Diagnosing Pancreatic Cancer: Diagnostic Tests and Stages of Disease
How is pancreatic cancer diagnosed?
The following tests are used to look for pancreatic cancer:
- CT scan detects very small tumors and helps find if any have spread beyond the pancreas.
- Endoscopic ultrasound finds tumors that cannot be detected by a CT scan or MRI
- A definitive tissue diagnosis is often established by endoscopic ultrasound with fine needle aspiration. The endoscopic ultrasound provides image guidance for placing a fine needle to extract cells for evaluation, also known as a biopsy. The cells are then examined under a microscope and identified. This identifies the type of pancreas cancer.
How is pancreatic cancer staged?
Pancreatic cancer is classified (staged) into three main groups:
- Operable cancer, which means a tumor is able to be surgically removed immediately or following chemotherapy with or without radiation therapy (resectable or borderline resectable). Borderline resectable tumors are those tumors that are involving important structures that may be need to be removed and reconstructed at the time of operation. These tumors are often treated with chemotherapy with or without radiation prior to surgery to increase the chances of successful surgical removal.
- Locally advanced cancer, which means the tumor is found only in the pancreas with no evidence of spread to other organs, but is involving structures which cannot be safely removed (tumors at this stage are unresectable). These tumors are often treated with chemotherapy and radiation, with consideration of surgery if tumors shrink in response to treatment.
- Metastatic disease, which means that the cancer has spread to other parts of the body, for example, the liver (tumors at this stage are also unresectable). These cancers are usually treated with chemotherapy.
These classification groups help to determine the most effective way to treat the cancer. If it's determined that the cancer can be successfully removed, then surgery is considered.
For patients with localized, but not operable, cancer, two treatment strategies are used:
- a combination of chemotherapy and radiation or
- chemotherapy alone
- Clinical trials which include promising therapies for pancreatic cancer, which are compared to existing treatments for pancreatic cancer.