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:
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.
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.
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.
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.
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.
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.
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.
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
All the tumor nodules can be removed.
Because the cancer has spread to tissues around the pancreas or into
the blood vessels, it can no longer be completely removed.
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:
Tumors that affect the ability of your pancreas to produce insulin
can lead to problems with glucose metabolism, including diabetes.
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.
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.
This can result both from the emotional difficulty of living with
pancreatic cancer and from the physical effects of the disease.
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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