Diagnosing pancreatic cancer

Accurately diagnosing pancreatic cancer often requires different types of tests. Your care team will 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.

Blood tests

Blood tests may provide clues, though not a definitive diagnosis. Tests may specifically look for:

• Bilirubin: A high level of bilirubin may indicate that a tumor is blocking the bile duct, impairing liver function as a result.
• Carbohydrate antigen 19-9 (CA19-9) and, to a lesser extent, carcinoembryonic antigen (CEA): These are tumor markers, or substances, linked to certain types of cancer. However, not all people with elevated levels of these tumor markers have pancreatic cancer, and not all people with pancreatic cancer will have elevated levels. If you have pancreatic cancer and your levels of these markers are high, repeating blood tests may help show whether treatment is working.

Imaging studies

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

Tests may include:

• Computed tomography (CT) scan makes 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.
• Positron emission tomography (PET) scan tracks the effects of a sugar substance that’s injected into a vein. Because cancerous cells use more sugar than normal cells, they would appear brighter in the images.
• Endoscopic retrograde cholangiopancreatography (ERCP) creates images using a scope inserted into the throat. A dye is injected to make bile ducts visible.
• Percutaneous transhepatic cholangiography (PTC) is an interventional radiology procedure in which a dye is injected into the bile duct connected to the liver under fluoroscopic guidance.
• Endoscopic ultrasound (EUS) uses an endoscope to insert an ultrasound probe adjacent to the pancreas to obtain detailed images.
• Magnetic resonance imaging (MRI) uses radio waves and magnets to produce detailed images of the pancreas and bile ducts.

Biopsy

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. 

Molecular testing

Molecular testing is a more sophisticated analysis of tissue and cell samples, looking for specific gene mutations or proteins that may help direct treatment. Ask your care team whether you are a candidate for this test and whether it can be performed on your tissue sample.

Reviewing your test results enables your care team to put together a more complete picture of your 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

Diagnosing pancreatic cancer in its earliest stages allows for a wider range of treatment options and a better chance for success. The main challenge is that symptoms typically don’t start in the initial period. 

When symptoms do occur, they may include:

• Jaundice (yellowing of the skin and eyes; also characterized by dark urine, light-colored or greasy stools, and itchy skin)
• Belly or back pain
• Weight loss and poor appetite
• Nausea and vomiting
• Gallbladder or liver enlargement
• Blood clots
• Diabetes

Keep in mind that these symptoms aren’t always due to pancreatic cancer and may be the result of other conditions. Still, it’s a good idea to report them to your doctor and get checked out. 

Here are some other challenges to finding pancreatic cancer early:

• It’s difficult to see or feel pancreatic tumors because the pancreas is so deep in the body.
• Other organs may block the tumors or make them hard to see on imaging tests.
• There isn’t a recommended screening method for most people.

Preventive screenings for pancreatic cancer are available but usually geared toward patients who are considered high risk because of inherited genetic syndromes or a family history of pancreatic cancer. About 10 percent of pancreatic cancer cases are familial, meaning there are multiple family members with pancreatic cancer, according to the American Society of Clinical Oncology (ASCO).

If you have a family history of cancer types other than pancreatic as well as any genetic mutations linked to pancreatic cancer, you may wish to speak with a genetic counselor and your doctor about screenings. 

Learn more about pancreatic cancer symptoms

Treatment options for pancreatic cancer depend on its stage and factors such as age and other health conditions. They include:

• Surgery
• Chemotherapy
• Radiation therapy
• Chemoradiation therapy
• Targeted therapy

In addition to existing treatments, clinical trials may offer newer forms of therapy. Provided you meet certain guidelines, one of these trials may be an option during your cancer care. 

ASCO recommends genetic testing for patients who’ve been diagnosed with pancreatic cancer, as it may determine the right course of treatment. Close family members may also want to undergo this testing to learn more about their risk for pancreatic cancer. 

Learn more about treatment options for pancreatic cancer