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Diagnosis and Prognosis of Pancreatic Cancer

Your doctor will ask you about your symptoms, and medical and family history. The abdomen and surrounding areas will be carefully examined. Your doctor may look for other possible causes of your symptoms. If cancer or other gastrointestinal conditions are suspected, a specialist may be recommended.

Suspicion of Pancreatic Cancer

If you are having symptoms that suggest problems with the pancreas, further testing will be done. Tests can help confirm a cancer diagnosis or another condition, such as pancreatitis. Tests may include:

  • Blood tests—Certain substances are released into the blood when a cancerous tumor develops. These tumor markers, such as CA 19-9, CA-125, or other specific blood proteins, may increase if cancer is present. Tumor markers are also used in cancer staging and evaluating treatments to see if they are working or if there is a risk of relapse.
  • Imaging tests—These tests can help look for changes to the pancreas and the location of tumors. Some tests use contrast material to make images more clear and detailed. Imaging tests may include:
  • Endoscopy—A lighted scope with a camera is inserted into the digestive tract through the mouth. Any abnormal tissue will be removed for biopsy and examined under a microscope. Endoscopy may include:
  • Laparoscopy —A tube-like instrument is inserted through small incisions in the abdomen. A lighted scope and camera is passed through the tube to look at the pancreas and surrounding area. Any abnormal tissue will be removed for biopsy and examined under a microscope.

Diagnosis of Pancreatic Cancer

Diagnosis of pancreatic cancer is confirmed with a biopsy. A biopsy is the removal of an area of suspicious tissue. A pancreatic biopsy is done during an ERCP, laparoscopy, or through a fine needle aspiration (FNA). With FNA, a small needle is inserted through the abdomen and into the pancreas. The tissue sample is then examined under a microscope. A biopsy will not only confirm that cancer is present, but can also show what type of cancer is there.

Staging of Pancreatic Cancer

If pancreatic cancer is confirmed, results from completed tests and new tests will help determine the stage of cancer. Staging is based on the characteristics of the tumor. It will help develop the prognosis and treatment plan. Factors that play a role in staging include where the tumor is found, how far the original tumor has spread, whether lymph nodes are involved, if cancer has spread to other tissue, and microscopic cellular details.

Staging Tests

Tests that may help determine pancreatic cancer stage:

  • Blood tests to look for changes in hormones or the liver.
  • Imaging tests—To help determine how far the cancer has spread from the primary site. They may also help to determine if there are any growths in other areas of the body. Some tests use contrast material to highlight structures so images are more clear and detailed. Imaging tests may include:
    • EUS
    • Chest CT scan
    • Laparoscopy
Stages of Pancreatic Cancer

Pancreatic cancer is staged from 0-IV:

  • Stage 0—Carcinoma in situ—A group of abnormal cells are found only in the lining of the pancreas. These cells are not yet cancer, but can become cancerous and spread.
  • Stage IA—Tumor is 2 centimeters (cm) or less in size AND has NOT spread beyond the primary site.
  • Stage IB—Tumor is more than 2 cm in size AND has NOT spread beyond the primary site.
  • Stage IIA—Cancer has spread to nearby tissue and organs BUT has NOT spread to any lymph nodes.
  • Stage IIB—Cancer has spread to the lymph nodes AND MAY also be found in nearby tissue and organs.
  • Stage III—Cancer has spread to pancreatic blood vessels AND MAY be in the lymph nodes.
  • Stage IV—Cancer has spread beyond the pancreas and lymph nodes to other parts of the body. The most common sites for metastatic pancreatic cancer are the peritoneum (a double-layered, fluid-filled membrane that surrounds and supports the abdominal cavity), liver, and lungs.

For planning treatment, sometimes another staging method is used. In this method, staging is based on whether or not the tumor can be surgically removed. These stages include:

  • Resectable—Cancer is limited to the pancreas or to an area just outside of it. The entire tumor can be removed at this stage. Some tumors may look resectable based on test results. Once the surgery starts, it may not be possible to remove the entire tumor.
  • Borderline resectable—The cancer has spread to neighboring tissues or pancreatic blood vessels. Under certain circumstances, it is possible that the entire tumor can be removed.
  • Unresectable—The tumor cannot be removed because it has spread into nearby structures or beyond the pancreas to other parts of the body.

Prognosis

Prognosis is a forecast of the probable course and/or outcome of a disease or condition. Prognosis is most often expressed as the percentage of patients who are expected to survive over 5 or 10 years. Cancer prognosis is an inexact process. This is because the predictions are based on the experience of large groups of patients with cancer in various stages. Using this information to predict the future of an individual patient is always imperfect and often flawed, but it is the only method available.

Pancreatic cancer is often relatively advanced at the time that it is diagnosed. As a result, the number of patients who survive for 5 years or more after diagnosis is very small, perhaps as low as 5%. About 21% of all patients diagnosed with pancreatic cancer survive for a year after diagnosis.

Revision Information

  • De La Cruz MD, Young AP, Ruffin MT. Diagnosis and management of pancreatic cancer. Am Fam Physician. 2014;89(8):626-632.

  • General information about pancreatic cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/pancreatic/patient/pancreatic-treatment-pdq#section/%5F110. Updated December 23, 2016. Accessed March 23, 2017.

  • Pancreatic cancer. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114527/Pancreatic-cancer. Updated July 6, 2016. Accessed March 23, 2017.

  • Pancreatic cancer. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/gastrointestinal-disorders/tumors-of-the-gi-tract/pancreatic-cancer. Updated January 2017. Accessed March 23, 2017.

  • Stages of pancreatic cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/pancreatic/patient/pancreatic-treatment-pdq#section/%5F139. Updated December 23, 2016. Accessed March 23, 2017.

  • Tests for pancreatic cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/staging.html. Updated May 31, 2016. Accessed March 23, 2017.