Pancreatic Cancer Overview

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Early Detection, Diagnosis, and Staging TOPICS

How is pancreatic cancer found?

It is hard to find pancreatic cancer early. Because the pancreas is deep inside the body, the doctor cannot see or feel tumors during a routine physical exam. By the time a person has symptoms, the cancer is usually large and has spread to other organs. This is the main reason that people with this cancer often have a poor outlook.

Right now there are no blood tests or other tests that can easily find this cancer early in people without symptoms. Doctors are looking at whether a test called endoscopic ultrasound might be useful to check people with a high risk of pancreatic cancer. Levels of tumor markers such as CA 19-9 and CEA may be higher than normal in people with pancreatic cancer, but the cancer is usually advanced by the time the levels become high.

Tests for certain gene defects can be done in people with a strong family history of the disease. These can help find people who have a higher risk for this cancer. The American Cancer Society strongly recommends that any person thinking about genetic testing talk with a genetic counselor, nurse, or doctor who can explain the about the test before they proceed with testing. It is important for people to understand and carefully weigh the benefits and risks of genetic testing before these tests are done. To learn more, see our document, Genetic Testing: What You Need to Know.

Signs and symptoms of pancreatic cancer

If one or more of the signs and symptoms described here is present, certain exams and tests may be done to find out whether they are caused by pancreatic cancer or by something else.

Jaundice: A yellowing of the eyes and skin is called jaundice. It is caused by a build-up of a substance (bilirubin) that is made in the liver. At least half of all people with pancreatic cancer (and all people with ampullary cancer) have jaundice. While jaundice can be a sign of cancer, more often it is caused by something else.

Pain: Pain in the belly area (abdomen) or in the middle of the back is a very common sign of advanced pancreatic cancer. Again, such pain is often caused by something else.

Weight loss: Losing weight (without trying) over a number of months is very common in patients with this cancer. They may also feel very tired and not feel like eating.

Digestive problems: If the cancer blocks the release of the pancreatic juice into the intestine, a person may not be able to digest fatty foods. Stools might be pale, bulky, greasy, and float in the toilet. Other problems may include nausea, vomiting, and pain that gets worse after eating.

Swollen gallbladder: The doctor may find that the gallbladder is enlarged. The doctor can sometimes feel this and see it on imaging studies.

Blood clots: Sometimes blood clots form in the veins of the legs, leading to swelling. These clots can sometimes travel to the lungs and cause breathing problems. But having a blood clot does not usually mean that you have cancer. Most blood clots are caused by other things.

Fatty tissue changes: Another clue that there may be pancreatic cancer is an uneven texture of the fatty tissue under the skin. This is caused by the release of the pancreatic enzymes that digest fat.

Diabetes: This cancer can cause problems with blood sugar. Sometimes (but not often) it can cause diabetes.

Tests to find pancreatic cancer

History and physical exam

First the doctor will ask questions about your health and do a physical exam. The exam will focus mostly on the belly (abdominal area). Sometimes this type of cancer spreads to the lymph nodes or to the liver so the doctor will check these for swelling. The skin and the white part of the eyes will be checked for yellow color (jaundice).

Certain other tests that make pictures of the inside of the body might also be done. These are called imaging tests.

Imaging tests

CT scan (computed tomography)

This is a special type of x-ray that creates detailed pictures of the inside of the body. CT scans are useful in finding cancer and in seeing how far it has spread. This is called staging the cancer.

CT scans show the pancreas clearly and often can confirm where the cancer is. CT scans can also show the organs near the pancreas, as well as lymph nodes and distant organs where the cancer might have spread. The CT scan can help the doctor to decide whether surgery is a good treatment option. CT scans can also be used to help guide a biopsy needle into the place that might be cancer (see below for more about biopsy).

A CT scanner has been described as a large donut, with a narrow table in the middle “hole.” You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken.

Before the test, you may be asked to drink 1 to 2 pints of a liquid called oral contrast. This helps outline your insides so that certain areas are not mistaken for tumors. You may also have an IV line through which a different kind of contrast dye (IV contrast) is put in. This helps better outline structures such as blood vessels in your body.

The dye can cause some flushing (redness and warm feeling). A few people are allergic to the dye and get hives or, rarely, have more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have any allergies or have ever had a reaction to any contrast material used for x-rays.

MRI (magnetic resonance imaging)

MRI scans use radio waves and strong magnets instead of x-rays to take pictures. Sometimes a contrast dye might be used, just as with CT scans. MRI scans are helpful in looking at the brain and spinal cord. MRI scans take longer than CT scans — often up to an hour. Also, you have to lie inside a narrow tube, which can upset some people. Special, “open” MRI machines can help with this if needed. The machine also makes loud thumping and clicking noises. Some places will give you headphones with music to block it out.

Most doctors prefer CT scans to look at the pancreas, but an MRI may sometimes give more information.

PET scan (positron emission tomography)

PET scans use a radioactive glucose (a type of sugar), which can be seen by a special camera. The radioactive material is put into a vein in your arm. Because cancer cells are very active, they take in large amounts of the sugar. A PET scan can be more helpful than many x-rays because it scans the whole body. This test is useful to see whether the cancer has spread to the lymph nodes or to other places.

PET/CT scan: This test combines the 2 types of scans to even better pinpoint the tumor. This test may be especially useful for spotting cancer that has spread beyond the pancreas and can’t be removed by surgery. It may also be useful for staging the cancer. It may even be able to spot early cancer.

Ultrasound

This test uses sound waves to make pictures of the inside of the body. The pictures are combined by a computer to give a detailed image. This test can help tell what kind of tumor is in the pancreas. For an ultrasound of the belly, a kind of wand (called a transducer) is moved around on the skin. But an endoscopic ultrasound is often the best way to look at pancreatic cancer. For this test, the wand (probe) is on the end of a long tube (called an endoscope) that is placed through the mouth or nose into the stomach. The probe can be pointed toward the pancreas. This gives a very good picture and is better than CT scans for spotting small tumors. Patients are given medicine to make them sleepy (sedated) for this type of ultrasound.

ERCP (endoscopic retrograde cholangiopancreatography)

For this test patients are given medicine to make them sleepy (sedated). Then a thin, flexible tube is passed down the throat, all the way into the small intestine. The doctor can see through the end of the tube and find where the common bile duct opens into the small intestine. A small amount of contrast dye is then pushed through the tube into the ducts. This dye outlines the ducts on x-rays. The pictures can show narrowed or blocked ducts that might be caused by a cancer of the pancreas. The doctor doing this test can also put a small brush through the tube to remove cells to look at under a microscope to see whether they look like cancer. ERCP can be used to place a small tube (stent) into the bile duct to keep it open if a nearby tumor is pressing on it.

Angiography

This is a type of x-ray that uses a dye to look at blood vessels. It can show whether blood flow in an area is blocked or slowed by a tumor. It can also show if there are any abnormal blood vessels. The results help the doctors decide whether the cancer can be removed and helps them plan the surgery.

Angiography can be uncomfortable because the radiologist who does it has to put a small tube (called a catheter) into the artery leading to the pancreas. Usually the catheter is put into an artery in the inner thigh and threaded up to the pancreas. Medicine called a local anesthetic is often used to numb the area before putting in the catheter. Then the dye is quickly put in to outline all the vessels while the x-rays are being taken.

Blood tests

Certain blood tests may be used to help find pancreatic cancer or to help decide on treatment options. High blood levels of the tumor markers CA 19-9 and CEA (carcinoembryonic antigen) may point to exocrine pancreatic cancer, but these tests aren’t always accurate.

Other blood tests can help tell about a patient’s general state of health (such as liver, kidney, and bone marrow function). These tests can also help the doctor decide if a patient will be able to go through the stress of a major operation.

Biopsy

During a biopsy a sample of tissue from the tumor is removed and looked at under a microscope to see if there are cancer cells. There are several types of biopsies that might be done. In the past, a biopsy was often done as part of surgery. Now, the FNA (fine needle aspiration) biopsy is most often used. For this test, the doctor puts a thin needle through the skin and into the pancreas to remove small pieces of tissue. This may be done while the doctor is looking at the tumor by CT or ultrasound. Another option is to use endoscopic ultrasound to guide the needle through the wall of the intestine into the tumor. This test can be done while you are awake. It rarely causes side effects.

Tumors can also be biopsied during ERCP using a small brush that is put through the tube.

Another way to get biopsy samples is by doing “keyhole surgery” (laparoscopy). For this you are given drugs to make you sleep. Then the surgeon makes small cuts and puts small, thin, telescope-like instruments into the belly. One of these instruments is connected to a video screen. The surgeon can look at your insides, see how big the tumor is, and see if it has spread. Biopsy samples can also be taken.

Most doctors who treat people with pancreatic cancer try to avoid surgery unless it looks like an operation might be able to remove all of the cancer. Even so, there are times when the doctor starts an operation only to find that the cancer has spread too far to be completely removed. In these cases, the doctor just takes a sample of the tumor and the rest of the operation is stopped.

See Testing Biopsy and Cytology Specimens for Cancer to learn more about different types of biopsies, how the tissue is tested in the lab, and what the results will tell you. You can find it on our Web site, or call us for a free copy.


Last Medical Review: 02/15/2013
Last Revised: 02/03/2014