How to diagnose pancreatic cancer
Currently, there is no blood test to confirm the diagnosis of pancreatic cancer. A doctor may suggest doing a blood tumor markers test for pancreatic cancer along with routine blood tests and radiological tests to confirm the diagnosis.
- The blood test commonly performed for pancreatic cancer is CA 19-9 (carbohydrate antigen 19-9). CA 19-9 is referred to as a tumor marker for pancreatic cancer, which is a chemical substance in the body that may be found at higher levels if cancer is present.
- CA 19-9 cannot diagnose cancer but can be used as a tool to evaluate the effectiveness of cancer therapy by comparing its pre- and post-treatment levels.
- The analysis from 2017 showed that a combination of elevated levels CA 19-9 together with CEA (carcinoembryonic antigen is a vital supplementary to CA 19-9) can play an important role in the clinical diagnosis of pancreatic cancer.
- Blood specimens may be collected to check the level of bilirubin and liver enzymes in a patient's blood, which measures liver and pancreas function. In a few cases, blood glucose levels are also monitored to check the function of the pancreas.
CA 19-9 and CEA are best used to monitor progress and treatment response rather than to establish a diagnosis. In some people, these markers may not be elevated at all. Hence, a doctor may recommend other investigations.
- It uses high-frequency sound waves to create images of the organs inside the body.
- An abdominal ultrasound examines the liver, gallbladder, spleen, pancreas and kidneys and can help identify abnormal structures or tissue.
Computed tomography (CT) scan
- This uses a series of thin X-ray images to capture the images of internal organs.
- CT scans can help detect tumors and determine whether it has spread to other parts of the body, such as the liver.
- There are different types of CT scans and special techniques that can be done to create more detailed images of the pancreas. A three-dimensional (3-D) CT scan (often referred to as a spiral or helical scan) can create extremely detailed images of the pancreas, nearby blood vessels and structures to help determine treatment decisions. A 3-D CT scan may be advised by a physician to confirm pancreatic cancer.
- This is a procedure that allows a gastroenterologist to view the esophagus, stomach and the first portion of the small intestine, as well as adjacent organs including the liver and pancreas.
- While the patient is placed on anesthesia, a thin, flexible tube called an endoscope is passed through the mouth into the stomach and small intestine.
- On the end of the tube is an ultrasound probe that emits sound waves that create images of the abdominal organs.
- If unusual masses are detected, the doctor may collect a specimen of tissue at the time of the procedure during a biopsy.
- The use of this procedure is that it can decrease the likelihood that a patient will need to go to the operating room for surgery.
Endoscopic retrograde cholangiopancreatography (ERCP)
- This procedure uses an endoscope, which is a long, flexible, lighted tube connected to a computer and television monitor.
- The doctor may guide the endoscope through the stomach and into the small intestine.
- ERCP combines two imaging techniques: endoscopy (the direct visualization of internal structures) and fluoroscopy (a live-action X-ray method).
- These two techniques allow the doctor to view images of the liver, gall bladder and pancreas ducts, which can help detect a narrowed or blocked duct.
Magnetic resonance cholangiopancreatography (MRCP)
- MRCP uses radio waves and a powerful magnet linked to a computer to visualize the biliary and pancreatic ducts in a noninvasive manner.
- These pictures can show the difference between normal and diseased tissue and can also detect bile duct obstruction.
- MRCP may be performed in patients who cannot have an endoscopic retrograde cholangiopancreatography (ERCP). It may also prevent unnecessary invasive procedures.
- A doctor to collect a small amount of tissue for the biopsy.
- A pathologist then uses a microscope to examine the tissue and identify the types of cells collected.
- Tissue can be collected at the time of an endoscopic ultrasound or endoscopic retrograde cholangiopancreatography.
- A biopsy also can be performed under the guidance of a CT scan.
- If necessary, a biopsy can be performed at the time of open surgery of the abdomen.
- A fine needle aspiration (FNA) utilizes a very narrow needle. A core needle biopsy uses a larger needle.
Both methods have advantages and risks. If cancer is suspected to have spread or metastasized, it is preferable to biopsy the tumor rather than the pancreas.
Pancreatic cancer is usually detected late. The diagnosis of this cancer is made after a combination of clinical examinations, imaging tests, blood tests and tumor tissue. These tests and analyses also make it possible to establish the stage of the disease’s progress. The treatment of these tumors is based on their growth stage. Standard treatments are surgery, chemotherapy, radiotherapy or a combination of these treatments.
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