NICE guideline 1: Diagnosing pancreatic cancer

People with jaundice

Pancreatic cancer can cause jaundice. Signs of jaundice include yellow skin and eyes, dark urine, pale poo and itchy skin.

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.

Read more about these tests for pancreatic cancer.

1.3 If you are having a stent inserted with an ERCP (endoscopic retrograde cholangiopancreatography) to treat the jaundice and haven’t had tissue samples taken, the doctor should take a tissue sample when the stent is inserted.

Tissue samples are used to help diagnose pancreatic cancer. Read more about having a stent put in.

People who have had scans that show something unusual in the pancreas but who don’t 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.

People with pancreatic cysts

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.

Read more about these scans.

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.

Read more about these scans.

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 helps 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.

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.

Read more about these genetic conditions.

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 are having monitoring and don’t have hereditary pancreatitis, doctors should consider 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 shouldn’t 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.

Read more about these scans.

Published: August 2018

Review Date: August 2023