Pancreatic Cancer Diagnosis

When cancer of the pancreas is suspected, a medical diagnosis is complicated by the physical location of the gland. It is buried in the abdomen, making a physical examination or palpation impossible. Before the advent of modern diagnostic techniques, the pancreas was referred to as “the hermit of the abdomen,” a reference to it’s well-protected location.

Diagnostic Tools

If cancer of the pancreas is suspected, various diagnostic tools may be used to make a medical diagnosis. Ultimately, the only certain way to test for pancreatic cancer is biopsy. However, the following tests can provide medical professionals with important information about the cancer’s progression.Diagram of the Pancreas Area

Endoscopic Retrograde Cholangiopancreatography (ERCP)

An ERCP is a specialized x-ray of the ducts in the liver and pancreas. A small tube, called an endoscope, is inserted down the throat and into the small intestine. During the endoscopy, a dye is injected into the bile and pancreas ducts through the endoscope. The ducts are then x-rayed to see if tumors are blocking them. If tumors are blocking the ducts, the obstructions can be removed. Endoscopy also provides an opportunity to take biopsy samples.

Magnetic Resonance Imaging (MRI) and Computed Tomography (CT Scan)

Computed tomography (also known as a CAT, or CT scan) uses a series of x-ray scans to generate a computerized picture of the internal organs. A spiral computed tomography takes x-rays as the x-ray machine spirals around the patient.

An MRI scan also produces computerized pictures of the internal organs. However, instead of x-rays, an MRI uses powerful magnets and radio waves to construct a 3-dimensional image.

Positron Emission Tomography (PET Scan)

During a PET scan a mildly radioactive form of glucose is injected into the bloodstream. The scanner rotates around the patient creating a “picture” that indicates how the cells are functioning. Cancerous tissue will appear as brighter areas on the picture because it uses more glucose than healthy tissue. While the PET scan is useful for indicating the location of a tumor, it cannot be used to determine its size.

Laparoscopy

During a laparoscopy, a small tube, known as a laparoscope, is inserted into the body through a small incision in the abdomen. The tube is equipped with a small light and relays pictures to a monitor. Laparoscopy allows doctors to visually examine the pancreas, and to remove small tissue samples for biopsy.

Transabdominal and Endoscopic Ultrasound

Ultrasound bounces high frequency sound waves off organs to create images of the organs on a monitor, allowing tumors and other abnormalities to be detected.

In a transabdominal ultrasound, the sound waves are sent and received by an instrument, called a transducer, placed on the skin of the abdomen. It is less invasive than the endoscopic ultrasound, which takes place within the body. Using endoscopy, a thin tube is inserted down the throat and into the small intestine. A special miniature ultrasound transducer is then inserted through the tube. This provides a clearer picture of the pancreas than is available with the transabdominal ultrasound.

Biopsy

No matter what diagnostic tools are used, removing a tissue sample and examining it microscopically is the only way to accurately diagnose cancer of the pancreas. A biopsy sample may be retrieved during laparoscopy or endoscopy. Tissue may also be removed during a needle biopsy procedure, in which a thin needle, often guided by ultrasound, is inserted into the tumor. The sample is then examined for abnormal cell growth.

Stages of Pancreatic Cancer

Cancer “staging” is a system used to determine the progression of the disease, and is based on the tumor size and the extent of spread to other organs. The four stages of pancreatic tumors are as follows:

  • Stage 1: Cancerous cells are confined to the pancreas.
  • Stage 2: The cancer has spread to surrounding tissue (bile ducts,sections of the small intestine or other nearby areas).
  • Stage 3: Lymph nodes close to the pancreas show evidence of cancer cells.
  • Stage 4: Metastasis has occurred (the cancer has spread to other organs).

Pancreatic cancers are often divided into three separate types: resectable, locally advanced, and metastatic. A resectable tumor can be removed surgically, with a three-year survival rate of 25 to 35 percent. Only fifteen percent of pancreas tumors are resectable.

Locally advanced tumors account for 65 percent of cases. If the cancer has progressed to this stage, surgery is no longer an option. Instead, chemotherapy and radiation therapy are offered. Survival times generally range from six to ten months after diagnosis.

If metastasis has occurred, the disease is usually fatal within three to six months. Palliative care is the only viable form of treatment.

Resources

Acinic Cell Carcinoma Information Center. (nd). Acinic cell carcinoma related definitions. Retrieved March 20, 2003, from www.aciniccell.org/definitions.html.

Cancer Research UK. (updated 2002). Pancreatic cancer. Retrieved March 11, 2003, from www.cancerresearchuk.org/aboutcancer/specificcancers/15233.

Maisonneuve, P.