Pancreatic cancer

Blood tests can check your general health. They can also check the level of substances called tumour markers or biomarkers. For example, CA19-9 and CEA. Sometimes people with pancreatic cancer have higher-than-normal levels of these biomarkers in their blood, but this isn't always the case.

If certain biomarker levels are raised, it can help to diagnose pancreatic cancer. Checking biomarker levels may also help doctors to see how well you are responding to treatment.

This is a special type of X-ray that gives a detailed 3D picture of the tissues inside your body. It is the most important test in the diagnosis of pancreatic cancer. It is also important when planning surgery. 

Read more about CT scans.

This gives X-ray images of your bile ducts and the surrounding area. 

Your doctor numbs an area of your abdomen (tummy) with local anaesthetic first. They then put a thin needle through your tummy and into your liver. A dye is injected into the area so that your doctor can see any blockages on the X-ray. 

Your doctor may also take a sample of cells (biopsy) during the PTC.

This stands for magnetic resonance cholangiopancreatography. It is a type of MRI scan that shows up the pancreatic duct, bile ducts and gallbladder in more detail. It is often helpful in planning treatment of jaundice that is due to a tumour. It takes about 20 minutes. 

An EUS is often used in the diagnosis of pancreatic cancer. It involves an endoscope, which is a thin tube that the doctor passes down your throat. It has an ultrasound tip, which can take pictures of the inside your body. This gives detailed, close-up pictures of your pancreas.

A biopsy needle can also be passed through the scope so that a sample of a tumour can be taken. This can confirm the diagnosis of pancreatic cancer.

Read more about having an EUS.

This is sometimes used to diagnose or stage cancer of the pancreas. It allows your doctor to look inside your abdomen (tummy). 

This test is done under general anaesthetic, so you will be asleep for the procedure. While you are asleep, your doctor will make 1-3 small cuts in your abdomen to place a laparoscope inside. This is a thin, flexible tube with a camera on the tip. 

By looking through the laparoscope, your doctor can see some of your pancreas and nearby organs. 

During the laparoscopy, your doctor may take a tissue sample (biopsy) to confirm a diagnosis of pancreatic cancer.

The result of the laparoscopy will also help your doctor to decide what kind of surgery is possible. 

Read more about having a laparoscopy.

This means taking a sample of tissue from the body and looking at it under a microscope to find out if cancer cells are present. There are many ways to take a biopsy. For example, it may be done during an EUS or laparoscopy. Or the doctor may put a needle through the skin in your tummy area, guided by an ultrasound or CT scan. 

This test can confirm a diagnosis of pancreatic cancer.

This is a special type of X-ray that gives a detailed 3D picture of the tissues inside your body. It is the most important test in the diagnosis of pancreatic cancer. It is also important when planning surgery.

An MRI scan uses magnetic energy and radio waves to create a picture of the tissues inside your body. MRI scans are sometimes used to clarify any irregularity seen on a CT scan. During the scan you will lie inside a tunnel-like machine for around 40-60 minutes. Usually, you can go home after the scan.

A PET scan can show if the cancer has spread to other tissues and organs. A low dose of radiotracer (radioactive sugar) is injected into your arm. An hour or so later you will have a scan. The scan uses the radiotracer to highlight cancer cells in the body. PET scans are not routinely used in pancreas cancer but are sometimes useful in staging the disease.

Read more about PET scans.

ERCP stands for endoscopic retrograde cholangiopancreatography. Your doctor passes a thin, flexible tube with a camera and a light down your throat and through your stomach. Your doctor can see the inside of your stomach and duodenum and can inject dye into the bile duct. These can be seen on X-rays and will show up any signs of blockage which may be due to cancer. Your doctor may also be able to take samples of the cancer (biopsy), which can be examined in the lab.

Read more about having an ERCP.

This means the cancer is at an early stage. The tumour is approximately 2cm in size or less and found within the pancreas. There is no sign that it is in the lymph nodes or that it has spread outside the pancreas.

The tumour is more than 2cm in size. It is now found outside the pancreas in nearby tissues like the bile duct and/or the small intestine (duodenum). There is no sign of cancer in the nearby lymph nodes.

The cancer has spread outside the pancreas to nearby tissues. It is also in the lymph nodes and may have spread to other body organs through the lymphatic system or bloodstream.

This is known as advanced or metastatic cancer. This stage can be divided into 4a and 4b:

• 4a: The cancer has spread to nearby organs and blood vessels. This includes the stomach, spleen, large intestine or large blood vessels. The cancer is also found in lymph nodes.
• 4b: The cancer has spread to the liver or the lungs, or both.

Looks like it is removeable with a clear margin (no cancer cells left). May be treated with surgery first or chemotherapy/radiotherapy first (before surgery).

Looks like it is removeable but there is a high chance that a microscopic amount of tumour will be left behind. Usually treated with chemotherapy and/or radiotherapy first, followed by surgery.

Looks like it is not removeable with surgery. This is divided into 2 groups: 

• Locally advanced unresectable: The tumour involves essential blood vessels near the pancreas. Usually treated with chemotherapy and radiotherapy. Some people may go on to have surgery if their tumour responds to this treatment. 
• Metastatic unresectable: Distant secondary tumours are present. Usually treated with chemotherapy.