Diagnosis

Pancreatic Cancer can be diagnosed by investigations that involve medical examination, various imaging techniques, blood tests, and biopsy procedures.

• Medical History

The doctor will review present health status, symptoms presented, past medical problems and treatment, family medical history, lifestyle, and habits like- smoking, chewing tobacco, alcohol intake, type of diet etc.

• Physical Examination

The doctor will also examine for any lumps in the abdomen and neck, yellowing of skin and eyes, fluid in the abdomen etc. The patient may be asked to take some scans and blood tests in addition to the physical examination conducted in the clinic.

• Imaging techniques

Introduction
Imaging techniques work by producing images of body parts, the images thus created can help the doctor to detect and diagnose diseases. The doctor may ask the patient to take one or more of such scans to identify tumors, to locate tumors, to know whether the tumor is localised or spread to other areas of the body and to determine the stage of the tumor.

Techniques

• Ultrasonography (US)
• Computed tomography (CT)
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET) and PET-CT imaging
• Endoscopic Retrograde Cholangiopancreatography (ERCP)
• Biopsy


• It is a procedure done to obtain a tissue or body fluid sample for studying the pathological and chemical changes that may have occurred due to a disease.
• Usually, a fine needle is used for collecting the sample and the size or quantity of the sample may vary from a very small portion to an entire lump or tumor.
• The sample obtained is then studied by a pathologist to detect any abnormalities if present and to know the severity of damage done to tissues or organs.
• The procedure may be done with ERCP or with X-ray, ultrasound, or CT scan for guiding the needle and collecting appropriate tissue samples.
• The procedure is invasive and done under sedation. It is the only definitive method of diagnosing cancer with absolute certainty.
• Pathology


• Cancers of pancreas are commonly found in the ducts of the pancreas. Pancreatic ductal adenocarcinoma is the commonest type of pancreatic cancer and is usually found in the head of the pancreas.
• The tumor does not have any specific shape and grows into the surrounding healthy tissues, which may include the neighboring pancreatic tissue, blood vessels, and lymph nodes.
• The tumors have features similar to glands (secretary tissue) and the normal cells are replaced with fibrous tissue.
• Abnormally high level of mucin (component of mucus) is produced by the tumors.⁵
• Blood tests


• Routine blood tests

Routine blood tests like complete blood count (CBC), coagulation profile, renal function tests (RFT) etc are advised to evaluate the general health status of the patient and to determine whether the patient can be considered for a particular treatment or not.

• Liver Function Tests

In addition to the above mentioned tests, the doctor may recommend that a patient undergoes a few more blood and urine tests to determine if the liver is functioning properly and to know severity of jaundice.

• CA 19 - 9



• Carbohydrate Antigen 19-9 is a substance produced by the tumor and released into the blood. It is therefore called as a tumor marker.
• A simple test can determine the level of CA19- 9 present in the blood and thus detect the presence of a tumor.
• The test may or may not be positive in patients with pancreatic cancer and is usually not relied upon to make diagnosis. ¹¹
• The test is also useful to know if a patient is responding to the treatment.