If your healthcare provider thinks you might have pancreatic cancer, you’ll need certain exams and tests to be sure. The process starts with your healthcare provider asking you questions. You'll be asked about your health history, your symptoms, risk factors, and your family history of disease. A physical exam will be done, focusing on your belly.
Based on the findings, your provider will decide what other tests are needed.
What tests might I need?
You may need 1 or more of these tests:
You may have blood tests to look for signs of pancreatic cancer.
Liver function tests (LFTs)
These tests look for certain chemicals in your blood to get an idea of how well your liver is working. They can sometimes help tell if a bile duct is blocked. This might be caused by a pancreatic tumor. Still, LFTs can't tell for sure if you have pancreatic cancer because there are other causes of blocked bile ducts. But if the results of these tests are abnormal, your healthcare provider may do other tests to check for cancer.
CA19-9 is a tumor marker. It’s a substance that can sometimes be found in high levels in your blood if you have cancer. This test by itself can't diagnose pancreatic cancer. That's because not everyone who has pancreatic cancer has a high CA19-9 level. Plus, sometimes people have a high CA19-9 level without having pancreatic cancer. But if this test is abnormal, your healthcare provider might do other tests to look for pancreatic cancer.
Imaging and endoscopy tests
Your healthcare provider may use imaging and endoscopy tests to look for pancreatic cancer. Imaging tests use things like X-rays and sound waves to take pictures of the inside of your body. For endoscopy tests, a thin tube (called an endoscope) is put into your body. A camera at the end of the tube lets your provider look at your organs and other tissues.
An ultrasound uses sound waves to look for changes in your pancreas and bile ducts. The sound waves bounce off body parts and send back a series of signals. A computer turns these into images of your insides. This might be the first test you have because it’s easy and doesn’t use radiation. During an ultrasound, the sound waves come from a wand-like device that’s moved over the skin on your belly (abdomen) and aimed at your pancreas.
For an endoscopic ultrasound (EUS), the images of the pancreas are taken from inside your body. This makes a better picture. Medicines are used to make you sleep for this test. Then a thin, lighted tube (called an endoscope) is put down your throat, through your stomach, and into the first part of your small intestine. At the tip of the endoscope is a tiny ultrasound device. It bounces waves into nearby tissues, including the pancreas, to make images on a computer screen. During the test, if your healthcare provider sees anything of concern, a small, hollow needle may be passed through the endoscope to take out a small piece (sample) of tissue. This is called a biopsy.
A CT scan uses X-rays taken from many angles. It creates very detailed cross-section pictures of your pancreas and nearby tissues. CT scans can often show pancreatic tumors and blocked bile ducts.
Sometimes a special type of CT scan called a pancreatic protocol CT is used. For this scan, a dye is put into your blood. Over a certain time, pictures are taken of the pancreas as the dye moves through it. This can help your healthcare team see if surgery to take out the pancreas might be an option.
PET (positron emission tomography) scan
For this test, a radioactive sugar is put into your blood through a vein in your arm or hand. Over time, the radioactive sugar collects in very active cells, like cancer cells. A special camera is then used to make pictures that show where the radioactive sugar collects. The picture from this test is not as detailed as a CT scan. It isn’t used alone to diagnose pancreatic cancer. But it can still sometimes be helpful. A PET scan may be done in combination with a CT scan (PET/CT scan).
MRI (magnetic resonance imaging)
This test uses magnets and radio waves to create detailed images of your pancreas and nearby organs. While MRIs can show more detail than other imaging tests, they aren’t used as often as CT scans when looking for pancreatic cancer.
ERCP (endoscopic retrograde cholangiopancreatography)
This test is a type of X-ray used to look at the bile ducts and the pancreatic duct. Medicines are used to make you sleep. Then a long thin tube (endoscope) is put down your throat, through your stomach, and into your small intestine. A smaller tube (catheter) is slid through the scope into the common bile duct. Dye is then injected through the catheter. It goes into your bile and pancreatic ducts. The dye shows up on X-rays. This can show ducts that might be blocked or narrowed by a tumor. If your healthcare provider sees anything that doesn't look normal, a tissue sample (biopsy) might be taken out and checked for cancer.
MRCP (magnetic resonance cholangiopancreatography)
This test is a lot like an ERCP, but it uses an MRI instead of an endoscope. MRCP can show both the bile ducts and the pancreatic duct without the need to put a scope in them. But if your healthcare provider sees something that doesn't look normal, a biopsy can't be done during this test.
PTC (percutaneous transhepatic cholangiography)
This is another type of X-ray of the bile duct. A thin needle is put through the skin on the right side of your belly and into your liver. A dye is then injected through the needle. The dye highlights blockages in bile ducts, which can then be seen on an X-ray. If a blocked bile duct is seen, your provider may take a biopsy and check it for cancer. This test is mostly done if an ERCP can't be done.
If an imaging test shows something in your pancreas that looks like it might be cancer, your healthcare provider may take out small pieces (called samples) of the changed tissue. This is called a biopsy.
A biopsy is usually the only way to be sure that a person has pancreatic cancer. A doctor who specializes in looking at cells, called a pathologist, looks at the samples under a microscope. Tests are done to see if they contain cancer. There are different types of biopsies.
Percutaneous (though the skin) needle biopsy
For this test, a thin, hollow needle is put through your skin and into the pancreatic tumor to get a sample of it. A CT scan or ultrasound of the pancreas is usually used to help your healthcare provider guide the needle into the tumor.
During procedures such as endoscopic ultrasound or ERCP, your healthcare provider may pass long, thin tools down the scope to take samples of areas that don't look normal. This might be done with a thin, hollow needle or a tiny brush.
For this test, your surgeon makes a small cut (incision) in your skin over your belly. A thin tube with a light and a tiny video camera on the end is put into this cut. This lets your provider see your pancreas and nearby areas. Other small cuts may be made to put in other tools to remove cells for testing.