By Dr Ananya Mandal, MD
Pancreatic cancer is not usually diagnosed early on in the disease course due to a lack of symptoms in the initial stages.
By the time the cancer becomes symptomatic, it is usually in the more advanced stages when treatment is less likely to be successful.
A general outline of the steps taken in the diagnosis of pancreatic cancer is given below:
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A detailed history of the patient’s symptoms and lifestyle habits as well as any family history of the condition is obtained.
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A physical examination of the abdomen and blood tests to check general health are performed.
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Blood and urine tests are carried out to check for raised bilirubin, an indicator of jaundice. The blood is also checked for pancreatic cancer markers CEA and CA199. However, these markers can be raised as a result of other conditions and are also not always raised in cases of pancreatic cancer. Therefore, these results are considered in combination with other clinical findings.
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An ultrasound scan is performed to generate images of the pancreas and liver. This is a non-invasive, painless test that uses high-frequency sound waves to check for evidence of cysts and other abnormalities. However, tissue level abnormalities may be missed during an ultrasound scan and test results are not definitive for a diagnosis of pancreatic cancer.
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A computed tomography (CT) scan and magnetic resonance imaging (MRI) scan are examples of further imaging studies that may be performed to evaluate the pancreas. These tests can be used to help identify abnormalities as well as to determine the tumor’s size and the degree of spread.
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Another form of ultrasound scan called endoluminal ultrasonography (EUS) is used to look at the pancreas from inside the body. If a lesion is identified on CT scan or MRI scan, it may be followed up with an EUS to take a more detailed look. A thin, flexible tube called an endoscope is passed down the throat and an ultrasound probe that lies at the tip of the endoscope is used to generate accurate images of the pancreas. EUS can also be used to take a tissue biopsy that can be sent for analysis to check for the presence of cancer cells.
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Endoscopic retrograde cholangiopancreatography (ERCP) is another endoscopic procedure used to check for abnormalities of the pancreas. In this procedure, a small amount of dye is injected into the pancreas and bile ducts and an endoscope used to help take an X-ray. A biopsy may be taken at the same time.
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A laparoscopy is a surgical procedure where small cuts are made in the abdomen and a long, thin instrument called a laparoscope is passed through the incisions so that an internal examination can be performed. This procedure helps the doctor to identify any suspicious areas and take a biopsy to send for analysis.
Reviewed by Sally Robertson, BSc
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