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Pancreatic cancer

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From MayoClinic.com

Screening and diagnosis

Detecting pancreatic cancer in its early stages is extremely difficult. Signs and symptoms usually don't appear until the cancer is large or has spread to other tissues. And because your pancreas is relatively hidden — tucked behind your stomach and inside a loop of your small intestine — small tumors can't be seen or felt during routine exams.

If your doctor suspects pancreatic cancer, you may have one or more of the following tests:

  • Ultrasound imaging. In this test, a device called a transducer is placed on your upper abdomen. High-frequency sound waves from the transducer reflect off your abdominal tissues and are translated by a computer into moving images of your internal organs, including your pancreas. Ultrasound tests are safe, noninvasive and relatively brief — a typical test takes between 30 minutes and one hour.

  • Computerized tomography (CT) scan. This imaging test allows your doctor to see your organs, including your pancreas, in two-dimensional slices. Split-second computer processing creates these images as a series of very thin X-ray beams pass through your body. Sometimes you may have a dye (contrast medium) injected into a vein before the test. The clearer images produced with the dye make it easier to distinguish a tumor from normal tissue. A CT scan exposes you to more radiation than do conventional X-rays, but in most cases, the benefits of the test outweigh the risks.

  • Magnetic resonance imaging (MRI). Instead of X-rays, this test uses a powerful magnetic field and radio waves to create images of your pancreas. During the test, you're placed in a cylindrical tube that can seem quite confining to some people. The machine also makes a loud thumping noise you might find disturbing. In most cases you'll be given headphones for the noise. If you're claustrophobic, ask your doctor whether an "open" scan or some mild sedation may be an option for you.

  • Endoscopic retrograde cholangiopancreatiography (ERCP). In this procedure, a thin, flexible tube (endoscope) is gently passed down your throat, through your stomach and into the upper part of your small intestine. Air is used to inflate your intestinal tract so your doctor can more easily see the openings of your pancreatic and bile ducts. The bile ducts are thin tubes that carry bile, a fluid produced in your liver that helps digest fats. These ducts are often the site of pancreatic tumors. A dye is then injected into the ducts through a small hollow tube (catheter) that's passed through the endoscope. Finally, X-rays are taken of the ducts. Your throat may be sore for a time after the procedure, and you may feel bloated from the air introduced into your intestine. Major complications are rare and include pancreatitis, infection and bleeding.

  • Endoscopic ultrasound (EUS). In this test, an ultrasound device is passed through an endoscope into your stomach. The device directs sound waves to your pancreas. A computer then translates the sound waves into close-up images of your pancreas and your bile and pancreatic ducts. The images are superior to those produced by standard ultrasound and are particularly useful for detecting small pancreatic tumors.

  • Percutaneous transhepatic cholangiography (PTC). In this test, your doctor carefully inserts a thin needle into your liver while you lie on a movable X-ray table. A dye is then injected into the bile ducts in your liver, and a special X-ray machine (fluoroscope) tracks the dye as it moves through the ducts. Any obstructions should show up on the X-ray. The table is rotated several times during the procedure so you can assume a variety of positions. During the test, you may have a feeling of pressure or fullness, or have slight discomfort in the right side of your back. There is a small risk of bleeding or infection. In rare cases, blood poisoning (septicemia) or bile peritonitis — a serious infection of the membrane covering the walls of the abdomen — may occur.

  • Biopsy. In this procedure, a small sample of tissue is removed and examined for malignant cells under a microscope. It's the only way to make a definitive diagnosis of cancer. Biopsies of the pancreas and bile ducts can be performed in several ways. If you have a mass that can be reached with a needle, your doctor may choose to perform a fine-needle aspiration (FNA) — a procedure in which a very thin needle is inserted through your skin and into your pancreas. An ultrasound or CT scan is often used to guide the needle's placement. When the needle has reached the tumor, cells are withdrawn and sent to a lab for further study. Tissue samples can also be removed during ERCP or EUS. Sometimes, in a procedure similar to ERCP, your surgeon uses an endoscope to pass a catheter into your bile duct where it empties into your small intestine. But instead of injecting dye, your surgeon uses a small brush placed through the catheter to scrape cells and bits of tissue from the lining of the duct.

  • Laparoscopy. This procedure uses a small, lighted instrument (laparoscope) to view your pancreas and surrounding tissue. The instrument is attached to a television camera and inserted through a small incision in your abdomen. The camera allows your surgeon to clearly see what's happening inside you. During laparoscopy, your surgeon can take tissue samples to help confirm a diagnosis of cancer. Laparoscopy may also be used to determine how far cancer has spread. Risks include bleeding and infection and a slight chance of injury to your abdominal organs or blood vessels.

Staging pancreatic cancer
Staging tests help determine the size and location of cancer and whether it has spread. They're crucial in helping your doctor determine the best treatment for you. Pancreatic cancer may be staged in several ways. Some surgeons use the Joint Committee on Cancer system. Others prefer the following method:

  • Resectable. All the tumor nodules can be removed.

  • Locally advanced. Because the cancer has spread to tissues around the pancreas or into the blood vessels, it can no longer be completely removed.

  • Metastatic. At this stage, the cancer has spread to distant organs, such as the lungs and liver.


Your pancreas produces a number of enzymes that break down food so your body can absorb the nutrients it contains. But pancreatic tumors often interfere with the production or flow of these enzymes. As a result, your body can't easily absorb nutrients, which can lead to diarrhea and severe weight loss.

Other complications of pancreatic cancer include:

  • Problems with glucose metabolism. Tumors that affect the ability of your pancreas to produce insulin can lead to problems with glucose metabolism, including diabetes.

  • Jaundice, sometimes with severe itching. Yellowing of your skin and the whites of your eyes can develop when a pancreatic tumor blocks your bile duct, the thin tube that carries bile from your liver to your duodenum. The yellow color comes from excess bilirubin. Bile acids may cause intense itching when they build up in your skin.

  • Pain. Large pancreatic tumors may press on surrounding nerves, leading to back or abdominal pain that may sometimes be severe. Often, your doctor can prescribe medications that help relieve pain. When medications aren't enough, cutting or injecting alcohol into some of the affected nerves may be an option.

  • Depression. This can result both from the emotional difficulty of living with pancreatic cancer and from the physical effects of the disease.

  • Metastasis. This is the most serious complication of pancreatic cancer. Your pancreas is surrounded by a number of vital organs, including your stomach, spleen, liver, lungs and intestine. Because pancreatic tumors are rarely discovered in the early stages, they often have time to spread to these organs or to nearby lymph nodes.

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