Diagnostic Tests Of Pancreatic Cancer

With pancreatic cancer there is at present no reliable screening test that one could employ similar to the PSA test for prostate cancer. For research purposes there are some cell markers such as CA 19-9 and CA 195 , which have more pancreatic cell specificity than CEA or CA 125, but all of these have too many false positives and false negatives to be of use for screening.

However, some of these markers can be used, when they are found to be positive, to follow treatment of a patient and hopefully see these tests turn negative with a positive treatment result. Otherwise the blood tests can be utilized to show that there is indeed an obstructive jaundice. Liver function tests will establish whether or not there are liver metastases. CT scans of the abdomen (2 black arrows in the left middle show a cancer of the head of the pancreas) will establish whether or not there is a pancreatic mass (A= cancer in head of pancreas; B= normal tail of pancreas) . As shown in this example it can be shown before the surgery whether the cancer is in the head or in the tail of the pancreas, which has consequences as to the surgical approach.

Endoscopic retrograde cholangiopancreatography (ERCP) is a test where in a first step an endoscope is swallowed by the patient and advanced to the opening of the pancreatic duct in the ampulla of the duodenum. The second step is the advancing of a smaller telescope by the specialist, which probes through this opening (=ampulla of Vater) and injects a radioopaque material into the common bile and main pancreatic duct so that x-rays can be done that show these ducts and the ampulla in relation to the pancreatic mass.

Further tests that are available to the physician are abdominal ultrasound and angiography, where the tumor vessels in relation to the normal vessels can be seen.

Other tests that are useful are fine needle aspiration biopsy of the pancreas and percutaneous (=through the skin) biopsy of liver metastases. These last two tests can be done under CTscan guidance to ensure that the needle is exactly where it should be when the biopsy is done. With these biopsy tests a tissue diagnosis can be made, which is the only way how cancer can be diagnosed directly. Finally, laparoscopy is a diagnostic test and mini-surgical procedure that is very useful. If the patient has ascites and likely has intraabdominal metastases, then the much easier laparoscopy, a much smaller procedure, can prevent the more invasive laparotomy (Ref. 1 and 2).

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Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. Cancer: Principles &Practice of Oncology.4th edition. Edited by Vincent T. DeVita, Jr. et al. Lippincott, Philadelphia,PA, 1993. Chapter on Cancer of the pancreas.

2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter on Cancer of the pancreas.

3. T Nishihara et al. Jpn J Cancer Res 2000 Aug;91(8):817-824.

4. L Staib et al. Int J Cancer 2001 Apr 1;92(1):79-87.

Last Modified: Dec. 12, 2007