Pancreatic Cancer

Diagnosis and Monitoring

Several tests are used to diagnose, classify and monitor pancreatic cancer. Doctors conduct physical examinations, perform blood and urine tests, and conduct diagnostic imaging to confirm cancer cases and help them recommend a treatment plan.

Pancreatic cancer often doesn’t come with symptoms, but those with high-risk factors might still catch the disease early through a routine en-doscopic ultrasound or by taking a CA 19-9 tumor marker test.

As the disease progresses, cancer cells separate from the initial tumor and migrate through the lymph system or blood to other parts of the body, a process called metastasis. The disease is still considered pancreatic cancer even if a tumor forms on another organ such as the brain or liver.

Confirming cancer

When doctors suspect you have cancer, they will typically perform a biopsy and examine the tissue in question under a microscope to look for abnormal cells. A pathologist will confirm these results and provide you and your doctor with a pathology report explaining the findings. Your doctor may recommend additional testing to further characterize and evaluate the disease through one or more of the following procedures:

  • Computerized tomography (CT) – A scanner creates three-dimensional X-ray images of organs, tissue and bones inside the body and displays cross-sectional pictures of them on a computer screen. Doctors may inject a special dye (called a contrast medium) into your veins and/or you may be asked to drink an oral contrast prior to the scan to help enhance the images and provide better detail. Patients must lie still on a table while the scan is being processed to obtain a clear image. A CT may also be called “computed tomography” or a “CAT scan.”
  • Magnetic resonance imaging (MRI) – MRI uses magnetic fields instead of X-rays to visualize internal structures of the body. For an MRI scan, you will lie on a table that moves through a large circular scanner. As with CT, you may have a contrast medium injected into your veins prior to the scan to enhance the images. Because the machine is loud and takes longer to process than a regular X-ray, let your doctors know if you are claustrophobic so they can take steps to make you more comfortable prior to the procedure. Two special types of MRI may be used:
    • MR cholangiopancreatography (MRCP) – This type is used to view the pancreatic and bile ducts.
    • MR angiography (MRA) – This type allows doctors to see if cancer cells have grown into blood vessels surrounding the pancreas.
  • Positron emission tomography (PET) – PET is a diagnostic procedure in which a radioactive chemical tracer is injected into a vein in your arm. The tracer travels through your bloodstream to all organs and tissues, collecting information on cells that use a lot of energy, including cancer cells. The tracer emits positively charged particles called positrons. A special camera then produces pictures of the positrons on a computer screen.
  • Ultrasound – Medical ultrasound uses sound waves to visualize internal organs and evaluate them for cancer and other conditions. When viewing the pancreas, one of two types of ultrasound devices may be used:
    • A transabdominal ultrasound involves a wand-shaped device placed on the outside of the abdomen.
    • An endoscopic ultrasound device involves a flexible tube that is inserted through the mouth to the stomach and the first section of the small intestine.
  • Percutaneous transhepatic cholangiography (PTC) – PTC is a procedure in which a needle is inserted into the liver to deliver a dye that helps the bile ducts show up on X-rays. This procedure allows doctors to see whether or not the bile ducts are blocked or narrowed.
  • Endoscopic retrograde cholangiopancreatography (ERCP) – This diagnostic procedure involves an endoscope (thin, flexible tube with a camera at one end) that’s inserted through the mouth and into the bile and pancreatic ducts. Dye is injected to help the ducts show up in X-rays, which allows the doctor to see whether a duct is narrowed or compressed. If it’s blocked, a plastic or metal stent can be placed inside to help hold open the affected duct.


How Cancer Cells Spread

Cancer cells can spread three different ways:

  1. The initial tumor can grow into nearby tissue.
  2. Cancer cells can invade the lymph nodes.
  3. Cancer cells can migrate into the blood where they can then travel to other organs.


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