Pancreatic cancer diagnosis

Pancreatic cancer accounts for approximately 3 percent of all cancers in the United States. In 2023, about 64,050 people will be diagnosed with pancreatic cancer (33,130 men and 30,920 women), according to the American Cancer Society (ACS). Accurately diagnosing pancreatic cancer often requires different types of tests.

The care team will likely consist of a:

• Gastroenterologist, or doctor who specializes in the diagnosis and treatment of digestive tract diseases
• Medical oncologist, or doctor who specializes in the diagnosis and treatment of cancer via chemotherapy, immunotherapy and targeted therapy
• Radiation oncologist, or doctor whose specialty is in using radiation therapy to treat cancer
• Surgical oncologist, or doctor who treats cancer surgically

The team may use blood tests, imaging tests, biopsies and possibly molecular testing to obtain as complete a picture as possible. This process also helps doctors identify appropriate treatment options.

Pancreatic cancer early detection

It’s challenging to detect pancreatic cancer early because there’s currently no standard diagnostic screening test for patients at average risk. For those with an above-average risk—such as those who have a family history of pancreatic cancer or a diagnosed genetic syndrome known to raise their predisposition, doctors may use screening tools such as an endoscopic ultrasound or magnetic resonance imaging (MRI).

Additionally, the pancreas is located so deep inside the body that it’s extremely difficult for doctors to palpate (feel) any tumors (and even the pancreas itself) during a physical examination.

However, it’s possible that pancreatic cancer may cause early symptoms, or that testing for other medical conditions may show signs of pancreatic cancer, causing the care team to diagnose it early. Most often, symptoms aren’t apparent in early stages, and small lesions aren’t always detected by pancreatic cancer diagnostic tests, so cases tend to be diagnosed in more advanced stages.

Tests for pancreatic cancer diagnosis

Blood tests

Blood tests may provide clues that indicate the presence of the disease, but they don’t provide definitive early detection of pancreatic cancer. Blood tests help the care team determine whether further testing is warranted. They include:

Liver function tests

The first sign of pancreatic cancer may be jaundice, which causes yellowing of the whites of the eyes and the skin. When a patient has jaundice, the doctor will typically order liver function tests to find out what’s causing it to occur. These blood tests measure levels of bilirubin, a chemical produced by the liver, as well as of liver enzymes in the blood, in order to differentiate between jaundice caused by liver disease and other issues. High levels of bilirubin present in the blood may indicate pancreatic cancer.

Tumor markers

Tumor markers are substances released into the body by a tumor. Identifying these substances, or biomarkers, can assist with the diagnosis of pancreatic cancer:

Carbohydrate antigen 19-9 (CA19-9): Even healthy people have some CA 19-9 protein in their blood, but elevated levels of this marker may indicate pancreatic cancer.

Carcinoembryonic antigen (CEA): Some noncancerous conditions may cause high CEA levels (such as rectal polyps or cirrhosis), but elevated CEA levels may also indicate pancreatic cancer.

Not all people with elevated levels of these tumor markers have pancreatic cancer, and not all people with pancreatic cancer will have elevated levels. Patients with pancreatic cancer and high levels of these markers may be asked to undergo repeated blood tests to evaluate whether the treatment is working.

Imaging tests

Imaging screenings provide a visual snapshot of the pancreas to expose potential abnormalities. The type of tests used may depend on each patient's situation and symptoms.

Tests may include:

• Computed tomography (CT) scan creates a detailed, often-3D image using X-rays taken from different angles. A contrast dye injected at the start of the procedure may help assess the pancreas and visualize affected areas. CT scans are able to provide clear images of the pancreas, as well as indicate whether pancreatic cancer has spread to nearby structures such as organs and lymph nodes. These images can also help the care team determine whether surgery is a viable treatment option.
• Positron emission tomography (PET) scan tracks the effects of a sugar substance that’s swallowed, inhaled, or injected into a vein. Because cancerous cells use more sugar than normal cells, they appear brighter in the images. A PET scan may also be used to see whether exocrine pancreatic cancers have spread, or metastasized.
• Endoscopic ultrasound (EUS) uses an endoscope to insert an ultrasound probe adjacent to the pancreas to obtain detailed images. During the procedure, the care team can view the digestive tract wall, as well as nearby lymph nodes, organs and blood vessels. If a tumor is present in the pancreas, it should be visible on an EUS. Tissue or fluid samples may be taken during this time if a biopsy is needed. A biopsy is the only way to confirm a pancreatic cancer diagnosis.
• Magnetic resonance imaging (MRI) uses radio waves and magnets to produce detailed images of the pancreas and bile ducts. Although CT scans are usually the preferred method of viewing the pancreas, sometimes an MRI may be done to help the care team determine whether further testing is warranted.
• Cholangiopancreatography refers to imaging tests that show the bile ducts and pancreatic ducts. They’re used to see if the ducts are narrowed, obstructed or dilated, and can be useful in determining whether a tumor is causing a ductal blockage. These tests may also be used to establish a plan for surgery.
  • Magnetic resonance cholangiopancreatography (MRCP) is a type of MRI that’s often done when pancreatic cancer is suspected. Using an MRI machine, doctors perform this diagnostic test to view pancreatic and bile ducts, but they can’t take a biopsy sample during this procedure.
  • Endoscopic retrograde cholangiopancreatography (ERCP) creates images using a scope inserted into the throat. A dye is injected to make the ducts visible, and the doctor will be able to view the ampulla of Vater, the area where the bile duct releases into the small intestine. Any blockages or narrowing of the bile ducts, possibly caused by pancreatic cancer, may be seen via X-ray images taken during the procedure. At this time, a small brush or biopsy forceps may be inserted through the endoscope to collect a biopsy of cells. In some cases, a cholangioscope (an endoscope that allows visual examination of the bile duct and pancreatic ducts to obtain a more targeted biopsy) is used. If a bile duct or pancreatic duct is constricted by a tumor, a stent may be placed inside to keep it open.
  • Percutaneous transhepatic cholangiography (PTC) involves the placement of a thin and hollow needle into the liver. A contrast dye is injected into the organ, and X-rays of the bile ducts and pancreatic ducts are taken. Fluid or tissue samples can be collected if a biopsy is needed, and a stent can be placed inside a blocked duct in order to keep it open. The procedure is more invasive than an ERCP, and it’s only performed if an ERCP cannot be done or has already been attempted.

Biopsy and lab tests

A biopsy tests suspicious tissue for signs of cancer and is an important part of the diagnostic process. A tissue sample is taken, either during one of the endoscopic imaging procedures or with a needle biopsy (in which a fine needle is inserted into the pancreas to retrieve cells), then sent to a pathologist who studies it under a microscope.

If other tests indicate a high likelihood that a tumor is cancerous, the patient may undergo surgery to have it removed. In this case, the tissue may be analyzed after surgery, instead of through a biopsy.

Advanced genomic testing and genetic testing for pancreatic cancer

The care team may recommend molecular testing or genetic testing for pancreatic cancer to help make more personalized decisions about treatments like immunotherapy or targeted therapy.

Genetic testing uses a saliva or blood sample to evaluate changes in cells called germline mutations to help guide treatment decisions.

Advanced genomic testing is a more sophisticated analysis of tissue and cell samples, looking for specific gene mutations or proteins that may help direct treatment. 

Patients should ask their care teams whether these tests might be an option for them.

Pancreatic cancer tests and staging

Reviewing test results enables the care team to put together a more complete picture of each patient's condition, including the stage of the cancer and treatment options.

Determining the stage of pancreatic cancer is based on three important factors:

• The size of the tumor and whether it has grown beyond the pancreas
• Whether the cancer has spread to lymph nodes
• Whether the cancer has spread to other parts of the body, such as other organs or bones

Learn more about the stages of pancreatic cancer