Table of ContentsView AllTable of ContentsLabs and TestsImagingDifferential DiagnosesStagingFrequently Asked QuestionsNext in Pancreatic Cancer GuidePancreatic Cancer
Table of ContentsView All
View All
Table of Contents
Labs and Tests
Imaging
Differential Diagnoses
Staging
Frequently Asked Questions
Next in Pancreatic Cancer Guide
The diagnosis of pancreatic cancer relies on several tools. A medical history focused on symptoms and risk factors, along with a physical exam, is the first step. Imaging tests, which may include a specialized abdominal CT scan, endoscopic ultrasound, MRI, and/or ERCP, can visualize the tumor.
Blood tests can help identify the causes of jaundice and may detect tumor markers. Depending on the preliminary findings, a biopsy may or may not be needed before surgery. After diagnosis, staging is done to determine the most appropriate treatments for the disease.
Talk to your healthcare provider and make an appointment to be seen right away if you developsymptoms of pancreatic cancer. Screening may be recommended based on yourrisk factors.
The American Gastroenterological Association recommends screening for people who are at high risk ofpancreatic cancer, including those who have a first-degree family history and certain genetic diseases and mutations. Screening includes genetic testing and counseling and should begin at age 50 or at an age that’s 10 years younger than the initial age of family onset.
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Your physical examination may show signs consistent with pancreatic cancer, but these changes can also occur with some other medical conditions.
Your skin and eyes may show evidence ofjaundice(yellowish discoloration of the skin and the whites of the eyes). Your abdominal examination may identify a. mass, enlargement of your liver, orascites(build-up of fluid in the abdomen).
Your healthcare provider might also observe that you appear malnourished or that you seem to have lost weight.
Blood test abnormalities are not specific to pancreatic cancer, but they can sometimes be helpful in making a diagnosis when combined with imaging tests.
Tests may include:
Blood sugar can be elevated with pancreatic cancer, which can cause insulin resistance or diabetes.
Individuals who experience a sudden case of pancreatitis (inflamed pancreas), have a higher risk of developing pancreatic cancer. Sudden-onset pancreatitis will show elevations in serum amylase and serum lipase in screening tests.
Tumor Markers
Another marker, CA 19-9, can be helpful in following the course of pancreatic cancer treatment, but it’s not always elevated with this kind of cancer, and it can be elevated with other conditions too.
What Is the Carcinoembryonic Antigen (CEA) Blood Test?
Neuroendocrine Tumor Blood Tests
Neuroendocrine tumors, which are rare, can develop in several different organs in the body, including the pancreas. These tumors involve endocrine cells, and they produce hormones or other proteins that can be detected with blood tests.
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Imaging tests are usually the primary method of visualizing a pancreatic mass.
CT Scan
Computerized tomography (CT), which uses X-rays to create a cross-section of a region of the body, is often the mainstay of diagnosis.For evaluating possible pancreatic cancer, a multiphase helical CT scan or pancreatic protocol CT scan is often recommended.
A CT scan can be helpful both for characterizing the tumor (determining its size and location in the pancreas) and looking for any evidence of spread to lymph nodes or other regions.
CT (Computed Tomography) Scan
Endoscopic Ultrasound (EUS)
Ultrasounduses sound waves to create an image of the inside of the body. A conventional (transcutaneous) ultrasound is not usually used to evaluate possible pancreatic cancer, because intestinal gas can make visualization of the pancreas difficult.
Endoscopic ultrasound can be a valuable procedure in making the diagnosis of pancreatic cancer. During this invasive test, an endoscope (a flexible tube with an ultrasound probe at its end) is inserted through the mouth and threaded down into the stomach or small intestine so that the images can be taken from inside the body.
This test allows healthcare providers to get a very good look at the pancreas.
This procedure is done with conscious sedation, and it is usually tolerated well. The test may be more accurate than CT for assessing the size and extent of a tumor but isn’t as useful for finding metastases (distant spread of the tumor) or determining if the tumor involves blood vessels.
CT may be more effective than endoscopic ultrasound in determining whether cancer has spread to the superior mesenteric artery, which is important in choosing treatment.
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Endoscopic retrograde cholangiopancreatography (ERCP)is an invasive test that involves endoscopy plus X-rays in order to visualize the bile ducts. ERCP can be a sensitive test for finding pancreatic cancer, but it is not accurate for differentiating the disease from other problems, such as pancreatitis.
MRI
Magnetic resonance imaging (MRI) uses magnets rather than X-rays to create an image of internal structures. MR cholangiopancreatography (MRCP) is used primarily for people whose diagnosis is unclear based on other studies, or if a person has an allergy to the contrast dye used for CT.
Octreoscan
A test called an octreoscan or somatostatin receptor scintigraphy (SRC) may be done if there’s concern about a neuroendocrine tumor of the pancreas.
Before an octreoscan, a radioactive protein tracer is injected into a vein. If a neuroendocrine tumor is present, the tracer will bind to cells in the tumor.Several hours later, a scan (scintigraphy) is done that picks up radiation that is being emitted. If present, neuroendocrine tumors will light up on the image.
PET Scan
PET scans, often combined with CT (PET/CT), may occasionally be done, but are not used often for diagnosing pancreatic cancer.
Biopsy
A biopsy (sample of tissue) is usually needed to confirm the diagnosis of pancreatic cancer. This test is also used to look at the molecular characteristics of the tumor.In selected cases, surgery can be done without a biopsy.
A fine needle biopsy (a procedure in which a thin needle is directed through the skin in the abdomen and into the pancreas to extract a sample of tissue) is most often done using ultrasound or CT guidance.
There is some concern that this type of biopsy could “seed” the tumor, resulting in the spread of cancer along the line where the needle is introduced.
It’s not known how often seeding occurs, but according to a 2017 study, the number of case reports of seeding due to endoscopic ultrasound-guided fine-needle aspiration has been rapidly increasing.
As an alternative approach, a more invasive procedure—laparoscopy—may be used to obtain a biopsy, especially if a tumor could potentially be completely resectable (able to be removed) during laparoscopic surgery. During a laparoscopy, several small incisions are made in the abdomen and a narrow instrument is inserted to obtain the biopsy sample.
There are a number of conditions that may mimic the symptoms of pancreatic cancer or result in similar findings on blood tests and imaging.
Healthcare providers will work to rule out the following before making a diagnosis:
Determining the stage of pancreatic cancer is extremely important when it comes to deciding whether cancer can be surgically removed or not. Staging can also assist in estimating the prognosis of the disease.
There are several staging systems used for pancreatic cancer. The simplest of these defines cancer as resectable, borderline resectable, or nonresectable.
TNM Staging
Healthcare providers use a system called TNM staging to determine the stage of a tumor.
Tstands for tumor. A tumor is given a number from T1 to T4 based on the size of the tumor, as well as other structures the tumor may have invaded.
For a primary pancreatic tumor:
Mstands for metastases. If a tumor has not spread, it would be described as M0, meaning no distant metastasis. If it has spread to distant regions (beyond the pancreas) it would be referred to as M1.
Based on TNM, tumors are given a stage between 0 and 4.
There are also substages:
Frequently Asked QuestionsThere isn’t a specific blood test for pancreatic cancer, but certain blood tests can help contribute to the diagnosis and guide treatment.These tests check:Liver functionBilirubin levelsTumor markersPlatelet countSeveral types of imaging tests may be used to diagnose pancreatic cancer:CT scanshelp determine if cancer is present and has spread and may guide a biopsy.MRIsare used for those who can’t undergo CT scans or when other tests are inconclusive.Ultrasoundsmay be done from outside the abdomen or via an endoscope that’s inserted into the digestive tract.It’s difficult to diagnose pancreatic cancer early because the organ is deep in the abdomen. It can’t be felt in a physical exam, imaging tests don’t catch small lesions, and there isn’t a single blood test that can detect it. Most cases of pancreatic cancer aren’t diagnosed untilstage 4when it’s metastasized.Learn MoreStage 4 Pancreatic Cancer: Prognosis and Survival Rates
There isn’t a specific blood test for pancreatic cancer, but certain blood tests can help contribute to the diagnosis and guide treatment.These tests check:Liver functionBilirubin levelsTumor markersPlatelet count
There isn’t a specific blood test for pancreatic cancer, but certain blood tests can help contribute to the diagnosis and guide treatment.These tests check:
Several types of imaging tests may be used to diagnose pancreatic cancer:CT scanshelp determine if cancer is present and has spread and may guide a biopsy.MRIsare used for those who can’t undergo CT scans or when other tests are inconclusive.Ultrasoundsmay be done from outside the abdomen or via an endoscope that’s inserted into the digestive tract.
It’s difficult to diagnose pancreatic cancer early because the organ is deep in the abdomen. It can’t be felt in a physical exam, imaging tests don’t catch small lesions, and there isn’t a single blood test that can detect it. Most cases of pancreatic cancer aren’t diagnosed untilstage 4when it’s metastasized.Learn MoreStage 4 Pancreatic Cancer: Prognosis and Survival Rates
It’s difficult to diagnose pancreatic cancer early because the organ is deep in the abdomen. It can’t be felt in a physical exam, imaging tests don’t catch small lesions, and there isn’t a single blood test that can detect it. Most cases of pancreatic cancer aren’t diagnosed untilstage 4when it’s metastasized.
Learn MoreStage 4 Pancreatic Cancer: Prognosis and Survival Rates
How Pancreatic Cancer Is Treated
18 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Lee ES, Lee JM.Imaging diagnosis of pancreatic cancer: a state-of-the-art review.World J Gastroenterol. 2014;20(24):7864-7877. doi:10.3748/wjg.v20.i24.7864Aslanian HR, Lee JH, Canto MI. AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review [published online ahead of print, 2020 May 19].Gastroenterology. 2020;S0016-5085(20)30657-0. doi:10.1053/j.gastro.2020.03.088Aslanian HR, Lee JH, Canto MI.AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review.Gastroenterology. Jul 2020. 159(1);358-362. doi:10.1053/j.gastro.2020.03.088Kim VM, Ahuja N.Early detection of pancreatic cancer.Chin J Cancer Res. 2015;27(4):321-331. doi:10.3978/j.issn.1000-9604.2015.07.03American Cancer Society.Tests for Pancreatic Cancer.Kwon CI, Cho JH, Choi SH, et al.Recent advances in the diagnosis and management of chronic pancreatitis.Korean J Intern Med. 2019;34(2):242-260. doi:10.3904/kjim.2019.051Schlieman MG, Ho HS, Bold RJ.Utility of tumor markers in determining resectability of pancreatic cancer.Arch Surg. 2003;138(9):951-955. doi:10.1001/archsurg.138.9.951Ballehaninna UK, Chamberlain RS.Serum CA 19-9 as a Biomarker for Pancreatic Cancer-A Comprehensive Review.Indian J Surg Oncol. 2011;2(2):88-100. doi:10.1007/s13193-011-0042-1National Cancer Institute.Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment (PDQ®)–Patient Version.Tummala P, Junaidi O, Agarwal B.Imaging of pancreatic cancer: An overview.J Gastrointest Oncol. 2011;2(3):168-174. doi:10.3978/j.issn.2078-6891.2011.036Squires MH, Volkan Adsay N, Schuster DM, et al.Octreoscan Versus FDG-PET for Neuroendocrine Tumor Staging: A Biological Approach.Ann Surg Oncol. 2015;22(7):2295-2301. doi:10.1245/s10434-015-4471-xMinaga K, Takenaka M, Katanuma A, et al.Needle Tract Seeding: An Overlooked Rare Complication of Endoscopic Ultrasound-Guided Fine-Needle Aspiration.Oncology. 2017;93 Suppl 1:107-112. doi:10.1159/000481235The National Pancreas Foundation.Preoperative Evaluation in Pancreatic Cancer- How much is enough?Li S, Tian B.Acute pancreatitis in patients with pancreatic cancer: Timing of surgery and survival duration.Medicine (Baltimore). 2017;96(3):e5908. doi:10.1097/MD.0000000000005908National Organization for Rare Disorders.Cholangiocarcinoma.De La Cruz MSD, Young AP, Ruffin MT.Diagnosis and Management of Pancreatic Cancer.Am Fam Physician.2014;89(8):626-632.American Cancer Society.Pancreatic Cancer Stages.National Cancer Institute, Surveillance, Epidemiology, and End Results Program.Cancer stat facts: Pancreatic cancer.Additional ReadingPancreatic Cancer Diagnosis. American Society of Clinical Oncology. Cancer.Net.Current and Emerging Therapies in Pancreatic Cancer, Springer Verlag.Kikuyama, M., Kamisawa, T., Kuruma, S. et al. Early Diagnosis to Improve the Poor Prognosis of Pancreatic Cancer.Cancers. 2018. 10(2):.pii: E48. doi:10.3390/cancers10020048.
18 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Lee ES, Lee JM.Imaging diagnosis of pancreatic cancer: a state-of-the-art review.World J Gastroenterol. 2014;20(24):7864-7877. doi:10.3748/wjg.v20.i24.7864Aslanian HR, Lee JH, Canto MI. AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review [published online ahead of print, 2020 May 19].Gastroenterology. 2020;S0016-5085(20)30657-0. doi:10.1053/j.gastro.2020.03.088Aslanian HR, Lee JH, Canto MI.AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review.Gastroenterology. Jul 2020. 159(1);358-362. doi:10.1053/j.gastro.2020.03.088Kim VM, Ahuja N.Early detection of pancreatic cancer.Chin J Cancer Res. 2015;27(4):321-331. doi:10.3978/j.issn.1000-9604.2015.07.03American Cancer Society.Tests for Pancreatic Cancer.Kwon CI, Cho JH, Choi SH, et al.Recent advances in the diagnosis and management of chronic pancreatitis.Korean J Intern Med. 2019;34(2):242-260. doi:10.3904/kjim.2019.051Schlieman MG, Ho HS, Bold RJ.Utility of tumor markers in determining resectability of pancreatic cancer.Arch Surg. 2003;138(9):951-955. doi:10.1001/archsurg.138.9.951Ballehaninna UK, Chamberlain RS.Serum CA 19-9 as a Biomarker for Pancreatic Cancer-A Comprehensive Review.Indian J Surg Oncol. 2011;2(2):88-100. doi:10.1007/s13193-011-0042-1National Cancer Institute.Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment (PDQ®)–Patient Version.Tummala P, Junaidi O, Agarwal B.Imaging of pancreatic cancer: An overview.J Gastrointest Oncol. 2011;2(3):168-174. doi:10.3978/j.issn.2078-6891.2011.036Squires MH, Volkan Adsay N, Schuster DM, et al.Octreoscan Versus FDG-PET for Neuroendocrine Tumor Staging: A Biological Approach.Ann Surg Oncol. 2015;22(7):2295-2301. doi:10.1245/s10434-015-4471-xMinaga K, Takenaka M, Katanuma A, et al.Needle Tract Seeding: An Overlooked Rare Complication of Endoscopic Ultrasound-Guided Fine-Needle Aspiration.Oncology. 2017;93 Suppl 1:107-112. doi:10.1159/000481235The National Pancreas Foundation.Preoperative Evaluation in Pancreatic Cancer- How much is enough?Li S, Tian B.Acute pancreatitis in patients with pancreatic cancer: Timing of surgery and survival duration.Medicine (Baltimore). 2017;96(3):e5908. doi:10.1097/MD.0000000000005908National Organization for Rare Disorders.Cholangiocarcinoma.De La Cruz MSD, Young AP, Ruffin MT.Diagnosis and Management of Pancreatic Cancer.Am Fam Physician.2014;89(8):626-632.American Cancer Society.Pancreatic Cancer Stages.National Cancer Institute, Surveillance, Epidemiology, and End Results Program.Cancer stat facts: Pancreatic cancer.Additional ReadingPancreatic Cancer Diagnosis. American Society of Clinical Oncology. Cancer.Net.Current and Emerging Therapies in Pancreatic Cancer, Springer Verlag.Kikuyama, M., Kamisawa, T., Kuruma, S. et al. Early Diagnosis to Improve the Poor Prognosis of Pancreatic Cancer.Cancers. 2018. 10(2):.pii: E48. doi:10.3390/cancers10020048.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Lee ES, Lee JM.Imaging diagnosis of pancreatic cancer: a state-of-the-art review.World J Gastroenterol. 2014;20(24):7864-7877. doi:10.3748/wjg.v20.i24.7864Aslanian HR, Lee JH, Canto MI. AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review [published online ahead of print, 2020 May 19].Gastroenterology. 2020;S0016-5085(20)30657-0. doi:10.1053/j.gastro.2020.03.088Aslanian HR, Lee JH, Canto MI.AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review.Gastroenterology. Jul 2020. 159(1);358-362. doi:10.1053/j.gastro.2020.03.088Kim VM, Ahuja N.Early detection of pancreatic cancer.Chin J Cancer Res. 2015;27(4):321-331. doi:10.3978/j.issn.1000-9604.2015.07.03American Cancer Society.Tests for Pancreatic Cancer.Kwon CI, Cho JH, Choi SH, et al.Recent advances in the diagnosis and management of chronic pancreatitis.Korean J Intern Med. 2019;34(2):242-260. doi:10.3904/kjim.2019.051Schlieman MG, Ho HS, Bold RJ.Utility of tumor markers in determining resectability of pancreatic cancer.Arch Surg. 2003;138(9):951-955. doi:10.1001/archsurg.138.9.951Ballehaninna UK, Chamberlain RS.Serum CA 19-9 as a Biomarker for Pancreatic Cancer-A Comprehensive Review.Indian J Surg Oncol. 2011;2(2):88-100. doi:10.1007/s13193-011-0042-1National Cancer Institute.Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment (PDQ®)–Patient Version.Tummala P, Junaidi O, Agarwal B.Imaging of pancreatic cancer: An overview.J Gastrointest Oncol. 2011;2(3):168-174. doi:10.3978/j.issn.2078-6891.2011.036Squires MH, Volkan Adsay N, Schuster DM, et al.Octreoscan Versus FDG-PET for Neuroendocrine Tumor Staging: A Biological Approach.Ann Surg Oncol. 2015;22(7):2295-2301. doi:10.1245/s10434-015-4471-xMinaga K, Takenaka M, Katanuma A, et al.Needle Tract Seeding: An Overlooked Rare Complication of Endoscopic Ultrasound-Guided Fine-Needle Aspiration.Oncology. 2017;93 Suppl 1:107-112. doi:10.1159/000481235The National Pancreas Foundation.Preoperative Evaluation in Pancreatic Cancer- How much is enough?Li S, Tian B.Acute pancreatitis in patients with pancreatic cancer: Timing of surgery and survival duration.Medicine (Baltimore). 2017;96(3):e5908. doi:10.1097/MD.0000000000005908National Organization for Rare Disorders.Cholangiocarcinoma.De La Cruz MSD, Young AP, Ruffin MT.Diagnosis and Management of Pancreatic Cancer.Am Fam Physician.2014;89(8):626-632.American Cancer Society.Pancreatic Cancer Stages.National Cancer Institute, Surveillance, Epidemiology, and End Results Program.Cancer stat facts: Pancreatic cancer.
Lee ES, Lee JM.Imaging diagnosis of pancreatic cancer: a state-of-the-art review.World J Gastroenterol. 2014;20(24):7864-7877. doi:10.3748/wjg.v20.i24.7864
Aslanian HR, Lee JH, Canto MI. AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review [published online ahead of print, 2020 May 19].Gastroenterology. 2020;S0016-5085(20)30657-0. doi:10.1053/j.gastro.2020.03.088
Aslanian HR, Lee JH, Canto MI.AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review.Gastroenterology. Jul 2020. 159(1);358-362. doi:10.1053/j.gastro.2020.03.088
Kim VM, Ahuja N.Early detection of pancreatic cancer.Chin J Cancer Res. 2015;27(4):321-331. doi:10.3978/j.issn.1000-9604.2015.07.03
American Cancer Society.Tests for Pancreatic Cancer.
Kwon CI, Cho JH, Choi SH, et al.Recent advances in the diagnosis and management of chronic pancreatitis.Korean J Intern Med. 2019;34(2):242-260. doi:10.3904/kjim.2019.051
Schlieman MG, Ho HS, Bold RJ.Utility of tumor markers in determining resectability of pancreatic cancer.Arch Surg. 2003;138(9):951-955. doi:10.1001/archsurg.138.9.951
Ballehaninna UK, Chamberlain RS.Serum CA 19-9 as a Biomarker for Pancreatic Cancer-A Comprehensive Review.Indian J Surg Oncol. 2011;2(2):88-100. doi:10.1007/s13193-011-0042-1
National Cancer Institute.Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment (PDQ®)–Patient Version.
Tummala P, Junaidi O, Agarwal B.Imaging of pancreatic cancer: An overview.J Gastrointest Oncol. 2011;2(3):168-174. doi:10.3978/j.issn.2078-6891.2011.036
Squires MH, Volkan Adsay N, Schuster DM, et al.Octreoscan Versus FDG-PET for Neuroendocrine Tumor Staging: A Biological Approach.Ann Surg Oncol. 2015;22(7):2295-2301. doi:10.1245/s10434-015-4471-x
Minaga K, Takenaka M, Katanuma A, et al.Needle Tract Seeding: An Overlooked Rare Complication of Endoscopic Ultrasound-Guided Fine-Needle Aspiration.Oncology. 2017;93 Suppl 1:107-112. doi:10.1159/000481235
The National Pancreas Foundation.Preoperative Evaluation in Pancreatic Cancer- How much is enough?
Li S, Tian B.Acute pancreatitis in patients with pancreatic cancer: Timing of surgery and survival duration.Medicine (Baltimore). 2017;96(3):e5908. doi:10.1097/MD.0000000000005908
National Organization for Rare Disorders.Cholangiocarcinoma.
De La Cruz MSD, Young AP, Ruffin MT.Diagnosis and Management of Pancreatic Cancer.Am Fam Physician.2014;89(8):626-632.
American Cancer Society.Pancreatic Cancer Stages.
National Cancer Institute, Surveillance, Epidemiology, and End Results Program.Cancer stat facts: Pancreatic cancer.
Pancreatic Cancer Diagnosis. American Society of Clinical Oncology. Cancer.Net.Current and Emerging Therapies in Pancreatic Cancer, Springer Verlag.Kikuyama, M., Kamisawa, T., Kuruma, S. et al. Early Diagnosis to Improve the Poor Prognosis of Pancreatic Cancer.Cancers. 2018. 10(2):.pii: E48. doi:10.3390/cancers10020048.
Pancreatic Cancer Diagnosis. American Society of Clinical Oncology. Cancer.Net.
Current and Emerging Therapies in Pancreatic Cancer, Springer Verlag.
Kikuyama, M., Kamisawa, T., Kuruma, S. et al. Early Diagnosis to Improve the Poor Prognosis of Pancreatic Cancer.Cancers. 2018. 10(2):.pii: E48. doi:10.3390/cancers10020048.
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