Pancreatic Cancer Testing & Diagnosis

Pancreatic cancer is usually diagnosed with tests that make pictures of the pancreas and the area around it. These imaging tests are also used to find out if cancer cells have spread within and around the pancreas, a process called staging. 

In addition to imaging, blood tests will likely be done to look for tumor markers—molecules produced by pancreatic cancer cells and released into the blood stream. Tumor markers are not made by any other cells in the body. Tumor markers are not found in all people with pancreatic cancer, but when they are present, they can help your doctor estimate prognosis because they provide information about the total amount of cancer in the body and how the cancer will respond to treatment.

Tests and procedures to find, diagnose, and stage pancreatic cancer are usually done at the same time. Knowing the stage of the disease and whether the cancer can be removed by surgery will help you and your doctor plan treatment.

Your doctor may use the following tests and procedures to diagnose and stage pancreatic cancer:

Imaging tests

CT scan (CAT scan)

CT scan uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body, such as the chest. The pictures are taken from different angles and are used to create 3-D views of tissues and organs. A dye may be injected into a vein or swallowed to help the organs or tissues including the pancreas and pancreatic lesions to show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography and often has dedicated imaging protocols to obtain the best, most detailed pictures of the pancreas. Learn more at Computed Tomography (CT) Scans and Cancer.

MRI/MRCP (magnetic resonance imaging/magnetic resonance cholangiopancreatography)

MRI uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). MRCP, which administers a dye which is excreted in the liver into the bile ducts, is a type of MRI that can make detailed pictures of the liver, bile ducts, gallbladder, pancreas, and pancreatic duct to check for abnormal areas and cancer.

PET scan (positron emission tomography scan)

PET scan uses a small amount of radioactive sugar (also called radioactive glucose) that is injected into a vein. The PET scanner rotates around the body and makes a picture of where sugar is being taken up and used by the body. Cancer cells show up brighter in the pictures because they take up more sugar than normal cells do. When this procedure is done at the same time as a CT scan or an MRI, it is called a PET-CT scan or a PET-MRI. PET scans, although not routinely used, can help to find cancer cells which have spread to other organs and improve the accuracy of staging.

Ultrasound

Ultrasound uses high-energy sound waves (ultrasound) that bounce off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. Abdominal ultrasound and endoscopic ultrasound may be used to look for pancreatic cancer.

Laboratory tests

Tumor marker test

Tumor marker tests use a blood sample to measure the amounts of certain substances, called tumor markers, released into the blood by pancreatic tumor cells. Levels of tumor markers CA 19-9—the most specific tumor marker for pancreatic cancer—and carcinoembryonic antigen (CEA) can help your doctor understand the total amount of pancreatic cancer in the body.

Liver function test

Liver function tests measure the amounts of certain enzymes and substances made by the liver and released into the blood. A higher-than-normal amount of a substance can be a sign that pancreatic cancer has spread to the liver or is blocking the bile duct.

Biopsy

Biopsy is the removal of a sample of cells or tissue from the tumor so that a pathologist can view it under a microscope to make a final diagnosis of pancreatic cancer. 

The following biopsy procedures may be used to collect the sample:

• Needle biopsy. Cells may be removed using a fine or wide needle inserted into the pancreas during an x-ray or ultrasound.
• Endoscopic retrograde cholangiopancreatography (ERCP). ERCP uses an endoscope and x-rays to look at the ducts that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreatic cancer causes these ducts to narrow, which blocks or slows the flow of bile and causes jaundice. Cells may be removed from these narrowed bile ducts using a brush or a grasping tool called forceps.

Laparoscopy

Laparoscopy is a minimally invasive surgery to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions.

If you are scheduled for surgery to remove a pancreatic tumor and you have high levels of CA 19-9, your surgeon may perform a diagnostic laparoscopy right before the surgery. During the laparoscopy, the surgeon will check for signs that the cancer has spread that imaging may have missed. If the surgeon finds that the cancer has spread, surgery to remove the tumor will be stopped and you will instead receive systemic therapy. That is because surgically removing a pancreatic tumor that has spread has not been shown to improve outcomes.

Molecular testing

A molecular test checks for certain genes, proteins, or other molecules in a sample of tissue, blood, or tumor. Molecular tests also check for certain changes in a gene or chromosomes that may cause pancreatic cancer or affect how fast the cancer grows and spreads. A molecular test can help diagnose pancreatic cancer and plan treatment. If molecular testing finds that the tumor has certain gene changes (mutations), you may be able to receive targeted therapies that target those specific gene changes. Because molecular tests can open additional treatment options, it is recommended that all people with pancreatic cancer receive molecular testing. Molecular testing, or molecular profiling, is often performed on the initial biopsy sample reviewed by the pathologist.

Your doctor might suggest genetic testing as part of diagnosing pancreatic cancer. Genetic testing can be done on a sample of your blood, saliva, or from a swab of inside your cheek. Genetic test results show if you were born with a change in a pancreatic cancer risk gene. Knowing if you have a specific genetic change may help your doctor suggest the best treatment for your cancer. These gene changes are sometimes called mutations or pathogenic variants.

Genetic counseling before genetic testing can help you understand your chances of having a gene change that caused pancreatic cancer. Genetic testing is recommended for all people with pancreatic cancer, even those without a family history of the disease, because it can help determine if you should receive targeted therapies.

Genetic counselors can help you cope with your genetic testing results, including how to discuss the results with family members. They can advise you about whether other members of your family should receive genetic testing to find out if they are at risk of pancreatic cancer or other cancers. Learn more about Genetic Testing for Inherited Cancer Risk.

Waiting for cancer test results can be stressful. Ask your doctor when the results will be ready and how you will be notified so you know how long it will be before you hear back. If you don’t hear back within the expected time, it’s okay to follow up with your doctor. 

Sometimes test results are released to your patient portal before you’ve met with your doctor. Although it can be difficult to wait to look at the test results until you are able to review them with your doctor, doing so can help avoid confusion about what the results mean. 

If you need help dealing with the stress of waiting for the test results, reach out to your care team. A social worker can offer support and resources to help you. Whatever the results, your doctor can help you understand next steps.