Unfortunately, there is still no screening test, such as a blood test, that can reliably detect pancreatic cancer — much less small lesions, precancers, or early-stage tumors. What’s more, noticeable pancreatic cancer symptoms that might raise a red flag, such as jaundice, rarely develop until the cancer has spread. When symptoms finally appear, they often mimic those of other, much more common illnesses, potentially delaying diagnosis even further. If you’re not feeling well and not improving, talk to your doctor about the persistent symptoms you are experiencing. Your doctor, often in consultation with appropriate specialists, such as a gastroenterologist, can order tests that will provide more information about what’s causing your problems.
A Medical History and Physical Exam May Offer the First Clues
A medical evaluation will typically begin with the doctor getting your medical history — including the pattern and severity of the symptoms you may be experiencing — and conducting a physical exam. Because the pancreas is hidden behind the stomach and other organs, the doctor will most likely be unable to feel a pancreatic tumor unless it has already advanced to the later stages of the disease and grown large. But the doctor may be able to detect any swelling of the liver or gallbladder by feeling your abdomen. These can be pancreatic cancer signs. Jaundice — yellowing of the skin and the whites of the eyes — may be another indication of trouble.
Imaging Tests: A Look Inside the Body
Imaging tests can help doctors look for pancreatic cancer and determine how far the disease has spread. There are a number of different imaging tests that doctors can utilize if they suspect pancreatic cancer. A few of the key ones:
Computed Tomography (CT) These scans create cross-sectional images of the body that show the pancreas in detail. There are also specialized CT scans aimed at diagnosing pancreatic disease.Magnetic Resonance Imaging (MRI) MRIs employ radio waves and strong magnets to visualize soft tissue in the body. Doctors can use specialized MRI scans to get a good look at the pancreas.Ultrasound This test produces images by creating sound waves and detecting echoes within the body. Endoscopic ultrasound (EUS) involves a small probe placed at the end of an endoscope (a thin, flexible tube) that is threaded through your mouth, esophagus, and stomach into the small intestine, close to the pancreas.Endoscopic Retrograde Cholangiopancreatography (ERCP) Using an endoscope, doctors thread a tiny video camera into the small intestine to help place a catheter (a small tube) into the common bile duct. By injecting a small amount of contrasting dye through the catheter, the physician can take X-rays of the bile and pancreatic ducts that may indicate any narrowing or blockages potentially caused by cancer.
RELATED: All About the Pancreas: Anatomy, Function, and Its Connection to Diabetes
Blood Tests to Collect More Evidence
No current blood test can reveal pancreatic cancer in the way that PSA (prostate-specific antigen) levels in the blood point to prostate cancer. But blood tests can deliver other types of information that are useful in a pancreatic cancer diagnosis:
Liver Function Test This test can gauge your level of bilirubin, a chemical produced by the liver that may build up if pancreatic cancer is present.Tumor Markers Substances in the blood called CA 19-9 or CEA (carcinoembryonic antigen) suggest pancreatic cancer. These so-called tumor markers are not completely reliable, though, because they can sometimes spike if you don’t have pancreatic cancer. Because of this, they are typically only checked if you are found to have a tumor on imaging.Hormones Unusual levels of insulin or other pancreatic hormones in the blood may indicate the presence of an uncommon type of pancreatic cancer called pancreatic neuroendocrine tumors (PNETs).
Biopsy: The Most Accurate Method
The most accurate way to diagnose pancreatic cancer is through biopsy: removing a piece of tissue from the suspected problem area and analyzing the sample under a microscope. Doctors can collect this tissue through various biopsy methods:
Inserting a thin, hollow needle through the skin into the pancreas.Using an endoscope threaded down the throat, through the stomach, and into the small intestine near the pancreas.Surgically removing pancreatic cells. (1)
RELATED: What Is a Pancreatic Cyst?
Specialized Testing for People at High Risk
Some people are at increased risk of developing pancreatic cancer because of family history, such as two or more first-degree relatives who have had the disease or a first-degree relative who developed the disease before age 50. Other men and women may be at high risk because of an inherited genetic syndrome associated with pancreatic cancer. These people may have access to surveillance programs that involve regular monitoring through imaging tests such as EUS, CT scans, or ERCP. They may also take part in experimental imaging procedures, receive advanced genetic testing, and permit researchers to collect biological fluids, such as blood and pancreatic juice, for analysis. Not only do participants get the benefit of cutting-edge detection methods, but they are also helping researchers develop new options for early diagnosis that can improve mortality rates overall. (2)
The Future of Pancreatic Cancer Diagnosis
Developing new tools and methods that can diagnose pancreatic cancer early is key to helping patients survive. Scientists are actively studying the genetics of pancreatic cancer in order to identify biomarkers (measurable substances in bodily fluids like blood) of early-stage pancreatic cancer. Some of this research has been encouraging. For instance, one early-phase study, led by teams at the University of Pennsylvania Abramson Cancer Center and the Mayo Clinic, homed in on two specific proteins: THBS2 and CA19-9. A screening test that measures levels of these proteins in the blood may help physicians diagnose early-stage cancer in people at high risk. More testing and clinical trials are in the works. (3) Scientists are also developing new imaging methods that show potential. One method under investigation enables doctors to look for minute changes in the cells of the duodenum (part of the small intestine next to the pancreas) that may be early evidence of pancreatic cancer. (2)
