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Tests And Diagnosis

If a person has signs and symptoms that might be caused by pancreatic cancer, certain exams and tests will be done to find the cause. If cancer is found, further tests will then be done to help determine the extent (stage) of the cancer.

Medical history and physical exam

Your doctor will ask about your medical history to check for any pancreatic cancer risk factors, and to learn more about any symptoms you are having, such as pain, changes in appetite, weight loss, and tiredness.

A thorough physical exam will focus mostly on your abdomen (belly) to check for any masses or fluid buildup. Cancers that block the bile duct may cause the gallbladder to enlarge, which can sometimes be felt on physical exam. Pancreatic cancer may spread to the liver, causing it to enlarge. Your skin and the whites of your eyes will be checked for jaundice (yellowing).

Pancreatic cancer can also spread to lymph nodes above the collarbone and other locations. These areas will be looked at carefully for lumps or swelling that might mean cancer spread.

If the results of the exam are abnormal, your doctor will probably order tests to help find the problem. You might also be referred to a gastroenterologist (a doctor who treats digestive system diseases) for further tests and treatment.

Imaging tests

Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests might be done for a number of reasons both before and after a diagnosis of pancreatic cancer, including:

  • To look for suspicious areas that might be cancer
  • To learn if and how far cancer has spread
  • To help determine if treatment is working
  • To look for signs of cancer coming back after treatment

Computed tomography (CT) scan

The CT scan uses x-rays to produce detailed cross-sectional images of your body. CT scans are often used to diagnose pancreatic cancer because they can show the pancreas fairly clearly. They can also help show if cancer has spread to organs near the pancreas, as well as to lymph nodes and distant organs. A CT scan can help determine if surgery might be a good treatment option.

A CT scanner has been described as a large donut, with a narrow table that slides in and out of the middle opening. You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken. Instead of taking one picture, like a standard xray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image of a slice of your body.

Before the test, you might be asked to drink 1 to 2 pints of a liquid called oral contrast. This helps outline the intestine so that certain areas are not mistaken for tumors. You might also receive an IV line through which a different kind of contrast dye (IV contrast) is injected. This helps better outline structures such as blood vessels in your body.

The injection can cause some flushing (redness and warm feeling). Some people are allergic to the dye and get hives or, rarely, have more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have any allergies or have ever had a reaction to any contrast material used for x-rays.

If your doctor suspects you might have pancreatic cancer, you may have one set of CT scans of your abdomen taken before you get IV contrast. Other sets of scans may then be taken over the next several minutes as the contrast passes through the pancreas and other parts of the body. These sets of scans together are known as a multiphase CT scan or a pancreatic protocol CT scan.

CT-guided needle biopsy: CT scans can also be used to guide a biopsy needle into a suspected pancreatic tumor. But if a needle biopsy is needed, most doctors prefer to use endoscopic ultrasound (described below) to guide the needle into place.

For this procedure, you remain on the CT scanning table while the doctor advances a biopsy needle through the skin and toward the tumor. CT scans are repeated until the needle is within the mass. A needle biopsy sample is then removed to be looked at under a microscope.

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