Pancreatic Cancer Overview

+ -Text Size

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 can’t see or feel tumors during a routine physical exam. By the time a person has symptoms, the cancer has usually spread to other organs.

Screening tests are used to look for cancer in people who have no symptoms. But there are no blood tests or other tests that can easily find pancreatic cancer early in people without symptoms. Blood 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, so these are not useful as screening tests.

Tests for certain gene defects can be done in people with a strong family history of the disease (or a family history of certain other cancers). Genetic tests can sometimes help find people who have a higher risk for this cancer. The American Cancer Society strongly recommends that anyone 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’s important to understand what the tests can and can’t tell you and what any results would mean, and to carefully weigh the benefits and risks of testing before these tests are done. To learn more, see our document Genetic Testing: What You Need to Know.

For people in families at high risk of pancreatic cancer, newer tests for detecting early pancreatic cancer may help. For example, doctors are looking at whether a test called endoscopic ultrasound might be useful to check people with a high risk.

Signs and symptoms of pancreatic cancer

Having one or more of the signs and symptoms below does not mean you have pancreatic cancer. In fact, many of these symptoms are more likely to be caused by something else. Still, if you have any of these, it’s important to have them checked by a doctor so that the cause can be found and treated, if needed.

Early pancreatic cancers often don’t cause any signs or symptoms. By the time they do cause symptoms, they have often already grown through the pancreas or spread beyond it.

Jaundice and related symptoms: 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. Most people with pancreatic cancer (and just about all people with ampullary cancer) have jaundice. The same problem that causes the skin to turn yellow can also cause other symptoms, such as dark-colored urine and itchy skin.

While jaundice can be a sign of cancer, more often it is caused by something else.

Belly or back pain: Pain in the belly area (abdomen) or in 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 tests (described below).

Blood clots: Sometimes blood clots form in a vein of the leg, leading to pain, swelling, and warmth in the leg. These clots can sometimes travel to the lungs and cause breathing problems and chest pain. 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. Symptoms can include feeling thirsty and hungry, and having to urinate often.

Tests to find pancreatic cancer

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

History and physical exam

First the doctor will ask about your symptoms, overall health, and family history. The doctor will then do a physical exam, focusing mostly on the belly (abdomen). Sometimes this type of cancer causes the gallbladder or liver to swell, so the doctor will check these. The skin and the white part of the eyes will be checked for yellow color (jaundice).

If the results of the exam aren’t normal, your doctor will order tests to help find the problem. You might also be referred to a gastroenterologist (a doctor who treats digestive system diseases) for further tests and treatment.

Imaging tests

Imaging tests make pictures of the inside of the body. They can be done to look for cancer, to see how far cancer has spread, or to help show if cancer treatment is working.

CT scan (computed tomography)

This test uses x-rays to create detailed pictures of the inside of the body. CT scans are useful in finding pancreatic cancer and in seeing how far it has spread. This can help show if surgery might be 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 that slides 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 might 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 might 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). Some 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.

Special types of MRI scans can also be used in people who might have pancreatic cancer:

  • MR cholangiopancreatography (MRCP) can be used to look at the pancreatic and bile ducts (the small tubes within and just outside the pancreas).
  • MR angiography (MRA) can help show if the cancer has grown into nearby blood vessels.

Ultrasound

These tests use sound waves to make pictures of the inside of the body.

Abdominal ultrasound: For an ultrasound of the belly, a wand-shaped probe called a transducer is moved around over the skin. If it’s not clear what might be causing a person’s belly symptoms, an ultrasound might be the first test done because it is easy to do and it doesn’t expose a person to radiation. But if signs and symptoms are more likely to be caused by pancreatic cancer, a CT scan is often done instead.

Ultrasound is also used to look at the liver, so it is often done if someone has symptoms (like jaundice) that point to a liver problem.

Endoscopic ultrasound (EUS): This test 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.

Cholangiopancreatography

These tests are used to look at the pancreatic and bile ducts to see if they are blocked, narrowed, or dilated. These tests can help show if someone might have a pancreatic tumor that is blocking a duct. They can also be used to help plan surgery.

Endoscopic retrograde cholangiopancreatography (ERCP): 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. A small amount of contrast dye is then pushed through the tube into the ducts, which outlines them on x-rays. The doctor 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 also be used to place a small tube (stent) into the bile duct to keep it open if a nearby tumor is pressing on it.

Magnetic resonance cholangiopancreatography (MRCP): This test uses an MRI machine to look at the pancreatic and bile ducts. It is non-invasive, unlike ERCP, so doctors often use MRCP if the purpose of the test is just to look at the pancreatic and bile ducts. But this test can’t be used to get biopsy samples of tumors or to place stents in ducts.

Percutaneous transhepatic cholangiography (PTC): In this test, the doctor puts a thin, hollow needle through the skin of the belly and into a bile duct within the liver. A contrast dye is then injected through the needle, and x-rays are taken as it passes through the bile and pancreatic ducts. As with ERCP, this test can also be used to take fluid or tissue samples or to place a stent into a duct to help keep it open. Because it is more invasive (and might cause more pain), PTC is not usually used unless ERCP has already been tried or can’t be done for some reason.

PET scan (positron emission tomography)

For a PET scan, a radioactive sugar called FDG is put into a vein in your arm. Because cancer cells are very active, they take in large amounts of the sugar. A special camera is then used to show the areas of radioactivity in the body. 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.

Angiography

This is an x-ray test 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.

X-ray angiography can be uncomfortable because the doctor 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 is 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.

Angiography can also be done with a CT scanner (CT angiography) or an MRI scanner (MR angiography). These techniques are now used more often because they can show the blood vessels in or near the pancreas without the need for a catheter in the artery. You might still need an IV line so that a contrast dye can be injected into the blood during the test.

Blood tests

Certain blood tests can be used to help find pancreatic cancer or to help decide on treatment options.

Jaundice (yellowing of the skin and eyes) is often one of the first signs of pancreatic cancer, but it can have many causes other than cancer. Doctors often get blood tests to assess liver function in people with jaundice to help determine its cause.

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 person’s general health (such as 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

Other tests might strongly suggest a person has pancreatic cancer, but usually the only way to be sure is to remove a small sample of tumor and look at it under the microscope. This is called a biopsy. Biopsies can be done in different ways:

Percutaneous (through the skin) biopsy: The doctor inserts a thin, hollow needle through the skin and into the pancreas to remove a small piece of a tumor. This is known as a fine needle aspiration (FNA). The doctor guides the needle into place using images from ultrasound or CT scans.

Endoscopic biopsy: The doctor passes an endoscope (a thin, flexible, tube with a small video camera on the end) down the throat and into the small intestine near the pancreas. A small brush or hollow needle is then use to remove cells from the bile or pancreatic ducts. You will be sedated (made sleepy) for these tests, but general anesthesia (being put into a deep sleep) is not usually needed.

Surgical biopsy: The most common way to do a surgical biopsy is to use laparoscopy (sometimes called keyhole surgery). You will be sedated or asleep for this procedure. The surgeon makes small incisions (cuts) in the abdomen and inserts small telescope-like instruments. The surgeon can look at the pancreas and other organs for tumors and take biopsy samples of abnormal areas. Surgical biopsies are now done less often than in the past.

Some people might not need a biopsy

Rarely, the doctor might not do a biopsy on someone who has a tumor in the pancreas if imaging tests show the tumor is very likely to be cancer and if it looks like surgery can remove all of it. Instead, the doctor will go straight to surgery, at which time the tumor cells can be looked at to confirm the diagnosis. If during surgery the doctor finds that the cancer has spread too far to be removed completely, only a sample of the cancer will be removed to confirm the diagnosis, and the rest of the planned operation will be stopped.

See our document Testing Biopsy and Cytology Specimens for Cancer to learn more about different types of biopsies, how the samples are tested in the lab, and what the results will tell you.


Last Medical Review: 08/01/2014
Last Revised: 08/01/2014