Diagnosis
Diagnosing pancreatic cancer
Any symptoms people do have can be quite vague and may
also be a sign of other more common illnesses which affect the
gastro-intestinal system (GUT) such as hepatitis, pancreatitis,
gallstones, irritable bowel syndrome or even stress. So it can be
particularly difficult for GPs to detect and diagnose pancreatic
cancer, especially in its early stages. As there is currently no
easy way of detecting pancreatic cancer, diagnosis may sometimes be
delayed while GPs or specialists spend time ruling out all the
different possible causes for people's symptoms. You can read more
here about signs and symptoms of pancreatic
cancer.
Routes to diagnosing pancreatic
cancer
The difficulty doctors have in detecting and diagnosing
pancreatic cancer means that people may arrive at a firm diagnosis
by different routes.
GP visit
Most people start by seeing their GP. Sometimes people may
see their GP several times because of vague symptoms that don't get
better over time. As with any illness, if your symptoms persist
it's important to go back to your GP until you get a firm diagnosis
or a referral for further investigations.
Your GP will begin by asking you about your symptoms,
which may or may not be obvious.
- They will usually look at your eyes and the colour of
your skin for signs of jaundice.
- They may also examine your abdomen (tummy) for any
swelling and to check if it is tender or painful.
- They will probably test your urine for bile.
- They may also take a blood sample.
- They may ask you whether you have had any problems with
eating, or digesting your food, and whether your bowel habit has
altered
- They may ask you whether you have been losing
weight
Your GP may decide to refer you to your local hospital for tests and to see a
specialist.
Some symptoms indicate that your GP should refer you to a
team specialising in pancreatic disease (an upper gastrointestinal
or hepatobiliary team) straight away. These symptoms include
jaundice, persistent unexplained abdominal pain and unexplained
weight loss. This is known as an urgent referral for suspected
cancer and means you should be seen by a specialist within two
weeks. Being referred urgently does not necessarily mean that you
do have cancer.
The National Institute for Health and Clinical Excellence
(NICE) has produced guidelines to help GPs with their
decision-making and you can read more about them here.
If you are very unwell when you see your GP they may
decide to send you straight to hospital for assessment and further
investigations as an outpatient, or they may feel it is more
appropriate to arrange your admission
as an emergency.
Referral to your
local hospital
If your GP isn't sure what's wrong with you they will
probably refer you to your local hospital for tests and to see a
gastroenterologist. Gastroenterologists are specialists in diseases
and disorders of the digestive system, including the stomach,
intestines, liver and pancreas.
The specialist will probably ask you the same questions
you were asked by your GP before giving you a physical examination.
They will then decide what tests and investigations you
need to work out what is causing your symptoms. It may take several
different tests before you are given a definite
diagnosis.
Getting admitted to
hospital
Sometimes people get admitted to hospital, perhaps even as
an emergency, because they are very unwell but at the time the
doctors don't know what is wrong.
For example, jaundice may be the first sign that something
is wrong and it can come on very quickly. Or someone might go into
hospital because they have severe pain or persistent nausea and
vomiting that can't be explained.
It is only once they are there that the specialists can
assess their symptoms and do whatever tests are needed to enable
them to reach a diagnosis.
Depending on the hospital people are usually admitted to a
medical or surgical assessment unit. Or they might come in to
Accident and Emergency if they've become ill very suddenly. The
medical team will assess them, treat the pain or other symptoms,
and do some initial tests, such as an ultrasound scan. They will
then be referred to a specialist (upper gastrointestinal or
hepatobiliary) team for further investigations.
Being referred to a specialist centre
Once someone has been diagnosed with pancreatic cancer
they should have their case reviewed at a cancer centre with a
specialist hepatobiliary team. This may involve an appointment at
the regional specialist centre or your local specialist and the
specialist team at the regional centre may discuss your scans
together without you having to attend the regional centre. Find out
more about regional specialist centres and treatment teams here.
Information about the tests and investigations used to
diagnose pancreatic cancer can be found here.