Diagnosis and Prognosis of Pancreatic Cancer

by Michael Jubinville, MPH

Your doctor will ask you about your symptoms, and health and family history. Your belly and the areas around it will be thoroughly checked. Your doctor will look for other causes of the problems you’re having.

Suspicion of Pancreatic Cancer

You will need more tests if your doctor thinks you have problems with your pancreas. Tests can help find cancer or other problems, such as pancreatitis. These may be:

Blood tests —Certain proteins are released into the blood as cancer grows. Looking for these proteins help when cancer is staged. They also can tell if treatments are working.
Imaging tests —These tests can help look for changes to the pancreas and find tumors. Some tests use contrast material to highlight structures. This makes them easier to see. These tests are:
- Abdominal helical CT scan
- MRI scan
- positron emission tomography (PET scan)
- Abdominal ultrasound
- Angiography
Endoscopy —A lighted scope with a camera is placed through the mouth and into the digestive tract. Any tissue that doesn’t look normal will be removed for biopsy. Then, it will be tested in a lab. These tests are:
- Endoscopic ultrasound (EUS)
- Endoscopic retrograde cholangiopancreatography (ERCP)
Laparoscopy—A tube is placed through small cuts in the belly. A lighted scope and camera is passed through the tube to look at the pancreas and structures near it. Any tissue that doesn’t look normal will be removed and tested in a lab.

Diagnosis of Pancreatic Cancer

Diagnosis of pancreatic cancer is confirmed with a biopsy. A biopsy is done during an ERCP, laparoscopy, or through a fine needle aspiration (FNA). With FNA, a small needle is placed into the belly and into the pancreas. This will also help find out what type of cancer it is.

Staging of Pancreatic Cancer

If pancreatic cancer is found, results from finished tests and new tests will help find out what stage it is in. The stage is based on what the tumor looks like during testing. It will help your doctors come up with ways to treat it. The stage of cancer is based on where the tumor is and how far it has spread.

Staging Tests

Tests that help with cancer stage are:

Blood tests to see how your liver and kidneys are working.
Imaging tests—To find how far the cancer has spread from the pancreas. They also help with finding growths in other parts of the body. Some tests use contrast material to highlight structures. This makes them easier to see. These may be:
- EUS
- Chest CT scan
- Laparoscopy

Stages of Pancreatic Cancer

Pancreatic cancer is staged from 0-4:

Stage 0—Carcinoma in situ —A group of cells that don’t look normal are found only in the lining of the pancreas. These cells are not yet cancer, but can become cancer and spread.
Stage 1A —Tumor is 2 centimeters (cm) or less in size AND has NOT spread beyond the first site.
Stage 1B —Tumor is more than 2 cm in size AND has NOT spread beyond the first site.
Stage 2A —Cancer has spread nearby BUT has NOT spread to any lymph nodes.
Stage 2B —Tumor is any size and cancer has spread to nearby lymph nodes.
Stage 3 —Cancer has spread to blood vessels in the pancreas AND MAY be in the lymph nodes.
Stage 4 —Cancer has spread beyond the pancreas and lymph nodes to other parts of the body. The most common sites are the lining in the belly, liver, and lungs.

Other methods can be used when planning treatment. The stages are based on whether the tumor can be taken out. These stages are:

Resectable —Cancer is only in the pancreas or just outside of it. The whole tumor can be removed at this stage. Sometimes a tumor may look like it could be taken out based on test results. Once the surgery starts, your doctor may not be able to take the entire tumor out.
Borderline resectable —The cancer has spread nearby or to blood vessels in the pancreas. In certain cases, it’s likely that the whole tumor can be removed.
Unresectable —The tumor can’t be removed because it has spread into nearby structures or beyond the pancreas to other parts of the body.

Prognosis

Prognosis is the forecast of the likely course of a disease. It is most often given as a percent of people with cancer who may survive over 5 or 10 years. This is an inexact way of getting this data. This is because the predictions are based on large groups of people who are in different stages of cancer. Doing it this way for one person isn’t perfect and somewhat flawed, but it’s the only method at hand.

Pancreatic cancer is often found in later stages. As a result, the number of people who survive for 5 years or more after it has been found is very small, perhaps as low as 5%. About 21% of all those with pancreatic cancer survive for a year after diagnosis.

References:

De La Cruz MD, Young AP, et al. 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. Accessed October 3, 2020.

Pancreatic cancer. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/pancreatic-adenocarcinoma. Accessed October 3, 2020.

Stages of pancreatic cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/pancreatic/patient/pancreatic-treatment-pdq#section/_139. Accessed October 3, 2020.

Tests for pancreatic cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed October 3, 2020.

Last reviewed September 2020 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP
Last Updated: 12/15/2020

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