreatic cancer
  • smoking tobacco
  • obesity
  • diabetes
  • occupational exposure to chemicals
  • history of chronic pancreatitis (inflammation or infection of the pancreas)

Your doctor will also ask you about a family history of pancreatic cancer or conditions that increase the risk of pancreatic cancer, such as:

  • hereditary breast and ovarian cancer (HBOC) syndrome
  • familial atypical multiple mole melanoma (FAMMM) syndrome
  • Peutz-Jeghers syndrome
  • Lynch syndrome (also called hereditary non-polyposis colorectal cancer , or HNPCC)
  • hereditary pancreatitis

A physical exam allows your doctor to look for any signs of pancreatic cancer. During a physical exam, your doctor may:

  • check your skin and whites of your eyes for jaundicejaundiceA condition in which the skin and whites of the eyes become yellow and urine is dark yellow.
  • feel your abdomen for any lumps or swellings
  • feel your abdomen to see if your gallbladder, liver or spleen is enlarged
  • check your legs for swelling
  • check the lymph nodes above your collarbone and in other places to see if they are swollen

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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. It is also used to provide a baseline that your doctors can use to compare blood counts during and after treatment.

Find out more about complete blood count (CBC).

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Blood chemistry tests

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs, such as the liver, are functioning and can help find abnormalities.

Blood chemistry tests may be used to measure the following chemicals:

  • bilirubin
  • alkaline phosphatase
  • lactic dehydrogenase (LDH)
  • alanine aminotransferase (ALT)
  • aspartate transaminase (AST)
  • amylase

An increased level of any of these chemicals may mean:

  • a blockage in the common bile duct or pancreatic duct
  • pancreatitis, which is inflammation or infection of the pancreas
  • pancreatic cancer has spread to the liver

Find out more about blood chemistry tests.

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CT scan

A computed tomography (CT) scan uses special x-ray equipment to make 3-D 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:

  • find tumours
  • find out the size of the tumour
  • find out if the tumour can be completely removed with surgery
  • find out if the cancer has spread to nearby organs and tissues
  • guide a fine needle aspiration (FNA) biopsy to get tissue samples

Find out more about CT scan.

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Ultrasound uses high-frequency sound waves to make images of structures in the body. It is used to:

  • find tumours
  • help tell different types of tumours apart
  • guide a fine needle aspiration (FNA) biopsy to get tissue samples

An abdominal ultrasound may be one of the first tests done if you have unexplained abdominal pain. It can also be used to look at the liver.

Endoscopic ultrasound (EUS) is a newer procedure that can diagnose pancreatic cancer more accurately than an abdominal ultrasound. An endoscope is a thin, tube-like instrument with a light and lens. During EUS, the doctor passes an endoscope down the throat, through the esophagus and stomach, and into the duodenum (first part of the small intestine). The doctor then passes an ultrasound probe down the endoscope and points it toward the pancreas. An ultrasound scan is taken of the pancreas and nearby organs.

EUS creates a very accurate picture and is good for finding small tumours. Doctors can also collect a tissue sample for a biopsy during EUS.

Find out more about ultrasound.

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Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-D pictures.

MRI is used to:

  • find tumours
  • find out if the cancer has spread to other organs and tissues

Find out more about MRI.

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Endoscopic retrograde cholangiopancreatography (ERCP)

ERCP is similar to endoscopic ultrasound. It is a procedure that uses an endoscope (a thin, tube-like instrument with a light and lens) and x-rays to examine the ducts that drain the pancreas, liver and gallbladder. 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 the bile duct or pancreatic duct
  • collect a sample for biopsy
  • place a stent to relieve the blockage of the bile duct

Find out more about ERCP.

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A laparoscopy is a procedure in which an endoscope (a thin, tube-like instrument with a light and lens) is passed through a small incision, or cut, in the abdomen. Using a laparoscopy can help avoid the need for more extensive abdominal surgery.

Laparoscopy is used to:

  • look at the pancreas and surrounding areas
  • collect a tissue sample for a biopsy

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During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. The report from the lab will confirm whether or not cancer cells are present in the sample.

Fine needle aspiration (FNA) is the type of biopsy used to collect a sample from the pancreas. An FNA uses a thin needle and a syringe to remove a small amount of fluid or cells.

FNA of the pancreas can be done through the skin. The doctor uses a CT scan or ultrasound to guide the needle to the tumour. FNA can be done during a laparoscopy, an EUS or an ERCP.

FNA may also be used to collect samples from the liver to confirm liver metastases.

Find out more about FNA.

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PET scan

A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3-D colour images of the area being scanned.

A PET scan may be used to:

  • find tumours
  • find out if the cancer has spread to other organs and tissues

Find out more about PET scan.

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Tumour marker tests

Tumour markers are substances in the blood that may mean pancreatic cancer is present. If certain tumour markers are higher than normal before treatment, your doctor may order tumour marker tests to check your response to treatment.

The tumour markers that may be measured for pancreatic cancer are:

Carbohydrate antigen 19-9 (CA19-9) is a protein found in very small amounts on the surface of certain cancer cells. The level of CA19-9 is higher than normal in 70%–80% of people with pancreatic cancer. Find out more about carbohydrate antigen 19-9 (CA19-09).

Carcinoembryonic antigen (CEA) is a protein normally found in the tissue of a developing fetus. Levels of CEA in the blood decrease after birth. The level of CEA is higher than normal in about 50% of people with pancreatic cancer. Find out more about carcinoembryonic antigen (CEA).

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Percutaneous transhepatic cholangiography (PTC)

PTC is an x-ray of the bile ducts and liver. The doctor inserts a thin needle through the skin into the bile duct area. A contrast medium, or special dye, is injected into the bile ducts. The dye outlines the structure of the bile ducts and liver on the x-ray.

PTC may be used to find out if there is a blockage in the bile duct. Doctors may also use PTC to guide them as they place a stent to open a blocked bile duct.

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Questions to ask your healthcare team

Find out more about diagnosis. To make the decisions that are right for you, ask your healthcare team questions about diagnosis.


Canadian Cancer Trials Group researcher Dr Wendy Parulekar The Canadian Cancer Trials Group found that extending hormone therapy keeps breast cancer at bay.

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Help for smokers trying to quit

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It’s okay to need help to quit smoking. The Canadian Cancer Society is here to support people who are ready to quit and even those people who aren’t ready.

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