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If one or more of the signs or symptoms described in the following list are present, there are certain medical tests and examinations that can be performed to determine whether or not pancreatic cancer is the cause.
Signs and symptoms include:
- Jaundice, yellowing of the skin and in the whites of the eyes, presents in at least half of all cases of pancreatic cancer and in all cases of ampullary cancer.
- Pain in the abdomen or back, this is common in cases of advanced pancreatic cancer.
- Unintentional or unexplained weight loss, poor appetite and fatigue are common in people with pancreatic cancer.
- If pancreatic juice is blocked from getting released into the intestines, it will inhibit the body's ability to digest fatty foods, this could signal a tumor within the pancreas. The undigested fats will cause stools to be greasy, bulky, pale and watery. If the cancer is wrapped around the end of the stomach and cause a partial blockage which can lead to nausea, vomiting and pain after eating.
- When cancer is blocking the bile duct, it can lead to a buildup in the gallbladder and cause it to become enlarged. During a physical examination a doctor might feel the enlargement and it may also be detected during an imaging test.
- A blood clot or fatty tissue abnormality is oftentimes the first clue of pancreatic cancer. Another sign of pancreatic cancer might be an uneven texture in the fatty tissue under the skin, this is a result of the release of pancreatic enzymes that digest fat.
- Because exocrine cancers destroy the cells that make insulin, diabetes can develop. This can be detected by using certain blood tests.
When examining a patient who possibly has pancreatic cancer, a physician will take a thorough medical history to check for certain risk factors, find out how long the pain has been present, ask questions about appetite, weight loss, fatigue and other symptoms.
A complete physical exam will involve manually manipulating the abdomen to check for swelling, tenderness and any masses. The physician will check the skin and eyes for signs of jaundice and the gallbladder for enlargement. If the cancer has spread to the liver, causing it to enlarge, this can also be felt during manipulation of the abdomen. Lymph nodes above the collarbone and other areas will also be checked to indicate whether or not the cancer has spread.
A computed tomography scan (CT), is an x-ray that produces a detailed cross-sectional image of the body. Unlike an x-ray which takes only one picture, a CT scan takes several pictures as it rotates around the body. A computer will then combine the pictures into images that resemble “slices” of the portion of the body that is being studied.
CT scans are a useful tool for detecting and diagnosing pancreatic cancer and can also assist in staging the cancer. A CT scan will show the pancreas clearly and confirm the location of the cancer, also shown are the organs around the pancreas, as well as the lymph nodes. A scan can help determine what type of treatment option would work best.
Magnetic resonance imaging (MRI) uses magnets and strong radio waves to make pictures of the body. Generally, a CT scan is more preferred over an MRI when looking at the pancreas, but at times an MRI may yield more information.
Positron emission tomography (PET) scan is a procedure that involves giving the patient a glucose (form of sugar) injection which releases a radioactive atom into the bloodstream. Because cancer cells grow rapidly, they absorb more of the glucose than a normal cell. A PET scan is a useful test to check if cancer has spread into the lymph nodes, the test is also good for allowing a physician to find out if cancer has spread to other parts of the body.
When a PET and CT scan are combined, it is even easier to pinpoint the location of a tumor. The test is useful for locating cancer that might have spread to another part of the body and may not be treatable with surgery. A combined scan can also be used to stage the cancer and may be able to spot early forms of cancer in the body.
Ultrasonography (US) utilizes sound waves to produce a picture of internal organs such as the pancreas. A wand probe, called a transducer is placed over the abdomen and it emits sound waves and detects the echo produced as the sound waves bounce off internal organs. The pattern of echoes is processed by a computer to produce an image, the echoes made by tumors of the pancreas are different from those of normal tissue of the pancreas.
An endoscopic ultrasound is done under sedation (medicine to make the patient drowsy),and is more accurate than one done on the abdomen, making it a better way to diagnose pancreatic cancer. The test is performed using an ultrasound probe attached to the end of an endoscope, which is a lighted, thin, flexible tube with fiber optics. A physician will use the probe to enter through the patients mouth or nose, and view the inside of the intestines. An endoscopic ultrasound is a good way to peer inside the pancreas and is better than a CT scan for spotting smaller tumors and if one is seen, it can be biopsied during the procedure.
Endoscopic retrograde cholangiopancreatography (ERCP) uses an endoscope which is passed down the throat, through the esophagus and stomach, into the upper portion of the small intestine. A physician can then see through the endoscope to locate the ampulla of Vater (where the bile duct connects to the small intestine). A catheter (small, flexible tube) is then threaded into the bile duct and a small amount of dye is injected and x-rays are taken. The dye helps to outline the bile duct and pancreas duct, the image may show narrowing or enlargement of the organ which could indicate the presence of cancer. An ERCP is usually done while the patient is under sedation and a biopsy may also be done during the procedure.
An angiography is an x-ray procedure which looks at the blood vessels using a small amount of contrast dye which is injected into an artery. The procedure will show whether blood flow in any particular area is blocked or compressed due to a tumor. It may also show any blood vessels which are abnormal and might be feeding the cancer. An angiography can assist surgeons in deciding whether the cancer can be removed without causing damage to vital blood vessels.
There are several types of blood tests which a physician can use to detect or help diagnose pancreatic cancer, or it can help determine which treatment options would work best. There are blood tests that check levels of different types of billirubin (a chemical manufactured by the liver). Other types of blood tests are used to evaluate the overall health of a patient and can be used to determine if the patient is strong enough to withstand major surgery.
If a patients blood tests or imaging results strongly suggest the presence of pancreatic cancer, a physician may want to remove a small sample of the tumor to study under a microscope. The procedure is called a biopsy and there are several different types. A fine needle aspiration (FNA) biopsy is the procedure most often done to diagnose pancreatic cancer. A surgical biopsy is called a laparotomy, which involves making a large incision into the skin of the abdomen to examine the internal organs. A patient undergoing a laparotomy will have to be put under general anesthesia and spend time in the hospital to recover.
Another option is a laparoscopy, which involves putting the patient under sedation and a surgeon makes several tiny incisions and inserts small telescopic instruments into the abdominal cavity. One of the instruments is connected to a video monitor and the surgeon can view the organs and take a tissue sample if necessary.
How is Pancreatic Cancer Staged?
Staging pancreatic cancer is the most important factor when deciding upon which treatment protocols are available. Using a staging system is the way an oncology team describes the extent that a cancer has spread. Pancreatic cancer staging is done using the American Joint Committee on Cancer, TNM system (T describes the size of the tumor; N describes the spread of the pancreatic cancer into nearby lymph nodes; M is used to denote whether the cancer has metastasized or spread to other parts of the body).