Pancreatic Cancer Diagnosis
Accurate diagnosis and staging for pancreas tumors
An estimated 53,670 people are diagnosed each year with pancreatic cancer.
Finding pancreatic cancer early -- before it has a chance to spread to other areas of the body, or metastasize – offers the best chance of beating cancer with powerful and effective treatment options. When found early, more than 30 percent of patients are alive five years after their diagnosis.
Our pancreatic cancer specialists offer surgical and non-surgical treatments for pancreatic cancer and other digestive cancers. They’ll provide you with the support you need to understand your diagnosis, seek treatment with confidence, and manage your symptoms.
Diagnosing pancreatic cancer
Many people do not experience any noticeable symptoms of pancreatic cancer at an early stage. Symptoms often do not arise until the cancer has progressed to an advanced stage and possibly spread to other areas of the body.
Some symptoms that could be signs of pancreatic cancer include:
- Epigastric abdominal pain that radiates to the spine: The tumor in the pancreas can irritate nerves that cause a dull or aching pain.
- New onset jaundice: Yellowing of the eyes and skin that often can be preceded by dark-colored urine, pale or gray stool, or itchy skin.
- Weight loss: Unintended weight loss that may be accompanied by a loss of appetite could be a sign of pancreatic cancer.
- Nausea: A tumor can irritate the stomach and cause nausea, pain, and vomiting after eating.
- New onset diabetes myelitis: Previously healthy patients may be diagnosed with diabetes, or if you have a long-standing history of diabetes, sugar glucose control may become more difficult.
Risk factors for pancreatic cancer
- Family history of pancreatic cancer or pancreatitis
- Gene mutations
- Age over 55
- History of smoking or other tobacco use
- Type 2 diabetes
- African-American ethnicity
Advanced diagnostic imaging
We offer the latest imaging and laboratory testing to detect and diagnose pancreas tumors and cysts.
- Computerized tomography (CT) scans. This imaging tool can clearly see and make detailed cross-sectional images of the pancreas. CT scans can show if cancer has spread to organs near the pancreas, as well as to lymph nodes and distant organs. It also can help determine if surgery might be a good treatment option.
- Magnetic resonance imaging (MRI). A machine that uses a magnet, radio waves and a computer that makes detailed pictures of areas inside the body. A related test, magnetic resonance cholangiopancreatography (MRCP), looks at the ducts of the pancreas.
- Magnetic resonance cholangiopancreatography (MRCP). This is a non-invasive way to look at the pancreatic and bile ducts using the same type of machine used for standard MRI scans.
- Endoscopic ultrasound (EUS). This test is more accurate than abdominal ultrasound for diagnosing pancreatic cancer. This test is done with a small ultrasound probe on the tip of an endoscope. Your doctor will use this thin, flexible tube to look inside the digestive tract.
- Endoscopic retrograde cholangiopancreatography (ERCP). This test uses an endoscope (a thin, flexible tube with a tiny video camera on the end) that is passed through your mouth and down the digestive tract to your small intestine. Your doctor will guide a very small tube (a catheter) through the tip of the endoscope and into the common bile duct. A small amount of dye (contrast material) is then injected into the common bile duct, and x-rays are taken. This dye outlines the bile and pancreatic ducts. This test is done while you are sedated.
When imaging test results suggest pancreatic cancer, biopsy is often performed to confirm the diagnosis. A biopsy takes a sample of cells from the tumor. This sample is sent to our pathology experts for an analysis and staging.
There are different biopsy options to check for pancreatic cancer, including:
- Endoscopic biopsy. This sample is taken during an endoscopy, where a thin, flexible, tube with a small video camera on the end is passed down the throat and into the small intestine near the pancreas. Your doctor will pass a needle down the tube and into the tumor to remove cells from the bile or pancreatic ducts.
- Percutaneous (through the skin) biopsy. A thin, hollow needle is inserted through the skin over the abdomen and into the pancreas to remove a small piece of a tumor.
- Surgical biopsy. It is rare to need a surgical biopsy. In most cases, they are only used if the surgeon believes cancer has spread beyond the pancreas. A surgical biopsy will allow the surgeon to examine and possibly biopsy other organs in the abdomen. The most common way to do a surgical biopsy is to use laparoscopy (sometimes called keyhole surgery) where the surgeon makes several small incisions in the abdomen and inserts long, thin instruments, including a small camera.
Not all patients will need a biopsy. In some cases, imaging tests may be able to confirm cancer, or show that surgery can remove all the tumor.
How pancreatic cancer is staged
Staging is a way to determine how much cancer is in your body and where it is located. Our team uses several methods to accurately diagnosis and stage your pancreatic cancer. Accurate staging allows our team to offer you the best treatment options.
We use a simple staging system when you are first diagnosed with pancreatic cancer to begin your treatment planning.
The simple staging system divides pancreatic cancer into two groups:
- Tumor can be removed with surgery (resectable). If the cancer is only in the pancreas and your surgeon may be able to completely remove the tumor with surgery. (This typically includes most stage IA, IB, and IIA cancers in the TNM system.) While some cancers might appear to be resectable based on imaging tests, surgery may reveal that only some of the cancer can be removed. If this happens, the procedure will be stopped to avoid potential harm.
- Cancer cannot be removed with surgery (unresectable). Pancreatic cancer that is locally advanced (grown into or around nearby major blood vessels) or has metastasized (spread) to other organs cannot be removed completely or cured with surgery. Some type of surgery might still be done to prevent or relieve symptoms, or other issues like a blocked bile duct or intestinal tract.
TNM staging system
Our pancreatic cancer team uses the American Joint Committee on Cancer (AJCC) TNM system M to stage your cancer based on the size of the tumor and how far it has spread in the body. This system is uses the letters T, N, and M to stage cancer.
- T (tumor): Describes the size of the main tumor and whether it has grown outside the pancreas and into nearby organs.
- N (nodes): Describes the spread to nearby lymph nodes.
- M (metastasized): Indicates whether the cancer has metastasized (spread) to other organs in the body, like the liver, lungs, and the peritoneum (the lining that covers the organs in the abdomen).
Next your cancer is given an overall stage of 0, 1, 2, 3 or 4.
- Stage 0: Abnormal cells are found in the lining of the pancreas. They may or may not be cancer. This cancer also is called carcinoma in situ.
- Stage 1: Cancer is found in the pancreas only.
- Stage 1A tumors are two centimeters or smaller, the size of a small peanut without the shell.
- Stage 1B tumors are larger than two centimeters.
- Stage 2: Cancer may spread to nearby tissue, organs or lymph nodes near the pancreas. Stage 2A cancer has spread to nearby tissue but not the lymph nodes.
- Stage 2B cancer has spread to lymph nodes nearby and possibly to nearby tissue or organs.
- Stage 3: Cancer has spread to major blood vessels near the pancreas, including the superior mesenteric artery, the celiac axis, the common hepatic artery and the portal veins. It also may have spread to nearby tissues.
- Stage 4: Cancer may be any size and has spread to other parts of the body such as the lung, liver or abdominal cavity, as well as other organs near the pancreas and its adjacent lymph nodes
Additionally, your pancreatic cancer team may use other factors to determine your prognosis, including:
- Tumor grade. This is grade is assigned based on how your tumor cells look under the microscope. Tumor grade uses a scale that ranges from G1 (cancers look most like normal, healthy cells and have a good outlook) to G4. The grading for neuroendocrine tumors (NETs) is slightly different. NETs are graded based on how many of the cells have started to split (divide) into two new cells. NETs are divided into two groups: Well-differentiated NETs (low-grade, G1 or G2) or poorly differentiated tumors (high-grade, G3 tumors).
- Extent of resection. This looks at whether all the tumor and microscopic cancer cells were removed with surgery. This scale categorizes cancer as R0 (all cancer is removed with no visible signs of microscopic cancer cells), R1 (visible tumor is removed but lab tests show some remaining cancer cells) and R2 (some visible tumor could not be removed with surgery).
Genetic screening for pancreatic cancer
About 5 percent to 10 percent of pancreatic cancer occurs in people who have relatives who have had pancreatic cancer. These people have inherited a gene mutation that raises their risk of getting pancreatic and other cancers.
Not everyone with these mutations will develop cancer. Inherited mutations may include the following genes: BRCA2, BRCA1, PALB2, P16/CDKN2A, PRSS1 and ATM.
If you are a loved one are found to have an abnormal gene associated with pancreatic cancer, we recommend undergoing cancer screening.
In 2012, the International Cancer of the Pancreas Screening Consortium (CAPS) released consensus guidelines for pancreatic cancer screening.
Recommendations include screening with endoscopic ultrasound, magnetic resonance imaging or magnetic resonance cholangiopancreatography (MRCP), a MRI test that looks at the ducts of the pancreas, for the following high-risk groups:
- Individuals with two or more blood relatives, and at least one first-degree relative, with pancreatic cancer
- Carriers of p16, PALB2, or BRCA2 mutations with a first-degree relative with pancreatic cancer
- All individuals with Peutz-Jeghers syndrome
- Individuals with Lynch syndrome and a first-degree relative with pancreatic cancer
If you have a genetic mutation, our team will schedule regular appointments careful monitor your health for early signs of pancreatic cancer.