Medical Tests & Diagnosis Methods
Pancreatic cancer is a form of cancer that is difficult to diagnose in
the early stages because its symptoms occur only when the cancer is advanced
or metastasized and because of the pancreas location behind the stomach
and inside a loop of small intestines. This makes it almost impossible
for the tumors to be detected during a routine physical examination. There
are several tests that can be administered in order to diagnose pancreatic
In order to diagnose the cancer each patient has to follow several steps
and medical tests. These steps include:
Anamnesis (a personal
The first step in establishing a diagnosis is a detailed and complex
medical review of past health problems, general health state,
displayed symptoms, the medical family history, and pancreatic
cancer risk factors (smoking, diet high in fat, etc.)
The next step is a physical examination that focuses on (1) the
abdomen area - if any suspicious masses or fluid accumulation
developed and can be felt, (2) the skin and eyes color - if there
is any sign of jaundice, (3) the liver size - when the cancer
spreads to liver, it becomes larger in size then normal and can
be felt by touch, and (4) lymph nodes - if they are swollen.
A reliable blood test that can be conducted in order to diagnose pancreatic
cancer is called CA 19-9. CA 19-9 is a substance produced by the pancreatic
cancer cells that can be detected in blood. The main disadvantage of
this blood test is that it can only detect pancreatic cancer when it
has reached an advanced stage, which is when CA19-9 is produced in higher
then normal amounts.
There are several imaging tests that can be done in order to diagnose
Computerized Tomography (CT) scan: This
is an imaging test, similar with an x-ray test, that creates a detailed
cross-sectional image of the body. Sometimes, this test is performed
after a contrast agent is administered (through an IV) that facilitates
a better visibility of the tumor. Normally, a CT scan involves two
steps. First, an initial set of pictures of the body are taken, and
second, a contrast agent is administrated and a second set of pictures
are taken and compared with the first. In general, this technique
is useful in providing information regarding the size and the exact
location of the tumor, and can show if the cancer has spread to other
organs or areas in the body. For pancreatic cancer patients, the CT
scan is used to make an initial diagnosis of the cancer and also for
establishing the stage of the cancer.
Positron Emission Tomography (PET): This technique
uses radioactive glucose to help locate cancerous tumors. The glucose
used in this diagnosis method contains a radioactive atom that is
highly absorbed by the cancerous cells. The radioactivity is then
detected by a special camera. A PET scan is used efficiently to determine
whether or not the cancer spreads beyond the pancreas and the exact
location where it has spread.
Magnetic Resonance Imaging (MRI): An
MRI is an advanced technique that uses radio waves and strong magnets
to reveal a complete image of a targeted area of the body. The energy
from the radio waves is absorbed by the tissues and then released
into a pattern that allows the cancer to be detected and diagnosed.
Ultrasound Imaging: Ultrasound imaging is a medical
technique that uses high-frequency sound waves to create an interior
image of the body on a special computer screen. This image is formed
from the echoes of the sound waves on the surface of the organs. Abnormal
tissue masses and organs reflect sound waves differently. This test
involves a device called a transducer that is placed on the upper
part of the abdomen and a computer that translates this sound into
image. Ultrasound Imaging is a safe, noninvasive and brief test that
can detect tumors.
Endoscopic Ultrasound (EUS) or Endosonography:
EUS is an efficient test in diagnosing pancreatic cancer. This procedure
is a little bit uncomfortable for the patient because a thin, lighted
tube (called endoscope) is inserted through the mouth or nose into
the body. The endoscope uses high-energy sound waves that bounce off
when they come in contact with internal tissues or organs, thereby
creating "echoes." These echoes form an inside image of
the body called a sonogram.
Endoscopic Retrograde Cholangiopancreatiography
(ERCP): ERCP is a procedure which x-rays the duct that carries
bile from the liver to the gallbladder and then to the small intestine.
Sometimes, pancreatic cancer narrows this duct and causes the bile
flow to be slowed or stopped causing jaundice. This procedure also
uses a thin, lighted tube (endoscope) that is inserted through the
throat down into the stomach and then into the small intestine. Through
the endoscope, the doctor air is blown in that inflates the intestine
offering a better view of the pancreatic and bile ducts. A catheter
is then inserted through the endoscope into the pancreatic duct and
through this catheter a dye is injected. If the pancreatic duct is
blocked by the tumor, a fine tube is also inserted in to unblock the
duct. If necessary, tissue samples are collected.
Percutaneous Transhepatic Cholangiography (PTC):
This is a procedure that uses a movable x-ray device and
a thin needle, (that is inserted through the skin into the liver,
below the ribs), in order to capture an image of the liver and bile
duct. During this procedure, a dye is inserted into the bile duct
and liver, and x-rayed. If any obstruction or blockage is revealed,
a thin tube (called a stent) is inserted and left in the liver to
help the bile to drain into the small intestine or into a collection
bag attached outside the body. This procedure is performed only if
the endoscopic retrograde cholangiopancreatiography cannot be performed.
A biopsy is a medical procedure that removes a certain amount of tissue
for a microscopic examination. This procedure allows the pathologist to
establish the nature of the cells and determine whether they are cancerous
or not, and the stage of the cancer.
There are several types of biopsies performed to diagnose cancer. The
most commonly used type of biopsy in diagnosing pancreatic cancer is fine
needle aspiration (FNA). This procedure involves taking a sample
of cells from the pancreas tissue or tumor by using a thin needle attached
to a syringe. Fine needle aspiration is performed only if the tumor can
be easily reached. This procedure is usually performed during an Ultrasound
or CT scan that guides the needle.
Tissue samples can also be removed during endoscopic retrograde
cholangiopancreatiography or percutaneous transhepatic
This procedure is rarely recommended today. When it is performed, a laparoscope
is employed to closely examine the pancreas and, if needed, to take a
sample of the pancreatic tissue. Laparoscopy is a medical procedure that
uses a small, lighted instrument called laparoscope to view the pancreas
and the surrounding areas. The laparoscope has a video camera attached
a that allows an interior image of the body to be seen on a monitor. This
procedure can aslo be used to determine how far the cancer had spread.
Article by Alina Morrow, MS
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