Pancreatic cancer diagnosis and early detection

Pancreatic cancer usually goes undetected until it's advanced. By the time symptoms occur, diagnosing pancreatic cancer may be relatively straightforward. Unfortunately, a cure is rarely possible at that point.

The goal, of course, is detection and diagnosis at the earliest time possible. How is pancreatic cancer diagnosed, and is early detection of pancreatic cancer possible?

(This section focuses on pancreatic adenocarcinoma, which is the most common type of pancreatic cancer. Other rare forms of pancreatic cancer are mentioned at the end.)

Diagnosing pancreatic cancer usually happens when someone comes to the doctor after experiencing weeks or months of symptoms. Pancreatic cancer symptoms frequently include abdominal pain, weight loss, or jaundice (yellow skin). To find the cause of these symptoms, the doctor would normally perform a series of investigations such as:

• Taking a medical history, a doctor learns the story of the illness, such as the time of onset, nature and location of pain, smoking history, and other medical problems.
• A physical examination, where the doctor might feel a mass in the abdomen, notice jaundiced skin, or weight loss.
• Laboratory tests which could show evidence that bile flow is being blocked, or other abnormalities.

 Based on a person's examination, laboratory tests, and description of symptoms, a doctor often orders an imaging test: 

• Computed tomography (CT scan): A scanner takes multiple X-ray pictures, and a computer reconstructs them into detailed images of the inside of the abdomen. A CT scan helps doctors make a pancreatic cancer diagnosis.
• Magnetic resonance imaging (MRI): Using magnetic waves, a scanner creates detailed images of the abdomen, in particular the area around the pancreas, liver, and gallbladder.
• Ultrasound: Harmless sound waves reflected off organs in the abdomen create images, potentially helping doctors make a pancreatic cancer diagnosis.
• Positron emission tomography (PET scan): Radioactive glucose injected into the veins is absorbed by cancer cells. PET scans may help determine the degree of pancreatic cancer spread. This is not commonly used in the UK for diagnosis, though it helps when investigating whether chemotherapy is effective

If imaging studies detect a mass in the pancreas, a pancreatic cancer diagnosis is likely, but not definite. Only a biopsy -- taking actual tissue from the mass -- can diagnose pancreatic cancer. Biopsies can be performed in several ways:

• Percutaneous needle biopsy: Under imaging guidance, a radiologist inserts a needle into the mass, capturing some tissue. This procedure is also called a fine needle aspiration (FNA).
• Endoscopic retrograde cholangiopancreatography (ERCP): A flexible tube with a camera and other tools on its end (endoscope) is advanced from the mouth to the small intestine, near the pancreas. ERCP can collect images from the area, as well as take a small biopsy with a brush.
• Endoscopic ultrasound: Similar to ERCP, an endoscope is advanced near the pancreas. An ultrasound probe on the endoscope locates the mass, and a needle on the endoscope plucks some tissue from the mass.
• Laparoscopy is a surgical procedure that uses several small incisions. Using laparoscopy, a surgeon can collect tissue for biopsy, as well as see inside the abdomen to determine if pancreatic cancer has spread. However, laparoscopy has higher risks than other biopsy approaches.

If pancreatic cancer seems very likely, and it appears the tumour can be removed in an operation, doctors may recommend surgery without a biopsy first.