Diagnosis

To properly diagnose pancreatic cancer, your provider will first take your medical history and perform a physical exam. This includes an assessment of symptoms, checking your overall health and feeling your abdomen for any abnormal changes. Then, if necessary, your doctor will refer you to a gastroenterologist, who specializes in diseases of the digestive tract.

Further diagnostic testing may include:

Blood tests. Used to help diagnose pancreatic cancer or to help determine treatment options if it is found.

  • Liver function tests. Jaundice is often one of the first signs of pancreatic cancer.
  • Tumor markers. Tumor markers can sometimes be found in the blood when a person has cancer. For pancreatic cancer, we look for tumor markers CA 19-9 and Carcinoembryonic antigen (CEA).
  • Other blood tests, like a CBC or chemistry panel. Can help evaluate a person’s general health.

Endoscopic ultrasound (EUS). Uses sound waves to produce images of the pancreas.

Biopsy. The only way to tell for sure if it is definitively cancer is by doing a biopsy.

  • Percutaneous biopsy or fine needle aspiration (FNA). A doctor inserts a thin, hollow needle through the skin over the abdomen and into the pancreas to remove a small piece of a tumor.
  • Endoscopic biopsy. Your doctor passes an endoscope down the throat and into the small intestine near the pancreas. At this point, the doctor can either use EUS to pass a needle into the tumor, or endoscopic retrograde cholangiopancreatography (ERCP) to place a brush to remove cells from the bile or pancreatic ducts.
  • Surgical biopsy. Useful if your surgeon is concerned the cancer has spread beyond the pancreas.

Imaging tests. X-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body.

  • Cholangiopancreatography. Looks at the pancreatic ducts and bile ducts to see if they are blocked, narrowed, or dilated.
  • Computed tomography (CT or CAT) scan. Uses X-rays to make detailed, cross-sectional images of your body. Unlike a regular x-ray, a CT scan creates detailed images of the soft tissues in the body. CT scans can also be used to guide a biopsy needle into a suspected area of cancer spread, called a CT-guided needle biopsy.
  • Magnetic resonance imaging (MRI) scan. Like CT scans, MRI scans show detailed images of soft tissues in the body.
  • Positron emission tomography (PET) scan. A PET scan can look for possible areas of cancer spread in all areas of the body at once.
  • PET/CT scan. We can do both a PET and CT scan at the same time.

UCHealth follows the American Joint Committee on Cancer (AJCC) TNM system, which is based on three key pieces of information:

  1. The extent of the tumor (T). How large is the tumor and has it grown outside the pancreas into nearby blood vessels?
  2. The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes? If so, how many of the lymph nodes have cancer?
  3. The spread (metastasized) to distant sites (M): Has the cancer spread to distant lymph nodes or distant organs such as the liver, peritoneum (the lining of the abdominal cavity), lungs or bones?

Cancer staging can be complex. If you have any questions about your stage, please ask your doctor to explain it to you in a way you understand.

AJCC Stage Stage grouping Stage description*
0 Tis
N0
M0
The cancer is confined to the top layers of pancreatic duct cells and has not invaded deeper tissues. It has not spread outside of the pancreas. These tumors are sometimes referred to as carcinoma in situ (Tis).

It has not spread to nearby lymph nodes (N0) or to distant sites (M0).

IA T1
N0
M0
The cancer is confined to the pancreas and is no bigger than 2 cm (0.8 inch) across (T1).

It has not spread to nearby lymph nodes (N0) or to distant sites (M0).

IB T2
N0
M0
The cancer is confined to the pancreas and is larger than 2 cm (0.8 inch) but no more than 4cm (1.6 inches) across (T2).

It has not spread to nearby lymph nodes (N0) or to distant sites (M0).

IIA T3
N0
M0
The cancer is confined to the pancreas and is bigger than 4 cm (1.6 inches) across (T3).

It has not spread to nearby lymph nodes (N0) or to distant sites (M0).

 

IIB

 

T1
N1
M0
The cancer is confined to the pancreas and is no bigger than 2 cm (0.8 inch) across (T1) AND it has spread to no more than 3 nearby lymph nodes (N1).

It has not spread to distant sites (M0).

T2
N1
M0
The cancer is confined to the pancreas and is larger than 2 cm (0.8 inch) but no more than 4cm (1.6 inches) across (T2) AND it has spread to no more than 3 nearby lymph nodes (N1).

It has not spread to distant sites (M0).

T3
N1
M0
The cancer is confined to the pancreas and is bigger than 4 cm (1.6 inches) across (T3) AND it has spread to no more than 3 nearby lymph nodes (N1).

It has not spread to distant sites (M0).

III T1
N2
M0
The cancer is confined to the pancreas and is no bigger than 2 cm (0.8 inch) across (T1) AND it has spread to 4 or more nearby lymph nodes (N2).

It has not spread to distant sites (M0).

OR
T2
N2
M0
The cancer is confined to the pancreas and is larger than 2 cm (0.8 inch) but no more than 4cm (1.6 inches) across (T2) AND it has spread to 4 or more nearby lymph nodes (N2).

It has not spread to distant sites (M0).

OR
T3
N2
M0
The cancer is confined to the pancreas and is bigger than 4 cm (1.6 inches) across (T3) AND it has spread to 4 or more nearby lymph nodes (N2).

It has not spread to distant sites (M0).

OR
T4
Any N
M0
The cancer is growing outside the pancreas and into nearby major blood vessels (T4). The cancer may or may not have spread to nearby lymph nodes (Any N).

It has not spread to distant sites (M0).

IV Any T
Any N
M1
The cancer has spread to distant sites such as the liver, peritoneum (the lining of the abdominal cavity), lungs or bones (M1). It can be any size (Any T) and might or might not have spread to nearby lymph nodes (Any N).

Source: American Cancer Society