Pancreatic cancer

Blood tests can check your general health. A special blood test called CA 19-9 might also be taken. CA 19-9 is a substance made by the pancreas and is called a biomarker. If it is raised, it can help to diagnose pancreatic cancer. Even with pancreatic cancer, however, you can have a normal level of CA 19-9. 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 can take ultrasound pictures from inside your body to help find small cancers. A biopsy needle can also be passed through the scope so that a sample of a tumour can be taken.

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. To do the test, the doctor needs to make a small cut in your abdomen so he can put in a scope which he can look through and use to take a biopsy. By looking through the scope the doctor can see your pancreas and nearby organs and can decide what surgery might be suitable. This test is done under anaesthetic. 

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.

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 due to a tumour. It takes about 20 minutes.

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.

Similar to an ERCP, this test gives X-ray images of the pancreas/bile ducts and surrounding area.

This means the cancer is at a very 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 bowel (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.

The cancer has spread to nearby organs and vessels. This includes the stomach, spleen, large bowel or large blood vessels. The cancer is also found in lymph nodes. 

The cancer has spread to the liver and/or the lungs. Your doctor may refer to stage 4 as advanced cancer or metastatic cancer.

Looks like it is removeable with a clear margin (no cancer cells left). Usually treated with surgery.

Looks like it is removeable but with a high chance of some microscopic tumour left behind. Usually treated with chemotherapy and radiotherapy first, followed by surgery.

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

• locally advanced unresectable (tumour involves essential blood vessels near the pancreas) 
• metastatic unresectable (distant secondary tumours are present).