NICE guideline 1: Diagnosing pancreatic cancer

People with jaundice

Pancreatic cancer can cause jaundice. Signs of jaundice include yellow skin and eyes, dark pee, pale poo and itchy skin. Yellow skin may be less obvious if you have brown or black skin, but you may notice the white part of your eyes looks yellow.

1.1 If you have jaundice and suspected pancreatic cancer, you should be offered a computerised tomography (CT) scan before treatment for jaundice.

This is because it is easier to diagnose pancreatic cancer using a CT scan before you have treatment for jaundice.

1.2 If the diagnosis is still not clear following the CT scan, you should be offered an FDG-PET/CT scan and/or an endoscopic ultrasound scan (EUS) with a biopsy.

1.3 The doctor should use a small brush to take cells from the bile duct to check under a microscope if:

• you are having a stent put in with an ERCP (endoscopic retrograde cholangiopancreatography) to treat the jaundice and
• you haven’t had tissue samples taken.

People who have had scans that show something unusual in the pancreas but who do not have jaundice

1.4 If you don’t have jaundice but have had a scan that showed a problem with your pancreas, you should be offered a CT scan.

1.5 If the diagnosis is still not clear after the CT scan, you should be offered an FDG-PET/CT scan and/or an endoscopic ultrasound scan (EUS) with a biopsy.

1.6 If tissue samples need to be taken, you should be offered an EUS with a biopsy.

Read more about these tests for pancreatic cancer.

People with pancreatic cysts

A cyst is a sac filled with fluid. Pancreatic cysts are often not cancerous, but some can become cancer.

1.7 If you have a pancreatic cyst, you should be offered a CT scan or a type of MRI scan called an MRI/MRCP (magnetic resonance cholangiopancreatography). If more information is needed after having one of these scans, you should be offered the other one.

1.8 You should be referred to have surgery if you have:

• jaundice and cysts in the head of the pancreas
• a scan shows that the cyst may have a solid part to it – this may suggest that the cyst could be cancer
• the main pancreatic duct (a tube in the pancreas) is 10mm in diameter or larger.

1.9 If you have had a CT scan or MRI/MRCP scan, you should be offered an EUS (endoscopic ultrasound) if:

• more information is needed on the chance of you having cancer or
• it’s not clear whether you need surgery.

1.10 If more information is needed on the chance of you having cancer, your doctors should consider a biopsy with EUS.

1.11 If you have had a biopsy, your doctors should test for carcinoembryonic antigen (CEA).

CEA is a substance that may help to tell the difference between mucinous cysts (which could become cancer) and non-mucinous cysts (which don’t become cancer).

1.12 If doctors think your cyst is cancer, they should follow the recommendations to work out how far the cancer has spread.

Read more about pancreatic cysts.

If you have any questions about pancreatic cysts, you can speak to our specialist nurses on our Support Line.

People with a family history of pancreatic cancer

1.13 If you have pancreatic cancer, your doctor should ask you if any of your first degree relatives (parent, brother, sister or child) have had it.

Your doctor should talk to you about any concerns you may have about an inherited risk of pancreatic cancer.

Read more about family history of pancreatic cancer.

1.14 You should be offered monitoring for pancreatic cancer if you have:

hereditary pancreatitis and a fault in the PRSS1 gene

faults in the BRCA1, BRCA2, PALB2 or CDKN2A (p16) genes and one or more first-degree relatives with pancreatic cancer

Peutz–Jeghers syndrome.

1.15 Monitoring for pancreatic cancer should be considered if you have:

• two or more first-degree relatives with pancreatic cancer, across two or more generations
• Lynch syndrome and any first-degree relatives with pancreatic cancer.

1.16 If you don’t have hereditary pancreatitis, doctors should consider monitoring with regular MRI/MRCP (magnetic resonance cholangio-pancreatography) or EUS (endoscopic ultrasound scan).

1.17 If you have hereditary pancreatitis and a fault in the PRSS1 gene, doctors should consider regular monitoring with CT scans, rather than MRI/MRCP or EUS.

1.18 If you have hereditary pancreatitis, you should not be offered an EUS to test for pancreatic cancer.

This is because pancreatitis can cause damage to the pancreas which may make an EUS less accurate than other scans.

Published: April 2025

Review Date: April 2028