How Is Pancreatic Cancer Diagnosed-Part 4

In order to diagnose pancreatic cancer, physicians will request a complete physical exam as well as personal and family medical histories. The way in which the cancer presents itself will differ depending on whether the tumor is in the head or the tail of the pancreas. Tail tumors present with pain and weight loss while head tumors present with steatorrhea, weight loss, and jaundice. Doctors also look for recent onset of atypical diabetes mellitus, Trousseau's sign, and recent pancreatitis.

In general, when making a pancreatic cancer diagnosis, physicians pay special attention to common symptoms such as abdominal or back pain, weight loss, poor appetite, tiredness, irritability, digestive problems, gallbladder enlargement, blood clots (deep venous thrombosis (DVT) or pulmonary embolism), fatty tissue abnormalities, diabetes, swelling of lymph nodes, diarrhea, steatorrhea, and jaundice.

It is also common for doctors to administer blood, urine, and stool tests. Blood tests can detect a chemical called carcinoembryonic antigen (CEA) as well as CA 19-9 - a chemical released into the blood by pancreatic cancer cells. Liver function tests check for bile duct blockage.

Several imaging techniques are employed in order to see if cancer exists and to find out how far it has spread. Common imaging tests include:

• Ultrasound - to visualize tumor
• Endoscopic ultrasound (EUS) - thin tube with a camera and light on one end
• Abdominal computerized tomography (CT) scans - to visualize tumor
• Endoscopic retrograde cholangiopancreatography (ERCP) - to x-ray the common bile duct
• Angiogram - to x-ray blood vessels
• Barium swallows to x-ray the upper gastrointestinal tract
• (MRI) - to visualize tumor
• Positron emission tomography (PET) scans - useful to detect if disease has spread

The only absolute way to make a cancer diagnosis is to remove a small sample of the tumor and look at it under the microscope in a procedure called a biopsy. A fine needle aspiration (FNA) biopsy is the most commonly used method. A thin needle is inserted into the pancreas through the skin, and the pathologist uses CT scan or ultrasound images as a guide. Another type is the brush biopsy performed during ERCP to gather cells. A laparotomy is sometimes ordered to determine the stage, or extent, of the disease because it provides access to a large part of the abdominal cavity.