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Pancreatic Cancer Detection, Diagnosis, and Staging

Pancreatic Cancer Detection 

Because there is presently no standard diagnostic screening test for adults at average risk, early detection of pancreatic cancer is difficult. Doctors may utilize screening technologies such as endoscopic ultrasonography or magnetic resonance imaging for those who have a higher-than-average risk of pancreatic cancer, such as those who have a family history of the disease or a documented genetic condition that increases their risk (MRI). 

Additionally, the pancreas is located so deep inside the body that it’s extremely difficult for doctors to feel any tumors during a physical examination. 

However, it’s possible that pancreatic cancer may cause early symptoms, or that testing for other medical conditions may show signs of pancreatic cancer, helping your doctor to diagnose it early. Most often, symptoms aren’t apparent in the early stages, and small lesions aren’t always detected by pancreatic cancer diagnostic tests, so cases tend to be diagnosed in more advanced stages. 

How is Pancreatic Cancer Diagnosed?  

Blood tests: Blood tests may provide clues that indicate the presence of the disease, but they don’t provide definitive early detection of pancreatic cancer. Blood tests help your doctor determine whether further testing is warranted. They include: 

  • Liver function tests: Jaundice or yellowing of the whites of the eyes and skin, is frequently the earliest indicator of pancreatic cancer. When a patient develops jaundice, the doctor will usually request liver function tests to determine the cause. These blood tests evaluate the levels of bilirubin, a substance produced by your liver, and liver enzymes in your blood to distinguish between liver disease and other causes of jaundice. The presence of high amounts of bilirubin in the blood may suggest the presence of pancreatic cancer. 
  • Tumor markers: Tumor markers are chemicals that a tumor releases into the body. Identifying these molecules, often known as biomarkers, can help with pancreatic cancer diagnosis.  However, not everyone with high levels of these tumor markers has pancreatic cancer, and not everyone with pancreatic cancer will have high levels of these tumor markers. Repeating blood tests may help reveal whether treatment is working if you have pancreatic cancer, and your levels of these indicators are high. 

Imaging tests: Imaging screenings provide a visual snapshot of the pancreas to expose potential abnormalities. The type of tests used may depend on your situation and symptoms.  

Tests may include: 

  • Computed tomography (CT) scan: Using X-rays taken from various angles, it creates a detailed, often-3D image. A contrast dye given at the beginning of the procedure may aid in assessing the pancreas and identifying damaged areas. CT scans can show whether pancreatic cancer has spread to surrounding tissues, including organs and lymph nodes, and provide clear images of the pancreas. These photos may also assist your doctor in determining whether surgery is an appropriate treatment choice. 
  • Positron emission tomography (PET) scan: The effects of a sugar substance eaten, breathed, or injected into a vein are monitored. Cancerous cells seem brighter in photos because they use more sugar than normal cells. A PET scan can be used to determine if exocrine pancreatic tumors have spread or metastasized. 
  • Endoscopic ultrasound (EUS): To obtain detailed images, an endoscope is used to inject an ultrasound probe next to the pancreas. Your doctor can see the digestive tract wall, as well as the adjacent lymph nodes, organs, and blood vessels, during the procedure. An EUS should reveal the presence of a tumor in the pancreas. If a biopsy is required, tissue or fluid samples may be collected at this time. A biopsy is the only way to confirm a diagnosis of pancreatic cancer. 
  • Magnetic resonance imaging (MRI): Produces detailed images of the pancreas and bile ducts using radio waves and magnets. Although CT scans are usually the preferred means of seeing the pancreas, your doctor may order an MRI to help evaluate whether more testing is necessary. 
  • Cholangiopancreatography: The bile ducts and pancreatic ducts are visible in imaging studies. They are utilized to see if the ducts are restricted, obstructed, or dilated, as well as to see if a tumor is creating a ductal blockage. These tests may also be utilized to establish a surgical strategy. 
  • Magnetic resonance cholangiopancreatography (MRCP): A type of MRI that is often done when pancreatic cancer is suspected. Using an MRI machine, doctors perform this diagnostic test to view pancreatic and bile ducts, but they can’t take a biopsy sample during this procedure. 
  • Endoscopic retrograde cholangiopancreatography (ERCP): Creates images using a scope inserted into the throat. A dye is injected to make the ducts visible, and the doctor will be able to view the ampulla of Vater, the area where the bile duct releases into the small intestine. Any blockages or narrowing of the bile ducts, possibly caused by pancreatic cancer, may be seen via X-ray images taken during the procedure.  
  • Percutaneous transhepatic cholangiography (PTC): Involves the placement of a thin and hollow needle into the liver. A contrast dye is injected into the organ, and X-rays of the bile ducts and pancreatic ducts are taken. Fluid or tissue samples can be collected if a biopsy is needed, and a stent can be placed inside a blocked duct to keep it open. The procedure is more invasive than an ERCP, and it’s only performed if an ERCP cannot be done or has already been attempted. 

Biopsy and lab tests: A biopsy tests suspicious tissue for signs of cancer and is an important part of the diagnostic process. A tissue sample is taken, either during one of the endoscopic imaging procedures or with a needle biopsy (in which a fine needle is inserted into the pancreas to retrieve cells), then sent to a pathologist who studies it under a microscope. 

If other tests indicate a high likelihood that a tumor is cancerous, the patient may undergo surgery to have it removed. In this case, the tissue may be analyzed after surgery, instead of through a biopsy.  

Molecular testing: Molecular testing is a more sophisticated analysis of tissue and cell samples, looking for specific gene mutations or proteins that may help direct treatment. Ask your care team whether you are a candidate for this test and whether it can be performed on your tissue sample. 

Pancreatic Cancer Screening 

There is no single test that can determine whether or not you have pancreatic cancer. A battery of imaging scans, blood tests, and a biopsy are required for a definitive diagnosis, and these procedures are normally only performed if you have symptoms. Because early pancreatic cancer rarely causes symptoms, the cancer has most certainly developed and spread to other organs by that time. 

People frequently question if there is a way to detect pancreatic cancer early, when surgery is still an option, and before the disease spreads. There is no suggested screening practice for people who aren’t at a higher risk of pancreatic cancer, as there is for breast and colon cancer. 

Pancreatic Cancer Staging 

Staging refers to the location of the cancer, if it has spread, and whether it has spread to other sections of the body. Staging is usually described in pathology and diagnostic reports. Doctors utilize diagnostic tests to determine the cancer’s stage, therefore it’s possible that the staging won’t be final until all of the tests have been completed. Knowing the stage aids the clinician in recommending the best treatment, predicting a patient’s prognosis (the likelihood of recovery), and identifying possible clinical trials for treatment. Distinct forms of cancer have different stage descriptions. It is critical that the staging be performed at a medical facility that has experience diagnosing and staging pancreatic cancer. 

Doctors use several systems to stage pancreatic cancer. The method used to stage other cancers, called the “TNM classification,” is not often used for pancreatic cancer. 

The more common way to classify pancreatic cancer is to classify a tumor into one 1 of the following four categories, based on whether it can be removed with surgery and where it has spread: 

  • Resectable (localized) :Pancreatic cancer of this sort can be surgically removed. Surgery is frequently performed soon following a diagnosis. Prior to surgery, further treatment may be necessary. The tumor may be limited to the pancreas or extend beyond it, but it has not grown into any of the area’s major arteries or veins. There is no indication that the tumor has spread beyond the pancreas. This stage is found in approximately 10 percent to 15 percent of patients.  
  • Borderline resectable :When a tumor is first identified, it may be difficult or impossible to remove surgically, but if chemotherapy and/or radiation therapy may decrease the tumor first, surgery to remove the tumor with negative margins may be achievable afterwards. A “negative margin” indicates that no visible cancer cells remain in the body after the procedure.  
  • Locally advanced :This type of pancreatic cancer is still located only in the area around the pancreas, but it cannot be surgically removed because it has grown into or close to nearby arteries, veins, or organs. This means that it cannot be removed with surgery because the risk of damaging these nearby structures is too high. There are no signs that it has spread to any distant parts of the body. 35 to 40 percent of patients are diagnosed at this stage.  
  • Metastatic :The tumor has spread beyond the area of the pancreas and to other organs, such as the liver, lungs, or distant parts of the abdomen. Approximately 45 percent to 55 percent of patients are diagnosed with this stage. 

Sources:  

https://www.hopkinsmedicine.org

https://www.webmd.com

https://www.cancer.net

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