Booklet: What You Need to Know about Pancreatic Cancer

Diagnosis and Staging

To find the cause of a person's symptoms, the doctor performs a physical exam and asks about the person's medical history. In addition to checking general signs of health, the doctor may perform blood, urine, and stool tests.

The doctor usually orders procedures that produce pictures of the pancreas and the area around it. Pictures can help the doctor diagnose cancer of the pancreas. They also can help the doctor determine the stage, or extent, of the disease by showing whether the cancer affects nearby organs. Pictures that show the location and extent of the cancer help the doctor decide how to treat it. Procedures to produce pictures of the pancreas and nearby organs may include:

• An upper GI series, sometimes called a barium swallow. A series of x-rays of the upper digestive system is taken after the patient drinks a barium solution. The barium shows an outline of the digestive organs on the x-rays.
• CT scanning, the use of an x-ray machine linked with a computer. The x-ray machine is shaped like a doughnut with a large hole. The patient lies on a bed that passes through the hole, and the machine moves along the patient's body, taking many x-rays. The computer puts the x-rays together to produce detailed pictures.
• MRI, the use of a powerful magnet linked to a computer. The MRI machine is very large, with space for the patient to lie in a tunnel inside the magnet. The machine measures the body's response to the magnetic field, and the computer uses this information to make detailed pictures of areas inside the body.
• Ultrasonography, the use of high-frequency sound waves that cannot be heard by humans. An instrument sends sound waves into the patient's abdomen. The echoes that the sound waves produce as they bounce off internal organs create a picture called a sonogram. Healthy tissues and tumors produce different echoes.
• ERCP, a method for taking x-rays of the common bile duct and pancreatic ducts. The doctor passes a long, flexible tube (endoscope) down the throat, through the stomach, and into the small intestine. The doctor then injects dye into the ducts and takes x-rays.
• PTC, in which a thin needle is put into the liver through the skin on the right side of the abdomen. Dye is injected into the bile ducts in the liver so that blockages in the ducts can be seen on x-rays.
• Angiography, x-rays of blood vessels taken after the injection of dye that makes the blood vessels show up on the x-rays.

The doctor can explain what is involved in each of these exams and what will be done to keep the patient comfortable.

Pictures of the pancreas and nearby organs provide important clues as to whether a person has cancer. However, doing a biopsy is the only sure way for the doctor to learn whether pancreatic cancer is present. In a biopsy, the doctor removes a tissue sample. A pathologist looks at the tissue under a microscope to check for cancer cells.

There are several ways to do a biopsy to diagnose pancreatic cancer, and some people may need to have more than one type of biopsy. One way to remove tissue is called a needle biopsy. The doctor inserts a long needle through the skin of the abdomen into the pancreas. Ultrasonography or x-rays guide the placement of the needle. Another type of biopsy is a brush biopsy. This is done at the same time as ERCP. The doctor inserts a very small brush through the endoscope into the opening from the bile duct and main pancreatic duct to rub off cells to examine under a microscope.

Sometimes, the biopsy to diagnose pancreatic cancer is done during surgery. In one type of surgery, called laparoscopy, the doctor inserts a lighted instrument shaped like a thin tube into the abdomen through a small incision. In addition to removing tissue samples to be examined under the microscope, the doctor can see inside the abdomen to determine the location and extent of the disease. During the laparoscopy, the doctor can decide whether a larger operation called a laparotomy is needed to remove the tumor or to relieve symptoms caused by the cancer.

In some cases, a laparotomy is necessary to make a diagnosis. In this operation, the doctor makes a larger incision and directly examines the organs in the abdomen. If cancer is found, the doctor can go ahead with further surgery. (The types of surgery done to treat pancreatic cancer are described in the Treatment Methods section.)

A person who needs a biopsy may want to ask the doctor some of the following questions:

• What type of biopsy do I need? Why?
• How long will it take? Will I be awake? Will it hurt?
• How soon will I know the results?
• If I do have cancer, who will talk with me about treatment? When?

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