Pancreatic Cancer

Endoscopies and biopsies

Using an endoscope a doctor can look inside the body. An endoscope is a thin, long, flexible tube that contains a light source and a video camera, so that images of the inside of the body can be seen on an external monitor (screen). Endoscopes can be inserted into the body through a natural opening, such as the throat (to look at the oesophagus or gullet and then the stomach and duodenum) or anus (the opening through which stools pass out of the body to look at the rectum and colon).Most people we interviewed had the cause of their symptoms investigated using an endoscope inserted via the throat, although a few had one inserted via the anus (colonoscopy) (see ‘Diagnostic tests for pancreatic cancer’).

Endoscopic retrograde cholangio pancreatography (ERCP) allows the doctor to see if a tumour is blocking the bile duct. Using the endoscope the doctor can inject a special dye into the bile and pancreatic ducts. Then an X-ray is taken. The dye shows up on the X-ray, and is intended to show where the bile duct is blocked. An ERCP can take between 30-60 minutes. People usually have a local anaesthetic and a sedative; rarely a general anaesthetic is required. A few people chose not to have a sedative for their first endoscopy but asked for one if the procedure was repeated.

The doctor did an endoscopy to establish where the tumour was and to estimate its size. The...

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Age at interview: 65

Sex: Male

Age at diagnosis: 63

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I was pretty nervous about having something stuck down one’s throat and they give you an anaesthetic. It’s not a general one. It makes you sort of drowsy.

A sedative probably.

Yes, yes. But I found that I woke up, sort of whilst it was still in and it was quite an unpleasant feeling this thing down and trying to sort of get one’s breath. And again, when he’d taken it out one had a bit of a sore throat. So my personal experience of that wasn’t that pleasant, frankly.

So do you know what the purpose of that test was? Was it just to have a look around?

Yes. Yes, no, the purpose of that test was to try and identify exactly where and how big the tumour was. And it was actually as a result of that test that my surgeon finally discovered a) the size, that it was bigger than he’d thought, and b) it’s location.

They didn’t take any biopsies at that time or anything?

No.

Most people who had an endoscopy hadn’t liked the idea of having to swallow the tube and had found the procedure itself unpleasant - but it hadn’t lasted long. Some of those who had had a sedative had fallen asleep and remembered little about it.

Phil was terrified by the thought of having an endoscopy but the sedative made him sleepy and the...

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Age at interview: 50

Sex: Male

Age at diagnosis: 50

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Can you say a bit more about the endoscopy? For people that don’t know

what an endoscopy is.

Yes, an endoscopy is a camera down the throat into the stomach to view the stomach lining. And the thought of it terrified me to be quite honest. But when I was given the sedative, it was a case of have you done it yet? And they’re already completed it. So…

Yes, so they put you to sleep almost.

Yes. It was, it was not unpleasant at all. But it was the thought of, its not nice, sort of having a tube down your throat,

Yes.

but the actual reality was okay.

Everyone we interviewed who had an endoscopy via the throat had an ERCP except for one man (Fred - Interview 38) who had a similar procedure called an endoscopic ultrasound (EUS), which involves passing an ultrasound probe down the endoscope to provide ultrasound pictures of the pancreas and surroundings organs.

During an endoscopy the surgeon can do a biopsy. A small instrument attached to the endoscope can collect cells from the suspected tumour to see if they are cancerous.

During an endoscopy Rory had a biopsy. She reacted badly to the procedure, had severe pain and...

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Age at interview: 66

Sex: Female

Age at diagnosis: 65

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And how did they do the biopsy?

They gave me a light anaesthetic.

But did they do it through an endoscopy?

Yes. Yes. And I actually had a sort of very violent reaction. I was, I’ve never experienced pain like it. It was absolutely horrendous and they whipped me straight up to a ward, and kept me there for three days.

Really?

Hmm.

Was that, the pain was where they’d done the biopsy?

With the pain. With the pain yes.

Oh dear.

Hm.

How awful.

But in some ways that gave me time to come to terms with everything.

Peter had several endoscopies. On one occasion the doctor did a biopsy. Peter does not recall any...

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Age at interview: 62

Sex: Male

Age at diagnosis: 62

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Well I know that some people have bad experiences having endoscopies but I never had any bad experiences, didn’t feel anything at all. Because what, what they do, you, you lie on a, on a bench, well, bed, and they introduce a camera, little camera thing on a tube and stick it down your throat. But they give you a choice. You can either have an anaesthetic or, or you can have a numbing thing to relax the muscles of your throat. The disadvantage of having the full works is that you have to have somebody to accompany you home afterwards because you might be a bit dozy. I think I had both at different times because I had several endoscopies, but I never had, I never felt any discomfort or pain from any of them as an aftermath, I didn’t feel a thing, didn’t feel a thing in fact. Didn’t feel the thing going down, didn’t feel it coming out. I was quite comfortable. But I think I was lucky because I think some people do experience adverse effects but fortunately I wasn’t one of them. And, and they were very attentive, again, the staff there, making sure that I knew what was happening and, and fussing around me, you know, like a mother hen round her chicks. It was, it was quite a good experience all in all, really.

And, and also, I know people go on about waiting and waiting in hospitals but I never found that I had to wait too long, you know, to be seen. Not more than I would have expected anyway, like within half an hour. So that was OK. And similarly I had x-rays done as well, and that was the same kind of experience.

So one occasion when they were doing an endoscopy they also took a biopsy?

Hm.

Presumably you didn’t feel that either?

No, even, even though that involved a needle extracting a portion of tissue. That was OK, fortunately.

Doctors sometimes do a biopsy of the pancreas, or a biopsy of another affected organ, using a long, thin needle, which goes through the patient’s abdomen. Ultrasound scans help to guide the needle towards the tumour.

Adrian had a biopsy of his pancreas. Doctors put a needle through his abdomen, guided by...

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Age at interview: 48

Sex: Male

Age at diagnosis: 47

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How did they do that biopsy?

The biopsy is done guided by ultrasound, just a needle in, straight in through the stomach. I was just under very mild sedation. And then had to go and have four hours not moving in the hospital bed afterwards, [laughs] which is the most uncomfortable part of the whole lot really.

Why do you have to not move?

Just in case they’ve hit something they shouldn’t, you have to stay still in your hospital bed in case, just, it’s a tiny, tiny chance that they’ve hit something or disturbed something that shouldn’t be, and you begin to bleed or something like that. So, it’s an uncomfortable four hours.

Lilian had two liver biopsies. Each time doctors inserted a needle, which did not hurt, but after...

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Age at interview: 74

Sex: Female

Age at diagnosis: 74

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Would you mind just summarising what it was like having a liver biopsy?

I’ve had two. I had one done at the first hospital, when they first realised I’ve got the abnormalities on the liver. And I had one at the second hospital.

I would say to anyone, don’t be, don’t be afraid because you will be taken obviously into a room, and they anaesthetise the part around your liver, so that it’s like when you have anything done. And then they, they put a long needle into you, it sounds dreadful and you actually can see this, and it looks dreadful. But you do not feel it. And from that needle, it I suppose it’s like a little clamp, because the clamp about two or three, depending on how many pieces of your liver they want. The first time I had two pieces taken, the second time I had three.

Then they take these little pieces of liver out, and they are analysed. That’s when they found out how serious it was. It wasn’t until the liver biopsy was done that they then realised the seriousness of the extent of what I’ve got.

And you said that after one of them you had the side effect of a bleed?

The second one I had.

And that was painful you said?

It wasn’t painful when they did the biopsy.

No, the bleeding?

But the bleeding, but it, but I will tell you in fairness to the hospital, when you have a biopsy, first of all, which is a bit daunting, when you’ve had it done you must lay on your side for five hours.

And they monitor you all the time, taking your blood pressure, taking your temperature, looking at, its, it’s here, so you, there’s a needle mark there. And they are checking it, and then after that you can then lie on your back for so many hours. You are actually in a bed for eight hours.

And so I advise anyone who has to have it done, take a good book if you’ve got a good book to read. And all day on the second one, they had monitored me, nothing was wrong, and they were so pleased with everything. It wasn’t until the Friday evening, the following Friday that I was in such agony and I was fortunate enough to have a friend who’s a doctor in the town where I was visiting, and he said, “Lilian, I think you’ve got a bleed. You’re got a bleed, and I would suggest George get you back to [the hospital].

Oh the hospital, the large, the second one, as quickly as possible.

So the side effect of the bleed started a few days after you’d had it?

Yes.

Okay.

In other words I think more, to be honest I think it was a fluke. It isn’t common.

Well why, and also why didn’t I bleed almost the next day?

Yes

It, but it did take a few days to sort itself out.

A biopsy may be done in other ways too. Sometimes doctors do a laparoscopy, making one or more small incisions in the abdomen and passing a laparoscope (telescope) through one of them. This allows the doctor to see inside and take the biopsy.

Hamish had a laparoscopy under general anaesthetic. During the operation the surgeon biopsied the...

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Age at interview: 76

Sex: Male

Age at diagnosis: 72

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They gave me a biopsy first.

Was that with an endoscopy? Down your throat?

No, no, that was a, I forget what you call it, but they go in with cameras and have a look and take samples.

Oh, were you did you have an anaesthetic for that?

Yes.

So you had a laparoscopy?

Laparoscopy, yes.

Would you mind saying a little bit about having a laparoscopy?

I didn’t really know much about it. The consultant concerned just came up, he said, “We’re going to do this.” And I think I was in the theatre for about an hour or so. Came out and I was home the next day with two little holes in me [laughs].

So they did it, with a sort of scope was it?

Yes, and then before I left, that was that was on the Wednesday, it’s coming back now, and on, he said, “We want you back on the Saturday to operate.” And explained what he was going to do.

The results of Helen’s first endoscopic biopsy were inconclusive so another one was taken during an operation to remove the tumour.

Some people we interviewed had a stent inserted to relieve jaundice at the same time as having the endoscopy (see ‘Treating the initial symptoms’).

Last reviewed September 2018.
Last updated June 2015.

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