How is cancer of the pancreas diagnosed?

To diagnose pancreatic cancer, the doctor does a complete physical exam and asks about the patient’s personal and family medical history. In addition to checking general signs of health (temperature, pulse, blood pressure, and so on), the doctor usually orders blood, urine, and stool tests. The doctor may also ask for a “barium swallow,” or “upper GI series.” For this test, the patient drinks a barium solution before x-rays of the upper digestive system are taken. The barium shows an outline of the pancreas on the x-rays.

Other tests may be ordered, such as:

* An angiogram, a special x-ray of blood vessels.
* CT scans, x-rays that give detailed pictures of a cross- section of the pancreas. These pictures are created by a computer.
* Transabdominal ultrasound to view the pancreas. In this procedure, an instrument that sends out high-frequency sound waves, which cannot be heard, is passed over the abdomen. The sound waves echo off the pancreas. The echoes form a picture on a screen that looks like a television.
* ERCP (endoscopic retrograde cholangiopancreatogram), is a special x-ray of the common bile duct. For this test, a long, flexible tube (endoscope) is passed down the patient’s throat through the stomach and into the small intestine. A dye is injected into the common bile duct, and x-rays are taken. The doctor can also look through the endoscope and take tissue samples.
* Endoscopic ultrasound is a relatively new procedure that can be used to diagnose pancreatic cancer. For the procedure, an endoscope is passed in the same way as for ERCP; however, on the end of the endoscope is an ultrasound probe which scans the pancreas for cancers. Because the ultrasound probe is closer to the pancreas than with transabdominal ultrasound, it is possible to identify small cancers within the pancreas. The cancers also can be biopsied through the endoscope.

A biopsy is the only sure way for the doctor to know whether cancer is present. In a biopsy, the doctor removes some tissue from the pancreas. It is examined under a microscope by a pathologist, who checks for cancer cells.

One way to remove tissue is with a long needle that is passed through the skin into the pancreas. This is called a needle biopsy. Doctors use x-rays or ultrasound to guide the placement of the needle. Another type of biopsy is a brush biopsy. This is done during the ERCP. The doctor inserts a very small brush through the endoscope into the bile duct to rub off cells to examine under a microscope.
Sometimes an operation called a laparotomy may be needed. During this operation, the doctor can look at organs in the abdomen and can remove tissue. The laparotomy helps the doctor determine the stage, or extent, of the disease. Knowing the stage helps the doctor plan treatment.

Tissue samples that are obtained with one kind of biopsy may not give a clear diagnosis, and the biopsy may need to be repeated using a different method.

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