Tests for pancreatic cancer

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 chemical substances produced by cancers called tumour markers. 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.

Ultrasound scans use sound waves to make a picture of the inside of the body. The images are displayed on a screen.

The scan is done while you are awake. 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.

If your diagnosis is still not clear after a CT scan, you should be offered a PET-CT scan or an EUS with a biopsy.

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. This is to check for any signs of cancer outside the pancreas and to decide the best treatment for you.

What does the scan involve?

During the scan, you will have an injection of dye into a vein to help to show the blood vessels in the area. You will be awake during the scan. You won’t feel any discomfort, but you may have a warm feeling while the dye is being injected.

You will lie flat on a bed that moves through the scanner, and x-rays will be taken from different directions. The CT scan usually lasts about 15 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.

What does the scan involve?

A thin 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 if it has spread outside the pancreas.

You will have a throat spray of local anaesthetic to numb your throat. You will also have a sedative, which won’t put you to sleep but 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 involves taking small tissue samples to be examined under a microscope. You may be offered a biopsy together with an EUS if your diagnosis is still not clear after having a CT scan.

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, 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. 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) after 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. A  harmless radioactive substance, called flurodeoxyglucose (FDG), is injected into a vein in your arm. You will have the scan about an hour after the injection. 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.

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 so that 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 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 may have an injection of a dye to help make the pictures clearer. The scan takes 20-30 minutes and you will be able to go home straight after it.