Techniques to Diagnose Pancreatic Cancer

There currently does not exist a method to detect and diagnose pancreatic cancer akin to those used for breast cancer, colon cancer, or prostate cancer (mammograms, colonoscopies and PSA tests, respectively). In fact, it is the mission of the Rolfe Pancreatic Cancer Foundation to fund research that will discover such a method, a breakthrough that we believe will be a watershed moment in the history of pancreatic cancer treatment. That being said, when a physician does suspect pancreatic cancer, there are a number of techniques that can be used to establish a diagnosis. 

Blood Tests: While there is no single blood test that can be used to make a specific diagnosis of pancreatic cancer, physicians will often run tests for CA-19-9 (a cancer marker), blood glucose levels (blood sugar levels, which are affected by pancreatic cancer) and blood bilirubin levels (one of the components of bile, which becomes more present in the bloodstream when a pancreatic tumor blocks the bile duct).  Blood test results can act as clues, and help guide physicians to a diagnosis. 

Radiology: The most important tests used to find pancreatic cancer are based in radiology, which is an umbrella term for imaging techniques. There are numerous technologies that can be employed to visualize pancreatic cancer, but the four most common are:

Computerized Axial Tomography (CAT or CT) Scanning: CT scans use modest levels of radiation to rapidly X-ray different angles and levels of the abdomen. A computer processer then produces images, usually as cross sectional slices of the abdomen, and renders finely detailed three-dimensional graphics. CT scans can visualize the vast majority of pancreatic cancers, and provide important information to determine treatment. They can also be used to discover whether the cancer has spread.  They are often the first test doctors order when they suspect a patient has pancreatic cancer, as they are widely considered to be one of the most useful imaging techniques available.

Endoscopic Ultrasound (EUS): An endoscopic ultrasound is a test in which a patient is placed under conscious sedation (sleep), and a probe – meaning a long, thin tube - is run through a patient’s mouth, down the esophagus and into the stomach and duodenum. Endoscopic ultrasounds are one of the best ways to get an up-close view of the pancreas, and enable doctors to get an intimate view of abnormalities.  The close proximity of the pancreas during an EUS can allow physicians to conduct a biopsy (the gold standard for diagnosing pancreatic cancer), the value of which can often be monumental in determining the exact nature of a tumor.

Positron Emission Tomography (PET): PET scans are largely used to determine the activity of a tumor. Using an ingested tracker that is concentrated in areas of the body that actively metabolize sugar (since many cancers do so as well), PET scans are excellent means of deducing whether or not a tumor is growing or shrinking. PET scans are sometimes performed in conjunction with CT scans, a process referred to as a PET/CT scan.

Magnetic Resonance Imagining (MRI): MRIs use a series of sophisticated magnets and unique detectors to build acute images of the pancreas and its surroundings.  They can be quite useful in mapping the specifics of a patient’s pancreatic duct system.

Biopsy: A biopsy is a sampling and physical (microscopic) examination of tissue. Biopsies can take a number of forms, but one of the most common is called a fine needle aspiration (FNA), which is a process in which a thin needle is either passed through a patient’s skin directly into the tumor, or, more commonly, it is threaded through an endoscope during an endoscopic ultrasound.

Biopsies are far and away the most accurate test a physician can conduct to diagnose whether a tumor is present, and, if so, classify the exact nature of that tumor (the accuracy rates approaches 99%). However, because of the buried location of the pancreas, biopsies are not necessarily easy tests to conduct prior to surgery when it comes to pancreatic cancer. There is always a biopsy ordered following surgery, in which the removed tumor and tissue is thoroughly analyzed and evaluated.

Screening: Although there does not currently exist a simple screening test to discover pancreatic cancer (such as breast cancer has with a mammogram), there are registry programs that high-risk individuals with family histories of pancreatic cancer can enroll in to track the health of their pancreas. A person is considered high-risk if (a) they have two or more first-degree relatives (sibling, parent or child) who have had pancreatic cancer, (b) they have a first-degree relative who developed pancreatic cancer before the age of 50, or (c) if they have inherited genetic syndromes associated with pancreatic cancer.

These programs generally involve annual examinations, which usually include combinations of CT and PET scans. This process of proactively monitoring for signs of pancreatic cancer is more of a surveillance program than anything; but because of its active approach, if a tumor does develop, it is more liable to be found in its early stages (when it is most treatable), and thus a patient will likely see a more favorable prognosis.

To learn more about a registry program that the Rolfe Pancreatic Cancer Foundation supports, please visit the website for Johns Hopkins Medicine’s National Familial Pancreas Tumor Registry.