Diagnostics

More often, pancreatic cancer is detected by chance during examination (for example, with an ultrasound of the abdominal cavity).

If cancer is suspected, the doctor will take further diagnostic steps. It is necessary to find out whether this is really a tumor and, if so, in which part of the gland it is located and how the disease progresses.

Important tests to confirm pancreatic carcinoma:

• Patient examination
• Laboratory examinations. The purpose of laboratory research, along with the diagnosis of a tumor, is to study the function of the pancreas. With the help of various tests of urine, stool and blood, the production of enzymes and hormones by the pancreas can be monitored. In addition, the so-called tumor markers are determined. The definition of a tumor marker often allows us to already assume the type of pancreatic carcinoma. Carcinomas originating from the ductal system of the gland produce primarily the oncormarker CA19-9. (cancer antigen). Other tumor markers are: CA 50, CA 195 and CA 242, as well as CEA and CA 72-4. For diagnosis, tumor markers are most likely of secondary importance. They are primarily used to assess the dynamics of tumor growth during treatment or for subsequent monitoring of the course of the disease.
• Ultrasound examination (sonography)
• Computed tomography (CT) Computed tomography is used in addition to ultrasound examination to accurately determine the spread of the tumor and identify metastases. Computed tomography can also determine how deep the tumor penetrates into the organ and the subsequent extent of the operation. In addition, computed tomography allows you to recognize whether the cancer has already spread to neighboring organs, such as the small intestine, stomach, spleen or lymph nodes, as well as the presence of metastases (for example, to the liver).

If the diagnosis of pancreatic cancer is established, further examinations are carried out to determine the prevalence of the process.

These surveys include:

• X-ray of the lungs
• Endoscopic examination of the stomach and duodenum. If ultrasound and computed tomography are not sufficient to make a diagnosis, for example, in the case of a still very small tumor, an endoscopic examination of the stomach and duodenum 12 (gastroduodenoscopy) is additionally performed, as well as an image of the pancreatic duct and bile ducts using x-rays ( endoscopic retrograde cholangiopancreatography (ERCP).
• Endoscopic image of the pancreatic duct and bile ducts using x-rays (ERCP). It is also today still an important diagnostic method. This examination is primarily carried out to eliminate jaundice in violation of the outflow of bile, by introducing tubules (stents) made of plastic or metal.
• Endoscopic ultrasound examination (endosonography).Due to the close proximity to the tumor, the quality and significance of ultrasound images are much higher than with normal ultrasound from the outside. Therefore, very small tumors, less than 5 mm in diameter, can already be seen with endosonography. In addition, under the control of ultrasound, a puncture of the tumor can be performed.
• Magnetic resonance imaging (MRI). The research method allows obtaining good images of the pancreatic duct and bile ducts (MR-CPG = MR-cholangiopancreatography) and vessels of the upper abdomen (magnetic resonance angiography) also without the use of contrast agents. For this reason, MRI is now often used as an alternative to ERCP or conventional angiography.
• INtaking a tissue sample (biopsy). In some cases, the doctor recommends a puncture, as it is not always easy to distinguish between benign and malignant tumors of the pancreas. During the puncture, the doctor obtains tumor tissue (biopsy). In the future, a histological examination of this tissue under a microscope for the presence of cancer cells is carried out. In most patients, it is possible to obtain cell and tissue samples without much effort using ultrasound and CT-guided puncture. If the tumor is located in the head of the pancreas, then tissue can be obtained by endoscopy or endosonography from the intestinal side. The puncture can also be performed from the outside through the abdominal wall.

Sometimes an examination of the abdominal cavity (laparoscopy) and skeletal scintigraphy are also performed. New examination methods include positron emission tomography (PET) and, in the case of endocrine tumors, octreotide scintigraphy. With the help of positron emission tomography, it is often possible to better distinguish between benign and malignant changes in the pancreas, as well as to identify other tumor foci (metastases). A further development in the field of diagnostics is PET-CT, in which PET and CT are performed in the same machine and the resulting images are recorded. Thus, multiple accumulations of radioactive material detected by PET can be better identified.

If all the results of the examinations are available, the medical specialist together with the patient decides which treatment methods to carry out.