Pancreatic Cancer

Pancreatic Cancer
Tests and Treatments

Diagnostics Tests For Pancreatic Cancer

Clinical History and examination: The doctors that treat cancer will ask for symptoms such as yellowing of the skin, abdominal pain, weight loss and symptoms of diabetes, such as thirst, frequent urination and fatigue. An abdominal examination is also done to palpate the abdomen for any abnormalities.

Radiological Imaging: Computed tomography (CT) scan: CT scans use X-rays to visualise the internal organs in cross-section. It is useful to diagnose and stage pancreatic cancer. Ultrasound: An ultrasound scan uses high-frequency sound waves to create an image of the inside of the body, and is useful to visualise the pancreases and other organs in the abdomen. Magnetic resonance imaging (MRI) uses magnetic fields and radio waves to produce images and is used for staging of pancreatic cancer.

CT Scan
Source: Covenant Health
How Does a PET Scan Work?
Source: NIBIB gov

Endoscopic ultrasound scan (EUS): In an EUS, an ultrasound scanner is attached to the end of an endoscope and is passed into the stomach through the mouth. This means that images can be taken from inside the body. Samples of tissue and lymph nodes can also be taken during the procedure to be tested later by the pathologist.

Endoscopic Ultrasound and Biopsy
Source: John Hopkins Pathology

Biopsy: It is the removal of a tissue sample for testing under the microscope by a pathologist. It may be obtained by inserting a needle through the skin and into the pancreas (also known as fine-needle aspiration) or during an endoscopic ultrasound scan, mentioned above.
Blood tests: Certain blood tests are useful to detect pancreatic cancer. There are specific proteins that are detectable in cases of certain genetic mutations. These are known as band are produced by some pancreatic cancers. Examples include cancer antigen 19-9 (or CA 19-9). An increase in the levels of this protein in the blood can help the clinical team decide how best to treat the cancer. CA 19-9 measurements alone are not used to make therapy decisions.

Germline testing: Familial pancreatic cancer (FPC) is a term to describe families with an abnormally high rate of pancreatic cancer where at least two members of the family, who are first-degree relatives, suffer from pancreatic cancer. In these suspected families, genetic testing is conducted to detect certain mutations known as germline mutations. If found to be positive, the family is referred to a genetic counsellor to explain the diagnosis and future risks of developing cancer as well as to create a plan for follow up and screening.

Additional Videos about Tests

Liver Function Tests
Cholangiography - ERCP Procedure
Source: eMedTV

Treatment Of Pancreatic Cancer

  • Surgery: Operations used in people with pancreatic cancer include the following:
    Tumours in the head of the pancreas: In these cases, a procedure known as Whipple procedure (pancreaticoduodenectomy) may be conducted. The procedure is technically challenging and involves the removal of the first part of the small intestine, the gallbladder, part of the bile duct and, in some cases, part of the stomach and lymph. A reconstruction surgery is then done to reconnect the remaining parts of your pancreas, stomach and intestines.
Surgery - The Whipple Procedure, Laparoscopic
Source: John Hopkins Medicine
Surgery - Total Pancreatectomy
Source: John Hopkins Medicine
  • Tumours in the body and tail of the pancreas: These surgeries involve the removal of the left side of the pancreas and is called distal pancreatectomy.
  • Surgery to remove the entire pancreas: Removal of the entire pancreas is known as total pancreatectomy. The patient will be prescribed lifelong insulin and digestive enzymes.
    Tumours affecting nearby blood vessels: In advanced cases involving the blood vessels, patients are ineligible for Whipple procedure or other pancreatic surgeries. These surgeries are performed by highly specialized and experienced surgeons which involve removal of the tumour and reconstruction of parts of blood vessels.
  • Side effects: Each surgery carries the risk of bleeding and infection. Other side effects include nausea, vomiting, leakage of stomach content into the abdomen etc.
  • Chemotherapy: Chemotherapy involves drugs which kill cancer cells taken through the mouth or injected into a vein. It may be combined with radiation therapy, also known as chemoradiation. This is typically used to treat cancer that has spread beyond the pancreas to nearby organs. Chemotherapy is used to control cancer growth and prolong survival in patients with advanced pancreatic cancer.
What is Chemotherapy?
Source: Covenant Health
  • Radiation therapy: Radiotherapy uses high-energy beams to destroy cancer cells. It is typically prescribed when cancer can't be treated surgically. In most cases, external beam radiation is considered, which uses radiation from a machine outside the body. In some cases, intraoperative radiation therapy is considered which is delivered during surgery.
    Endoscopic retrograde cholangiopancreatography (ERCP): ERCP is a procedure used to obtain pictures of the digestive tract and the pancreas. A dye is injected through a thin tube and multiple X-rays are taken, which allows doctors that treat cancer to diagnose pancreatic cancer or to treat its symptoms. It is useful to detect pancreatic cancer, get a biopsy (tumour samples), to identify if the tumour is blocking the pancreas or bile ducts which transport digestive enzymes and to treat jaundice by unblocking these tubes.
What is cancer radiotherapy?
Source: Cancer Research UK
Radiation Therapy: What to Expect
Source: Accelerated Education Program
  • Percutaneous Transhepatic Cholangiogram (PTC): The PTC method is similar to ERCP. A dye is used to identify the obstruction on X-ray but rather than a tube being inserted through an endoscope, a needle will be inserted through the skin and a guide-wire passed through the liver and into the blocked bile duct. A stent is then passed along this wire and this stent helps relieve symptoms of jaundice and try and prevent a future block.
  • PEG Tube: This is a tube inserted through the wall of the abdomen directly into the stomach. It allows air and fluid to leave the stomach and can be used to give drugs, food and liquids. This form of feeding is called enteral nutrition and is used in end stage cancers.
    Palliative care: This is specialized medical care by nurses and doctors that focuses on providing relief from pain and other symptoms of pancreatic cancer. Palliative care is prescribed in patients undergoing aggressive treatments, such as surgery, chemotherapy and radiation therapy. Palliative care aims to improve the quality of life for cancer patients and their families.

Sources: European Society of Medical Oncology (ESMO); Mayo Clinic; Cancer.Net; Pancreatic Cancer Action Network; National Cancer Institute