Pancreatic Cancer

Diagnostic tests for pancreatic cancer

Pancreatic cancer is hard to diagnose - the symptoms may be vague and other conditions can cause them. Doctors may order various tests, including blood tests, ultrasound scans of the abdomen, computer tomography (CT), magnetic resonance imaging (MRI), (Magnetic Resonance Cholangio-Pancreatography (MRCP – a type of MRI that can give clearer pictures) and other slightly more invasive procedures (such as endoscopy (ERCP), endoscopic ultrasound (EUS) or biopsies see ‘Endoscopies and biopsies’ for more information). If initial signs and symptoms include change in bowel habit, e.g. loose stools, the GP or gastro-enterologist may also want to test the stools (faeces) for abnormal enzymes or for blood, and they may suggest a colonoscopy or sigmoidoscopy to check for bowel abnormalities.

When a person first complains of symptoms that may indicate pancreatic cancer (see ‘Signs and symptoms of pancreatic cancer’) doctors usually order blood tests to examine liver function and to look for other abnormalities such as unusual levels of blood sugar. Some people we interviewed had had blood tests which had all come back completely normal, while others remembered that their tests had been abnormal.
Some of the people we interviewed had had a blood test for the tumour marker CA19-9. They had usually had it some time after the scans had suggested there might be a problem, or after a bout of pancreatitis, or after treatment had started. Maureen wondered why she had not had this test as part of a routine private health check before her cancer was diagnosed. A consultant surgeon explained that many conditions that affect the liver or pancreas temporarily raise CA19-9, and by the time a person has significantly elevated levels of CA 19-9, pancreatic cancer is usually at an advanced stage. Thus this test is not useful as a marker of early disease and can be normal in patients with pancreatic cancer.

An ultrasound scan is usually one of the first investigations to be done but is not the best way to diagnose pancreatic cancer. If ultrasound shows an abnormality the doctor usually orders a CT scan or other scans. The ultrasound scan is painless; it uses sound waves, not radiation, to create images of organs and structures inside the body. The scans are similar to those that pregnant women have. Some people had to wait for a few weeks to have scans in NHS hospitals or clinics. In some areas facilities have been privatised. One man was told that he had to wait three weeks to have a scan locally. However, he could drive 30 miles and have the scan done the next week in a private clinic paid for by the NHS.


Some people had suspected from the radiographer’s behaviour or demeanour that something was wrong. For instance, Anthony’s wife had told him that the radiographers had been chatty at first, but then suddenly went silent.

Alison was told she would have to wait four weeks to have an NHS scan so she chose a private referral to a consultant surgeon. She saw him within a few days and had a scan the next morning. Her husband’s private medical insurance paid for the scan.

NICE – National Institute for Health and Care Excellence has issued new guidelines (NG12 June 2015) which state that doctors should:

“Consider an urgent direct access CT scan (to be performed within 2 weeks), or an urgent ultrasound scan if CT is not available, to assess for pancreatic cancer in people aged 60 and over with weight loss and any of the following: 
•    diarrhoea
•    back pain
•    abdominal pain
•    nausea
•    vomiting
•    constipation
•    new onset diabetes.”

After the ultrasound scan the people we interviewed had at least one CT scan. CT scans are far more detailed than ordinary X-rays. The scanner looks like a large doughnut. During the scan the patient lies on a bed. The bed then moves slowly backwards and forwards to allow the scanner to take pictures of the body.

Before the CT scan some people were given an aniseed flavoured drink to help identify the stomach and small intestine, some found the drink unpalatable. During the scan the radiographer usually injected a contrast material or “dye” into an arm vein to make organs and abnormalities more visible. The scan did not hurt.

Vicky had dreaded having the needle inserted into a vein, and one day the dye leaked out of a vein into the surrounding tissue, which was ‘excruciatingly painful’. A few people we interviewed also had Magnetic Resonance Imaging (MRI). These scans use strong magnetic fields and radio waves to produce a detailed image of the inside of the body. The scanner consists of a large tube that contains a series of powerful magnets. The patient lies inside the tube during the scan. Donna had had MRI scans before and knew there was nothing to worry about and May said the staff had put her at ease, but some people found MRI noisy and rather frightening.

Two people had had Positron Emission Tomography (PET) scans as part of a clinical trial (see ‘Clinical Trials’). This type of scan can show how body tissues are working, as well as what they look like and also scans the whole body. These scans may help to identify tumours at an early stage, but in the UK are not done routinely to test for pancreatic cancer. One man needed a PET scan before starting Cyberknife treatment, to make sure his cancer had not spread to other organs (see ‘CyberKnife treatment and side effects’). Others had a PET scan when they developed symptoms which might have been due to a recurrence (see ‘Signs or symptoms of a recurrence’).

A few people said that before they'd had major surgery, such as a Whipple’s operation (see ‘Potentially curative surgery’), they'd had a laparoscopy (keyhole surgery) so that their surgeon could make sure that the cancer hadn't spread to other organs. Laparoscopy is an operation performed with the aid of a camera under general anaesthetic through one or more small incisions. Most people said that this simple operation went smoothly, though Audrey recalled that when she awoke from the anaesthetic she was in a lot of pain. She thought this might have been due to the gas that the surgeon had put into her abdomen to help see all the organs clearly.

Last reviewed June 2015.
Last updated June 2015.

 

Feedback

Please use the form below to tell us what you think of the site. We’d love to hear about how we’ve helped you, how we could improve or if you have found something that’s broken on the site.

Make a Donation to healthtalk.org





Find out more about how you can help us.

Send to a friend

Simply fill out this form and we'll send them an email