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Tests for Pancreatic Cancer

If your doctor suspects pancreatic cancer, you may have one or more of the following tests to diagnose the cancer:

Transabdominal ultrasonography is the most sensitive test for detecting gallstones, an ever-present issue in the elderly patient who is jaundiced. Ultrasonography can demonstrate dilated intrahepatic and extrahepatic bile ducts, liver metastases, pancreatic masses, ascites, and enlarged peripancreatic lymph nodes. Pancreatic cancer typically appears as a hypoechoic mass on ultrasonography. Ultrasonography will reveal a pancreatic mass in 60 to 70 percent of patients with cancer. Because helical CT is just as sensitive as ultrasonography and provides more complete information about surrounding structures and the local and distant extent of the disease, ultrasonography has been largely replaced by CT.

Computerized tomography (CT) scan – a CT scan uses an X-ray that is linked to a computer to take a series of detailed pictures that will help your doctor see your internal organs. The CT machine has a large hole, and you will lie on a bed that passes through this hole. As you move through the hole, the CT takes several X-rays. In some cases, you may receive an injection of dye into a vein in your arm to help highlight the areas your doctor wants to see. The most sensitive way to diagnosis a pancreatic cancer by CT is to ensure that a High-Quality Three-Phase CT with Pancreatic Protocol is performed. Other types of CT are not as sensitive and may miss a mass, lesion, tumor or cancer. Helical or spiral CT is the preferred noninvasive imaging test for the diagnosis of pancreatic cancer. Pancreatic cancer usually appears as an area of pancreatic enlargement with a localized hypodense lesion. In addition to determining the primary tumor size, CT is used to evaluate invasion into local structures or metastatic disease.

Magnetic resonance imaging (MRI) – MRI uses a strong magnetic field and radio waves to create images of your pancreas. In general, MRI offers no significant advantages over CT because of a low signal-to-noise ratio, motion artifacts, lack of bowel opacification, and low spatial resolution. More recently, however, the introduction of magnetic resonance cholangiopancreatography (MRCP) has offered a promising noninvasive technique that can visualize both the bile duct and the pancreatic duct; images are similar to those obtained with ERCP.

Endoscopic retrograde cholangiopancreatography (ERCP) -- ERCP uses a dye to highlight the bile ducts in your pancreas. During ERCP, your doctor gently passes an endoscope, which is a thin, flexible tube, down your throat through your stomach and into the upper part of your small intestine. Air is used to inflate your intestinal tract so your doctor can more easily see the openings of your pancreatic and bile ducts. Your doctor then injects a dye into the ducts through a catheter that is passed through the endoscope. Finally, X-rays are taken of the ducts. The X-rays can show whether the ducts are narrowed or blocked by a tumor or anything else. The sensitivity of ERCP for the diagnosis of pancreatic cancer approaches 90%. The finding of a long, irregular stricture in an otherwise normal pancreatic duct is highly suggestive of a pancreatic cancer. Often, the pancreatic duct will be obstructed with no distal filling. Although ERCP is reliable in confirming the presence of a clinically suspected pancreatic cancer, it should not be used routinely. Diagnostic ERCP should be reserved for patients with presumed pancreatic cancer and obstructive jaundice in whom no mass is demonstrated on CT, symptomatic but nonjaundiced patients without an obvious pancreatic mass, and patients with chronic pancreatitis in whom the development of a pancreatic mass is suspected based on clinical evidence or the development of jaundice.

Percutaneous transhepatic cholangiography (PTC) -- Your doctor inserts a thin needle into your liver and injects the dye into your liver to highlight your bile ducts. A fluoroscope, which is a special X-ray machine, tracks the dye as it moves through the ducts. Unless there is a blockage, the dye should move freely through the bile ducts.

Biopsy – During a biopsy, your doctor removes a small sample of tissue from the pancreas to examine under a microscope to look for cancer cells. Your doctor can obtain a sample by inserting a needle through your skin into your pancreas. This is called fine-needle aspiration. Your doctor also can get a sample using endoscopic ultrasound to guide special tools into your pancreas where a sample of cells can be obtained for testing. However, you do not have to have a biopsy to prove pancreatic cancer. Any patient over the age of 45 who presents jaundice, with a mass in the head of the pancreas has a pancreatic cancer in greater than 95% of the time. Delaying treatment options to obtain a biopsy is not warranted.

Staging Pancreatic Cancer