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The process of diagnosis includes the following:
Your doctor will ask you to describe your symptoms in detail. You’ll be asked about your smoking and alcohol habits (past and present), history of exposure to chemicals, personal medical history, and family medical history.
Your doctor will perform a complete physical examination, paying particular attention to the abdominal exam. Your doctor will feel for a mass in your abdomen, and ask if you have any pain or tenderness during the course of the exam.
The following tests may be done:
A number of blood tests may be performed, although they cannot be used to definitively diagnose pancreatic cancer. The tests may show some of the changes that occur during pancreatic cancer, such as elevated levels of the enzymes amylase and lipase, increased bilirubin, elevated glucose, and changes in liver function tests. These changes can occur in other conditions, as well.
Specific blood tests for pancreatic cancer include tumor marker cancer antigens, CA 19-9, CA 72-4, and also human chorionic gonadotropin (hCG). These tests are useful in predicting prognosis and identifying relapse after surgical resection.
Imaging studies are very important for diagnosing pancreatic cancer. A number of different types of imaging may be performed, such as:
During laparoscopy , tiny incisions are made in the abdomen, and a small fiberoptic tube with a lighted tip (a laparoscope) is inserted. The scope can be used to look at the pancreas, the surrounding tissues, the liver, and the wall of the abdomen for the presence of tumor. Miniature surgical tools can also be inserted into the abdomen to remove tissue samples (biopsies). The tissue samples will be checked for cancer cells. Laparoscopy is useful for both diagnosing pancreatic cancer and determining whether the cancer has spread outside of the pancreas. This can be done as an outpatient procedure.
Biopsy involves the removal of a small sample of pancreatic tissue and examination under a microscope to check for the presence and type of cancer cells. This is an important part of diagnosing pancreatic cancer.
The tissue sample may be obtained during the course of an ERCP exam, during laparoscopy, or through fine needle aspiration (FNA) . During fine needle aspiration, a tiny needle is inserted directly through the skin of the abdomen and into the pancreas in order to withdraw a sample of pancreatic tissue. Some researchers believe that FNA should not be performed unless the tumor is inoperable because the cancer cells may accidentally be spread along the track of the needle. If an abnormality is seen in another organ (such as the liver), a biopsy of that abnormality may be done instead.
Cytology is the study of cells. The cytology of cancer cells differs significantly from normal cells, and doctors use the unique cellular features seen on biopsy samples to determine the diagnosis and assess the prognosis of a cancer.
The first thing that cytology studies will do is determine what type of pancreatic cell the cancer involves. Exocrine cells are much more commonly involved in pancreatic cancer than endocrine cells. Cytology will also try to determine the degree of abnormality and aggressiveness of the cancer cells.
Staging is the process by which doctors determine the prognosis of a cancer that has already been diagnosed. Staging is essential for making treatment decisions (eg, surgery or chemotherapy). Several features of the cancer are used to arrive at a staging classification, the most common being the size of the original tumor, extent of local invasion, and spread to distant sites (metastasis). Low staging classifications (0-1) imply a favorable prognosis, whereas high staging classifications (4-5) imply an unfavorable prognosis.
Information to aid in staging pancreatic cancer can come from the results of imaging studies and laparoscopy. These studies help detail whether the pancreatic cancer is contained within the pancreas, or whether it has begun to invade blood vessels, lymph nodes, or other organs and tissues surrounding the pancreas. If your doctor is suspicious that the cancer has spread to distant areas of your body, then other tests may be done to study those organs.
Once all the information has been collected, your doctor will put it all together to determine the stage of your cancer. A common system used for staging is called the TNM system. This system characterizes three aspects of pancreatic cancer: information about the tumor (T), the lymph nodes (N), and the presence of distant metastasis (M). As with grading, the higher numbers reflect a greater degree of abnormality and spread.
The T stages are as follows:
The N stages are as follows:
The M stages are as follows:
Once the T, N, and M categories have been determined, the information is grouped together to determine your stage. The groupings are as follows:
T, N, and M Classifications
T1, N0, M0
T2, N0, M0
T3, N0, M0
T1, T2, or T3; N1; M0
T4; N0 or N1; MO
T1, T2, T3, or T4; N0 or N1; M1
Another method of staging addresses whether the original pancreatic tumor can be surgically removed or not. Most doctors believe that tumors that have invaded major blood vessels (T4 or Stage III) cannot be removed. Therefore, this method of staging utilizes information about blood vessel invasion. This system has three designations:
Prognosis is a forecast of the probable course and/or outcome of a disease or condition. Prognosis is most often expressed as the percentage of patients who are expected to survive over five or ten years. Cancer prognosis is an inexact process. This is because the predictions are based on the experience of large groups of patients suffering from cancers at various stages. Using this information to predict the future of an individual patient is always imperfect and often flawed, but it is the only method available.
Unfortunately, pancreatic cancer is often relatively advanced at the time that it is diagnosed. As a result, the number of patients who survive for five years or more after diagnosis is very small, perhaps as low as 5%. About 21% of all patients diagnosed with pancreatic cancer survive for a year after diagnosis. Also, being overweight or obese can further reduce your chance of survival.
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What you need to know about cancer of the pancreas. National Cancer Institute website. Available at: http://www.cancer.gov/cancerinfo/wyntk/pancreas#2 . Accessed April 8, 2009.
7/21/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Li D, Morris JS, Liu J, et al. Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. JAMA. 2009;301:2553-2562.
Last reviewed September 2014 by Mohei Abouzied, MD, FACP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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