Diagnosis of pancreatic cancer
Pancreatic cancer can be difficult to diagnose and is often discovered at a late stage. Anyone experiencing symptoms that may indicate pancreatic cancer should contact their GP. If necessary, the GP will refer them to a gastroenterologist. A physical examination and additional imaging may then be used to establish a diagnosis.
Ultrasound
An ultrasound scan is often the first test when pancreatic cancer is suspected. It uses sound waves to produce images of the pancreas and bile ducts and may reveal a tumour. The procedure is straightforward and painless.
During an endoscopic ultrasound, a thin flexible tube fitted with a small ultrasound probe is passed through the mouth into the stomach. This gives the specialist a detailed view of the pancreas and allows tissue samples to be taken if necessary.
CT scan and MRI scan
A CT scan, and sometimes an MRI scan, is normally used to assess suspected pancreatic cancer. These images show how far a tumour has grown and whether it has spread. CT uses X-rays, while MRI uses a strong magnetic field. Both scanners create a series of detailed cross-sectional images of the body.
PET scan
A PET scan provides insight into, for example, metastases. It is usually combined with a CT or MRI scan. Cancer cells use more sugar than normal cells; the PET scan tracks them using a small amount of radioactive sugar injected into the blood.
ERCP
ERCP uses a flexible endoscope fitted with a light and camera to examine the bile ducts and pancreatic duct. The specialist can also treat certain problems during the procedure, for example by removing a gallstone or inserting a stent to open a narrowing.
MRCP
Doctors now often use MRCP instead of ERCP for diagnostic imaging. This specialised MRI scan shows the bile ducts and pancreatic duct without an invasive procedure. It cannot be used to treat a blockage, however; that still requires ERCP or surgery.
Laboratory tests
Pancreatic cancer is often associated with jaundice, and diabetes is also common. Both may be detected through blood tests. General laboratory tests are often performed to assess organ function and blood clotting.
Laparoscopy
A laparoscopy, or keyhole examination, is sometimes performed under general anaesthetic. A camera is inserted through small incisions in the abdomen so the specialist can look for signs that the cancer has spread and take tissue samples. The pancreatic tumour itself can be difficult to see because the organ lies deep within the abdomen.