Pancreatic Cancer (cont.)
How is cancer of the pancreas diagnosed?
To diagnose pancreatic cancer, the doctor does a complete
physical exam and asks about the patient's personal and family
medical
history. In addition to checking general signs of health
(temperature,
pulse, blood pressure, and so on), the doctor usually orders
blood, urine,
and stool tests. The doctor may also ask for a "barium
swallow,"
or "upper GI series." For this test, the patient
drinks a barium
solution before x-rays of the upper digestive system are taken.
The barium
shows an outline of the pancreas on the x-rays.
Other tests may be ordered, such as:
- An angiogram, a special x-ray of blood vessels.
- CT scans, x-rays that give detailed pictures of a
cross- section of the pancreas. These pictures are created by a computer.
- Transabdominal ultrasound to view the pancreas. In
this procedure, an instrument that sends out high-frequency sound waves, which
cannot be heard, is passed over the abdomen. The sound waves echo off the
pancreas. The echoes form a picture on a screen that looks like a television.
- ERCP (endoscopic retrograde cholangiopancreatogram), is a
special
x-ray of the common bile duct. For this test, a long, flexible
tube
(endoscope) is passed down the patient's throat through the
stomach and
into the small intestine. A dye is injected into the common
bile duct, and
x-rays are taken. The doctor can also look through the
endoscope and take
tissue samples.
- Endoscopic ultrasound is a relatively new procedure that can be used to diagnose pancreatic cancer. For the procedure, an endoscope is passed in the same way as for ERCP; however, on the end of the endoscope is an ultrasound probe which scans the pancreas for cancers. Because the ultrasound probe is closer to the pancreas than with transabdominal ultrasound, it is possible to identify small cancers within the pancreas. The cancers also can be biopsied through the endoscope.
A biopsy is the only sure way for the doctor to know whether
cancer is present. In a biopsy, the doctor removes some tissue
from the
pancreas. It is examined under a microscope by a pathologist,
who checks
for cancer cells.
One way to remove tissue is with a long needle that is passed
through the skin into the pancreas. This is called a needle
biopsy.
Doctors use x-rays or ultrasound to guide the placement of the
needle.
Another type of biopsy is a brush biopsy. This is done during
the ERCP.
The doctor inserts a very small brush through the endoscope
into the bile
duct to rub off cells to examine under a microscope.
Sometimes an operation called a laparotomy may be needed.
During
this operation, the doctor can look at organs in the abdomen
and can
remove tissue. The laparotomy helps the doctor determine the
stage, or
extent, of the disease. Knowing the stage helps the doctor plan
treatment.
Tissue samples that are obtained with one kind of biopsy may
not
give a clear diagnosis, and the biopsy may need to be repeated
using a
different method.
Next: How is cancer of the pancreas treated? »
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