Tests to evaluate pancreatic cancer include:
The doctor examines the skin and eyes for signs of jaundice. The doctor then feels the abdomen to check for changes in the area near the pancreas, liver and gallbladder. The doctor also checks for ascites, an abnormal buildup of fluid in the abdomen.
The doctor may take blood, urine and stool samples to check for bilirubin and other substances. Bilirubin is a substance that passes from the liver to the gallbladder to the intestine. If the common bile duct is blocked by a tumor, the bilirubin cannot pass through normally. Blackage may cause the level of bilirubin in the blood, stool or urine to become very high. High bilirubin levels can result from cancer or from noncancerous conditions.
An x-ray machine linked to a computer takes a series of detailed pictures. The x-ray machine is shaped like a donut with a large hole. The patient lies on a bed that passes through the hole. As the bed moves slowly through the hole, the machine takes many x-rays. The computer puts the x-rays together to create pictures of the pancreas and other organs and blood vessels in the abdomen. Sometimes, a contrast medium, or special dye, is injected into a vein to provide better detail. A CT scan helps doctors determine the location and extent of the cancer.
The ultrasound device uses sound waves that cannot be heard by humans. The sound waves produce a pattern of echoes as they bounce off internal organs. The echoes create a picture of the pancreas and other organs inside the abdomen. The echoes from tumors are different from echoes made by healthy tissues.
To make images of the pancreas, the doctor places the ultrasound device on the abdomen and slowly moves it around. This technique is commonly used to look at babies during development, but can also be used to look at many organs.
EUS (Endoscopic Ultrasound): The doctor passes a thin, lighted tube called an endoscope through the patient’s mouth and stomach, down into the first part of the small intestine. At the tip of the endoscope is an ultrasound device. The doctor slowly withdraws the endoscope from the intestine toward the stomach to make images of the pancreas and surrounding organs and tissues. This is usually done under sedation, so the patient sleeps through the procedure.
Positron Emission Tomography (PET) Scan
In a PET scan, sugar molecules tagged with a marker visible on the scanner are injected into the body. It is a scan that shows your body’s metabolic activity. Cancer cells absorb sugar more quickly than normal cells, so they light up on the PET scan. PET scans are often used to complement information gathered from CT scan, magnetic resonance imaging (MRI) and physical examination. Sometimes, CT and PET scans can be performed after each other and the images are fused together.
Endoscopic Retrograde Cholangiopancreatography (ERCP)
The doctor passes an endoscope through the patient’s mouth and stomach, down into the first part of the small intestine. The doctor then slips a smaller tube, or catheter, through the endoscope into the bile ducts and pancreatic ducts. After injecting dye through the catheter into the ducts, the doctor takes x-ray pictures. The x-rays can show whether the ducts are narrowed or blocked by a tumor or other condition. The patient is lightly sedated during this process.
Percutaneous Transhepatic Cholangiography (PTC)
A dye is injected through a thin needle inserted through the skin into the liver. Unless there is a blockage, the dye should move freely through the bile ducts. The dye makes the bile ducts show up on x-ray pictures. From the pictures, the doctor can tell whether there is a blockage from a tumor or other condition.
In some cases, the doctor may remove tissue. A pathologist then uses a microscope to look for cancer cells in the tissue. The doctor may obtain tissue in several ways. One way is by inserting a needle into the pancreas to remove cells. This is called fine-needle aspiration. The doctor uses x-ray or ultrasound to guide the needle. Sometimes the doctor obtains a sample of tissue during EUS or ERCP. Another way is to open the abdomen during an operation.