How is pancreatic cancer diagnosed?

A number of tests may be performed to investigate symptoms of pancreatic cancer and confirm a diagnosis. The more common tests include: 

• physical examination 
• imaging tests, including 
• computerised tomography (CT) scans, which may include getting an injection of a dye into a vein before the scan 
• magnetic resonance imaging (MRI) scans, which may include getting an injection of a dye into a vein before the scan 
• ultrasound tests, including endoscopic ultrasound, which uses an ultrasound probe on the tip of an endoscope (a tube that is passed through the nose or mouth into the digestive tract) 
• endoscopic retrograde cholangiopancreatography, which includes using an endoscope to insert a dye into the bile duct, then taking X-rays of the pancreatic ducts and bile ducts 
• somatostatin receptor scintigraphy, which uses a radioactive substance attached to a hormone-like substance that is injected into the body (for endocrine cancers) 
• positron emission tomography (PET) scans, which may include getting an injection of a radioactive dye into a vein before the scan 
• angiography – X-ray that looks at blood vessels 
• blood tests for liver and kidney^[12] function, pancreatic hormones, or certain proteins produced by cancer cells (tumour markers) 
• surgery to look at the organs in the abdomen using a thin tube with a light on the end (laparoscopy) 
• removing a small sample of tissue from the pancreas (biopsy) for examination under a microscope. 

Staging of pancreatic cancer

If you are diagnosed with pancreatic cancer, you might have more tests to determine the stage of the disease and whether the cancer has spread to other parts of the body. Knowing the stage of the disease helps your medical team plan the best treatment for you. 

Pancreatic cancer is divided into 5 stages: 

• Stage 0 (carcinoma in situ)
  • the cancer is only in the top layers of pancreatic duct cells and has not spread to deeper tissues; it has not spread outside the pancreas. 
• Stage I
  • the cancer is only in the pancreas; it has not spread to nearby lymph nodes or distant parts of the body. The cancer is 
  • 2 cm across or smaller; OR 
  • bigger than 2 cm but no more than 4 cm across. 
• Stage II  
  • the cancer is only in the pancreas and is bigger than 4 cm across. It has not spread to nearby arteries, veins, lymph nodes or distant parts of the body; OR 
  • the cancer is no more than 4 cm across and has note spread to nearby arteries and veins. It may have spread to no more than 3 nearby lymph nodes^[13]. It may have spread to nearby tissue and organs^[14], but has not spread to distant parts of the body.^[15] 
• Stage III (locally advanced cancer) 
  • the cancer has grown into nearby major blood vessels or nearby organs such as the stomach or colon. It may have spread to nearby lymph nodes, but has not spread to distant parts of the body. 
• Stage IV (metastatic cancer) 
  • the cancer has spread to distant parts of the body, such as the liver, lungs or the lining of the abdomen. 

Some doctors classify pancreatic cancer based on whether surgery can be used to remove the cancer. This system is commonly used for exocrine cancers, where treatment is based on how much the cancer has spread. There are 4 main groups to classify pancreatic cancer this way: 

• Resectable: the cancer has not spread outside the pancreas and appears to be easily removed by surgery. 
• Borderline resectable: the cancer has not spread outside the pancreas (or it has grown to a small extent into nearby blood vessels), but it is uncertain whether it can be completely removed by surgery. 
• Locally advanced (unresectable): the cancer has spread outside the pancreas to nearby blood vessels, lymph nodes or other tissues. These cancers cannot be completely removed by surgery. 
• Metastatic (widespread): the cancer has spread outside the pancreas to distant organs and tissues, such as the abdomen, liver, lungs, bone or brain. These cancers can’t be completely removed by surgery.