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Diagnosis

How Is Pancreatic Cancer Diagnosed?

Pancreatic cancer can be difficult to diagnose early, as symptoms frequently do not develop until the later stages of the disease. Patients who are experiencing any of the symptoms of pancreatic cancer should see their physician, who will perform a series of diagnostic exams and tests. The results of these exams and tests will also help the patient and his or her physician decide the best treatment options.

Imaging Tests and Procedures

Several types of imaging tests and procedures are used to diagnose pancreatic cancer. The patient’s physician may request one or more of the following:

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Blood Tests

Blood tests may be performed for a variety of reasons. For example, if a patient has jaundice, a blood test may be done to check the patient’s liver function to see what may be causing it.

Blood tests may also be used to check for levels of the tumor markers CA 19-9 and CEA (carcinoembryonic antigen) in the blood. These tumor markers may be elevated in patients with pancreatic cancer.

Other blood tests check for organ function. These tests can help a physician determine whether a patient is able to undergo major surgery.

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Staging

Staging is used to determine the extent of the cancer. The most common system used to stage pancreatic cancer is the American Joint Committee on Cancer’s TNM system. The TNM system takes into account the size of the primary tumor (T), whether cancer is present in nearby lymph nodes (N), and whether the cancer has metastasized (spread) to other organs or tissues in the body (M). View TNM staging for pancreatic cancer here.

The three categories are combined to determine the overall stage of the cancer. This is called stage grouping.

Stage Grouping for Pancreatic Cancer

Stage I: The cancer is only present in the pancreas.

Stage II: The cancer has invaded nearby tissues but has not invaded nearby blood vessels. The cancer may have spread to the lymph nodes.

Stage III: The cancer has invaded nearby blood vessels.

Stage IV: The cancer has spread to other organs in the body.
(National Cancer Institute 2010)

The grade of the cancer—how the cells appear under a microscope—also plays an important role in determining the extent of the cancer. Cancers are graded on a scale of G1 (the cells appear relatively normal) to G3 (or G4) (the cells appear very abnormal).

For treatment purposes, physicians may group pancreatic cancers into the following four categories:

  • Resectable: The entire cancer can be surgically removed.
  • Borderline resectable: Surgeons may be able to remove the entire cancer, even though it may have spread to nearby blood vessels. Sometimes a trial of chemotherapy is performed to try to shrink the tumor prior to surgery.
  • Locally advanced (unresectable): The cancer is still local, but it cannot be entirely removed.
  • Metastatic: The cancer has spread to distant sites in the body.
    (American Cancer Society 2015a)

Patients are encouraged to discuss cancer staging and treatment options with their physicians.

Gastroenterology/Hepatobiliary Tumor Board

The results of the diagnostic tests are discussed at the Gastroenterology/Hepatobiliary Tumor Board. During this weekly meeting, the entire multidisciplinary team comes together to discuss new cases and develop individualized treatment plans for each patient.

References

American Cancer Society. 2015a. Pancreatic Cancer Overview. PDF.
http://www.cancer.org/acs/groups/cid/documents/webcontent/003071-pdf.pdf

-----2015b. “What are the risk factors for pancreatic cancer?” Last modified January 9, 2015.
http://www.cancer.org/cancer/pancreaticcancer/detailedguide/pancreatic-cancer-risk-factors

American Joint Committee on Cancer. 2009. Pancreas Cancer Staging. 7th ed. PDF. https://cancerstaging.org/references-tools/quickreferences/Documents/PancreasSmall.pdf

National Cancer Institute. 2010. What You Need To Know About™ Cancer of the Pancreas. Bethesda: National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services. http://www.cancer.gov/publications/patient-education/pancreas.pdf