How is pancreatic cancer diagnosed ?
The process of diagnosing pancreatic cancer usually begins with a visit to the patient's primary care doctor (referring doctor) or a specialist, in this case, a gastroenterologist, a doctor specializing in digestive diseases.
The doctor will ask the patient about the symptoms they are experiencing that suggest pancreatic cancer. They will inquire about personal medical history, such as chronic pancreatitis, diabetes, and tobacco use. The doctor will also observe for potential obesity.
The doctor will ask about family history, specifically regarding the presence of pancreatic cancer, pancreatitis, or other benign or malignant diseases in family members.
A physical examination will be performed to look for any signs of pancreatic cancer. The doctor will observe the skin and the whites of the eyes for jaundice, palpate the abdomen to check for a mass, and assess whether the gallbladder, spleen, or liver are enlarged. They will check for swollen legs and look for abnormal lymph nodes.
The doctor will also check for possible peritoneal involvement (membrane affecting the intestines) through a rectal or vaginal examination. Additionally, they may order various blood tests, such as measuring CA 19-9 or CEA (Carcinoembryonic Antigen) levels. CA 19-9 and CEA are known as "tumor markers", and their levels may be elevated in cases of pancreatic cancer.
💡 DID YOU KNOW ?
Tumor markers are molecules produced by tumor cells and found in the bloodstream. These markers are also produced by normal cells, and therefore, they are not specific to cancer cells.
The level of these markers is measured in a blood sample taken during a blood test in a laboratory. Their levels increase in the presence of cancer, but they can also rise in the case of benign conditions such as inflammation. As a result, they are not used for cancer screening but rather as one of the factors in diagnosing cancer and, most importantly, for monitoring the progression of the disease during treatment.
The doctor will also request medical imaging tests, including an ultrasound, an abdominal and pelvic CT scan, or magnetic resonance imaging (MRI).
If pancreatic cancer is suspected, the referring doctor will refer the patient to a specialist in the diagnosis and treatment of pancreatic cancer. This specialist works in an oncology department and may request additional imaging tests, such as a pancreatic endoscopic ultrasound.
Regardless of the imaging test used, the diagnosis of pancreatic cancer can only be made after analyzing pancreatic tissue. This tissue will be obtained by taking a small sample (biopsy) with a fine needle.
The sample can also be obtained during surgery with an abdominal incision (laparotomy). The sample will be examined under a microscope by a pathologist, a doctor specialized in analyzing organs, tissues, and cells. The microscopic examination will determine whether the cells are normal or tumor cells and assess their morphological characteristics.
Histological analysis will also allow the pathologist to determine the grade of the tumor, which ranges from 1 to 4. The higher the grade, the more the appearance of the cancer cells deviates from that of normal cells, and the more aggressive the cancer cells are.
TO REMIND YOU
Grade 1 cancers (well-differentiated cancers) have cells that appear relatively normal and divide slowly.
Grade 3 and 4 cancers (poorly differentiated cancers) have highly undifferentiated cells that multiply rapidly.
Grade 2 cancers (moderately differentiated cancers) have characteristics that are intermediate between those of grade 1 and grade 3 or 4 cancers.
In the case of confirmed pancreatic cancer, an extent evaluation will be conducted to determine whether the cancer is localized or has spread to distant areas, forming metastases.
In addition to ultrasound, CT scan, MRI, or endoscopic ultrasound, positron emission tomography (PET/CT) is a recommended imaging test for detecting metastases.
Expert perspective
In a positron emission tomography (PET) scan, a type of radioactive sugar is used to detect the presence of cancer cells, which are highly sugar-consuming. A computer analyzes the distribution of radioactivity and produces three-dimensional, color images of the examined area.
A laparoscopy may also be performed.
Expert perspective
Laparoscopy also called celioscopy , is a surgical procedure performed under general anesthesia.
It allows the examination of the abdomen or pelvis using a laparoscope. This is a thin instrument equipped with a light source and a camera. It is introduced through a small incision and enables visualization of the inside of the abdomen or pelvis.
These different examinations will help determine the stage of the cancer.
TO REMIND YOU
The determination of a cancer's stage is primarily of therapeutic importance , as knowing the stage helps establish the most appropriate treatment for the patient. It also allows for predicting the most likely progression of the disease ( prognostic significance ).
The stage of cancer is determined based on three criteria. The first criterion depends on the characteristics of the tumor ( T ). The second criterion depends on the number of affected lymph nodes N for Node ]. The third criterion depends on the presence of metastases and the number of organs involved ( M ).
These three criteria are used to define the stage of cancer according to an internationally recognized classification ( TNM classification ).
Stage I pancreatic cancers are localized cancers: the tumor is confined to the pancreas and measures up to 4 cm.
Stage II cancers are locally advanced: the tumor exceeds 4 cm or reaches nearby lymph nodes.
Stage III and IV cancers are advanced cancers: Stage III tumors have spread to more lymph nodes or large blood vessels.
Stage IV tumors are metastatic cancers that have spread to other organs such as the liver or lungs. Knowing the grade and stage of pancreatic cancer is important for determining the treatment that will be proposed.
--
Article updated on Jan 21, 2025
Get a second opinion for your cancer from an expert
Response within 7 days