To determine if the patient has pancreatic cancer, a number of different procedures are performed.
A physical examination usually is the first step towards diagnosis. When a patient exhibits symptoms, the physician will feel the abdomen for changes in the area around the pancreas, liver, and gallbladder and for abnormal fluid swelling in the abdomen, called ascites. Blood, urine and stool samples may be checked for bilirubin, a buildup which can occur from the blockage of the common bile duct by a tumor. Tumor markers, proteins that appear in the blood at the time of cancer, can be helpful for diagnosis and follow-up.
A computerized tomography (CT) scan is a type of x-ray that can take very detailed pictures. The CT scan is used to detect tumors in the pancreas, lymph nodes, and liver, in addition to detecting a blocked bile duct. When having a CT scan the patient, lying down, is slowly slid through a ring, which takes pictures in sequence. A contrast dye is injected through an IV so internal structures can be seen more clearly on the resulting pictures. Together, the pictures create a thorough internal image of the body.
An ultrasound utilizes inaudible sound waves, which bounce off internal organs and create a picture of the internal body. Two kinds of ultrasound procedures are employed at the possibility of pancreatic cancer: external or internal. Externally an ultrasound device is placed on the abdomen, which is referred to as a transabdominal ultrasound. Internally, in an endoscopic ultrasound (EUS) an endoscope, or a thin tube with an ultrasound device at the end, is inserted into the body via the mouth through to the small intestine. An ultrasound device is at the end of the tube.
In an endoscopic retrograde cholangiopancreatography (ERCP), an endoscope, or thin tube, is passed through the body through the mouth. The physician can see through the tube as it is pushed towards the small intestine, where then a smaller tube, called a catheter, is inserted through the endoscope. The catheter releases harmless dye that outlines the structure of the ducts. An x-ray is taken showing whether the ducts are blocked or narrowed.
In a percutaneous transhepatic cholangiography (PTC), harmless dye is injected to the liver through the skin. An x-ray is taken showing if or where there are blockages in the bile ducts, which can indicate tumorous growth.
In a biopsy, a piece of tissue is extracted from the pancreas and examined under a microscope by a pathologist. The tissue can be removed with a needle, during an ERCP or an EUS, or during an operation on the abdomen.
PET scans are now used often to determine if the cancer can be removed surgically.