Tests for pancreatic cancer
You may need several tests to work out what’s causing your symptoms. If you are diagnosed with pancreatic cancer, your doctors will use the test results to help decide the best treatment for you. Read more on what your tests results mean.
Your hospital will give you detailed information about each test and where you need to go for your appointment. Ask your doctor for this information if you haven’t been given it.
If you have any questions about the tests you are having and why you are having them, speak to your doctor. You can also speak to our specialist nurses on our free Support Line.
What tests are used to diagnose pancreatic cancer?
You may have different tests at different times. For example, you may have tests which diagnose pancreatic cancer, but then need more tests to find out exactly what type of pancreatic cancer you have and what stage it is. You probably won’t need all the tests described here, and you may not have them in this order.
The tests used to diagnose pancreatic cancer include:
- blood tests
- an ultrasound scan of the tummy area
- a CT (computerised tomography) scan
- an MRI (magnetic resonance imaging) scan
- an EUS (endoscopic ultrasound scan)
- a biopsy
- a PET-CT scan (positron emission tomography)
- an ERCP (endoscopic retrograde cholangio-pancreatography)
- an MRCP (magnetic resonance cholangio-pancreatography)
- a laparoscopy.
You may find this diagram of the pancreas and its surrounding organs helpful when reading about some of the tests below.
Blood tests are used to check your blood cell levels (blood count), how well your liver and kidneys are working, and your general health. If you have jaundice a blood test will show how severe the jaundice is.
Blood tests can also check for tumour markers that show up in the blood. Tumour markers are chemical substances produced by cancers. CA19-9 is a marker that may be used to help diagnose pancreatic cancer. But not all pancreatic cancers produce tumour markers, and other conditions that aren’t cancer can also produce them. This means blood tests must be used together with other tests to make a diagnosis. Most blood tests can be done straight away.
Ultrasound scans use sound waves to make a picture of the inside of the body. The images are displayed on a screen.
You will probably be asked not to eat anything for six to eight hours before the scan and only drink clear fluids. The scan is done while you are awake and lying on your back on a bed. Gel is spread on the skin of your tummy, then a probe is passed over the area. It can take up to 30 minutes and you can go home as soon as it’s over.
A CT scan uses x-rays to create a 3D picture of the pancreas and the organs around it. If you have jaundice and suspected pancreatic cancer, or have had another scan that showed a problem with your pancreas, you should be offered a CT scan.
The NICE guidelines recommend that if you have been diagnosed with pancreatic cancer and haven’t had a CT scan, you should be offered one. It is usual to have a CT scan of your chest and pelvic area (below your tummy) to check for any signs of cancer outside the pancreas and to decide the best treatment for you.
What does the scan involve?
You will be asked not to eat anything for six to eight hours before your CT scan and only drink clear fluids. Before the scan, you may be asked to drink a liquid containing a dye. This helps the different organs show up on the scan. You may also be given an injection into a vein to help to show up blood vessels.
You will be awake during the scan, and you won’t feel anything. The radiographer who takes the scan won’t be in the room, but can hear and talk to you during the scan. You will lie flat on a bed which moves through the scanner, and a series of x-rays will be taken from different directions. The CT scan usually lasts about 30 minutes, and you will probably be able to go home straight afterwards.
MRI scans use magnets and radio waves to build up detailed pictures of the pancreas and surrounding areas.
As the MRI scan uses magnets, you will be asked whether you have any metal implants in your body, such as a pacemaker or pins in your bones. You will need to wear loose clothing and make sure you have no metal objects on you, including zips and buttons.
What does the scan involve?
The scanner is shaped like a tunnel, and you will lie on a bed that moves into the scanner. The scanner is noisy so you may be given earplugs or headphones. You won’t feel anything during the scan. You will be able to hear and talk to the radiographer who operates the scanner from outside the room. The scan usually takes 20-30 minutes and you can go home afterwards.
You may be offered an endoscopic ultrasound scan (EUS) together with a biopsy if your diagnosis is still not clear after having a CT scan. A biopsy involves taking tissue samples. Read more on what a biopsy involves.
An EUS is usually done in hospitals which specialise in pancreatic cancer. Read more on specialist hospitals.
What does the scan involve?
A thin, flexible tube (called an endoscope) is passed through your mouth and down into your stomach. The tube has a light at the end and a small ultrasound probe. The ultrasound probe creates detailed pictures that help to show where the cancer is in the pancreas, how big it is and whether it has spread outside the pancreas.
You won’t be able to eat or drink for six to eight hours before the EUS. You will be given a throat spray of local anaesthetic to numb your throat and help stop you coughing during the procedure. You will also be given a sedative by an injection in your arm or the back of your hand. It won’t put you to sleep but it will make you feel drowsy and relaxed. This makes it easier for the doctor to pass the endoscope into your stomach.
If you are having a biopsy with the EUS, a needle is passed through the tube to take tissue samples. This is called an EUS-guided fine-needle aspiration (EUS-FNA). You may hear this test called an EUS-guided fine needle biopsy (EUS-FNB) if a larger tissue sample is taken.
The EUS takes 30-60 minutes and you will probably be able to go home a couple of hours afterwards. You will need someone to take you home, as you can’t drive for 24 hours after having a sedative.
A biopsy is the only way of being absolutely certain that you have pancreatic cancer. But it can sometimes be difficult to get enough tissue to make a definite diagnosis, and a second biopsy may be needed.
The results can show exactly what type of cancer you have, which may help the doctors decide on the most suitable treatment. You will need to have a biopsy to confirm your diagnosis before having chemotherapy, chemoradiotherapy (chemotherapy combined with radiotherapy treatment) or starting a clinical trial.
What does this test involve?
A biopsy can be taken during a CT scan, EUS, endoscopic retrograde cholangio-pancreatography (ERCP) or laparoscopy.
If the biopsy is taken during a CT scan the doctor will put a needle directly through your skin into the area where they think there may be cancer, and remove a small sample of tissue. This is done under a local anaesthetic, so you will be awake but won’t feel anything.
If you are having surgery for operable cancer, for example a Whipple’s operation, you may not have a biopsy. The tissue removed during surgery will be examined under a microscope to confirm that it is cancer. If you're not sure if you have had a biopsy, ask your doctor or nurse about this.
This combines a CT scan with a PET (positron emission tomography) scan. A PET-CT scan helps to build up a clearer picture of the cancer and how it is behaving. It may be used to learn more about the stage of the cancer and how best to treat it. It may also be used after you have been diagnosed to check if there is a chance of the cancer spreading, or to check how your treatment is working.
The NICE guidelines recommend that if a diagnosis is not clear following a CT scan, you should be offered a PET-CT scan. If you have been diagnosed with pancreatic cancer that is contained within the pancreas (localised pancreatic cancer) following a CT scan, you should also be offered a PET-CT scan. This helps to confirm whether it is possible to remove the cancer with surgery.
What does the scan involve?
A PET-CT scan is similar to a CT scan. You won’t be able to eat anything for at least four hours before the PET-CT scan, although you may be able to drink water. A small amount of a harmless radioactive substance, called flurodeoxyglucose (FDG), is injected into a vein in your arm before the scan. You will wait for about an hour after the injection to have the scan. The scan takes 20-45 minutes, and you can usually go home straight afterwards.
The FDG injection contains sugar, so people with diabetes may need to have their blood sugar levels monitored before they can have this scan. Speak to your doctor or nurse about this and what you can eat before the scan. You can also speak to our specialist nurses on our Support Line.
An ERCP (endoscopic retrograde cholangio-pancreatography) is sometimes used to diagnose problems with the pancreas. It is usually used if your bile duct is blocked, to insert a small tube (called a stent) into the bile duct to unblock it. The bile duct is the tube that carries fluid (bile) from the liver to the duodenum (the first part of the small intestines). View our diagram of the pancreas and surrounding organs.
What does this test involve?
An ERCP uses an endoscope and the procedure is similar to an EUS. But an ERCP also involves taking x-rays. Dye is injected through the endoscope into the ampulla of Vater, which is where the pancreatic duct opens into the duodenum. Any blockages will show up on x-rays.
While the endoscope is in place the doctor may use a small brush to take cells from the bile duct to check under a microscope. They may also take tissue samples for a biopsy. If you are having a stent inserted with an ERCP and haven’t already had tissue samples taken, the doctor should take a tissue sample during the ERCP.
If your ERCP is done to get x-rays and tissue samples, you will be able to eat within a couple hours, and will probably be able to go home after a few hours. You will need someone to take you home, as you can’t drive for 24 hours after having a sedative. If your ERCP is done to insert a stent, you will usually need to stay in hospital for a couple of days.
You will be given details of who to contact if you have any problems after the ERCP.
Read about how a stent is inserted.
An MRCP (magnetic resonance cholangio-pancreatography) is a type of MRI scan that looks at the bile duct, liver, gallbladder and pancreas. It can give clearer pictures of the bile duct and pancreatic duct, and any blockages in them.
You will usually be asked not to eat or drink anything for up to four hours before the scan. You may have an injection of a dye to help make the pictures clearer. You will be able to go home straight after the MRCP.
A laparoscopy is only done occasionally. This is a small operation, sometimes called keyhole surgery, which can be used to:
- help check that the cancer can be removed by surgery, before you have the actual surgery
- confirm a diagnosis of pancreatic cancer
- or work out the stage of the cancer.
A biopsy may also be taken during a laparoscopy. In some cases, if a laparoscopy shows that the cancer has not spread, it may be possible to carry out surgery to remove the cancer at the same time as the laparoscopy.
What does a laparoscopy involve?
You will have a general anaesthetic, so you are asleep and won’t feel anything. A long tube with a camera at one end is inserted through a small cut in your tummy, so that the doctor has a clear picture of inside of your tummy. Other small cuts may be made so instruments can be inserted to help with the examination.
Because of the general anaesthetic you won’t be able to eat or drink for at least six hours before the laparoscopy. You will need to recover from the anaesthetic before you go home, but you may be able to go home on the same day. You will need someone to take you home and look after you overnight. You may need to take painkillers for a few days if the small wounds are uncomfortable.
If you have any questions about your tests, speak to your your doctor, nurse or medical team. You can also speak to our specialist nurses.
Questions to ask
- Have you done a biopsy as part of these tests?
- When will I get my test results?
- How will I get my test results?
- Who can I contact if I have any questions?
How long will I have to wait for my test results?
It may take from a few days to a couple of weeks to get the test results – ask how long it will be when you go for the test. You can also ask who to contact if you don’t hear anything. You will need an appointment with your consultant to find out what the results show and discuss what happens next.
Your test results should also be sent to your GP, and you may be sent a copy of the letter. If there’s anything in the letter that’s not clear, your GP or medical team can help explain what it means.
You might also find it helpful to talk things over with one of our specialist nurses on our free Support Line, as waiting for test results can be an anxious time.
Updated August 2018
Review date August 2020