Pancreatic Cancer Diagnosis
Pancreatic Cancer Diagnosis Tests
Being diagnosed with cancer can be a scary time for anyone. Here you will find information to help you understand some of the terms you might have heard.
In order to diagnose pancreatic cancer, your oncology specialist will do a range of tests. There might be one test or a mix of tests, some of which are explained below.
Blood tests
Blood tests are usually taken first to check your blood count and see if your liver and kidneys are working well. Blood tests can also detect tumour markers (chemical substances) that some cancers produce. It is important to note that not all cancers produce these tumour markers, and some other illnesses also produce these markers and so blood tests are often undertaken in combination with other tests.
Computed tomography (CT) scan
A computerised tomography scan (CT scan) combines a series of x-ray images that are taken from different angles around the body. You will lie on a motorised bed that passes through a doughnut shaped tube. It is important that you lay still for good quality images to be taken and so a strap and/or pillows may be used to help with this. It isn’t painful and usually takes about 1 hour in an outpatient setting.
To prepare for the scan, you may be asked to:
Stop eating or drinking for 4 hours before your scan
Take off some or all of your clothing and wear a hospital gown for the scan
Remove all objects such as jewellery, piercings, dentures, and glasses as they will interfere with the picture quality.
A CT scan uses small amounts of radiation. This is greater than the amount you would get during a simple x-ray, however it is still a small amount and so the risk to your health is very low. The low dose of radiation you are exposed to during a CT scan has not been shown to cause harm.
Ultrasound
Ultrasound[HL1] scans use a microphone (probe) that gives off sound waves to provide an image on a computer of the inside of your body. Some gel is put on your tummy and the probe is moved over the gel with a little pressure. Sometimes you may have a contrast dye injection before your scan that will help to show any growths clearly.
The scan usually occurs in an outpatient clinic and takes about 30 minutes. It is not painful, and you can go home after it.
To prepare for the ultrasound you may be asked to:
Stop eating 6 hours before the scan
Drink a litre of water 90 minutes before your appointment
Refrain from going to the toilet 90 minutes before your appointment to ensure your bladder is full as this helps provide a clearer image
Lie on a bed and adjust your clothes, or put on a hospital gown, so that the Sonographer can put some gel and the probe onto your tummy to do the scan
Once the scan has been taken you can go to the bathroom.
Endoscopic ultrasound (EUS)
An endoscopic ultrasound uses a flexible tube with a camera on it (called an ‘endoscope’) which is inserted into the stomach through the mouth and oesophagus (food pipe). It uses sound waves to create images. Sometimes, there is a small needle on the end that can take fluid or tissue samples (a biopsy) that can be analysed later by the lab.
During an upper EUS test, you lie on your left side. A healthcare provider:
Gives you an IV sedative to help you relax
Sprays your throat with a numbing medicine
Places a plastic mouthguard in your mouth. The mouthguard protects your teeth and prevents you from biting down on the endoscope
Inserts the ultrasound endoscope through your mouth, oesophagus, and stomach until it reaches the duodenum (top part of the small intestine)
You shouldn’t feel any pain and you will be able to breathe as usual
When the images and/or biopsy have been taken, the healthcare provider gently removes the endoscope and stops anaesthesia. You slowly wake up in a recovery room.
An EUS takes about 1 hour and occurs in an outpatient setting. As you will receive a sedative you will need to take someone with you who can drive you home and stay with you for the remainder of the day.
To prepare for your EUS you may be asked to:
Adjust the dosage of your medications such as blood thinners or insulin as recommended by your provider
Not eat or drink for a set period of time before the test
Take off your clothes on your upper body and change into a hospital gown
Endoscopic ultrasounds are a very safe procedure, but sometimes minor complications may occur. These include:
Sore throat
A small amount of bleeding if a biopsy has been taken
Bloating – as air is sometimes pumped through the endoscope during the procedure
Small tear in the throat – from insertion of the endoscope
Fluid on the lungs – if fluid from your mouth went into the lungs during your procedure
Shortness of breath – due to the effects of the sedative
Endoscopic retrograde cholangiopancreatography (ERCP)
An ERCP [HL1] is when a long thin flexible tube with a camera on the end is passed through your mouth and stomach to be able to see any issues occurring in the pancreas, bile ducts, gallbladder, or liver. A dye is also injected and x-rays are used to be able to see if there are any blockages in the bile ducts. You will be given a sedative and anaesthetic throat spray to numb your throat and a mouth guard is then put into your mouth before the tube is inserted.
The procedure usually occurs in hospital and if there are no issues found you can usually go home the same day. If any blockages found, you may have to stay in hospital for stents (small tubes) to be inserted into the bile ducts to open them up.
The procedure usually takes 30-60 minutes, and you will have to stay in hospital for about 4 hours afterwards until the sedative has worn off. Due to the effects of the sedative, you will need someone to drive you home and stay with you for the rest of the day.
In preparation for the procedure, you may be asked to:
Refrain from eating for 6-8 hours beforehand
Remove your clothes and put on a hospital gown
Laparoscopy
A laparoscopy [HL1] is a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) without having to make large incisions (cuts) in the skin. This procedure is also known as keyhole surgery or minimally invasive surgery. The specialist puts a small tube with a camera on the end (laparoscope), through the cut, into your abdomen which relays images to a television monitor. It can also be used to take biopsies and remove damaged/diseased tissue.
It is done under general anaesthetic (you will be asleep) and usually you can leave hospital the same day or the next day.
The advantages of laparoscopy over traditional open surgery are:
A shorter hospital stay and faster recovery time
Less pain and bleeding after the operation
Reduced scarring
Laparoscopy is a common procedure and serious complications are rare. Minor complications occur for about 1-2 in every 100 people which may include infection or bleeding around the site.
Biopsy
A biopsy is when a small sample of tissue is taken to check under a microscope. The biopsy can be taken at the time of the EUS or laparoscopy.
It's important to acknowledge that some of these tests can be confronting or sometimes frightening. Taking a friend or whānau member with you can help ease anxiety. Be encouraged to tell staff if you need extra reassurance during the test, you'll find some very compassionate people working in healthcare.
Waiting to have tests carried out
Even if you have been given an urgent referral for a particular scan or investigation you may have to wait several days or possibly weeks for your appointment. This can be frustrating and worrying, especially if you are already feeling unwell.
Several weeks of testing to confirm a diagnosis or awaiting appointments is relatively common and is unlikely to alter overall outcomes. Cancer growth is considered to be negligible over a period of weeks, and this waiting period is unlikely to cause you harm if your symptoms are stable.
If your symptoms get worse or you start to feel more unwell while you are waiting, it is a good idea to get in touch with your GP or specialist if you already have one. If you cannot get in contact with them, you may need to present to the closest emergency department if your symptoms cannot be controlled at home.
How long will I have to wait for my test results?
Depending on which tests you have had it may take from a few days to a few weeks for the results to come through. Waiting for test results can be an anxious time.
It is a good idea to ask how long you may have to wait when you go for tests. If you think you have been waiting too long, then contact your GP or a specialist to follow up on the progress of your results. Usually, the doctor who does the test will write a report and send it to your specialist. If your GP sent you for the test, the results will be sent to the GP clinic.
You will need an appointment with your specialist or GP to discuss the test results and how they might affect your treatment. Usually, your specialist will discuss your results and plan your subsequent care.
All these tests will give the specialist more information about the cancer such as where it is, if it is growing, and if it has spread. This is called staging. Staging helps to work out the best treatment plan for you.
Pancreatic cancer stages
You may have heard people talk about the stages of cancer. Staging provides an indication of the size of the cancer and if it has spread to other areas of the body and contributes to the treatment planning.
There are two ways in which the stage of cancer can be described. One uses numbers (stage 1, 2 etc) and the other uses letters and numbers (T1, N0, M0 etc) also known as TNM (Tumour-Nodes-Metastases) staging. The cancer may be described in one or both ways by your healthcare team.
Click here to learn more about the stages of cancer:
TNM (Tumour-Nodes-Metastases) staging
The TNM gives a number according to tumour size (T), how many lymph nodes are affected (N), and how far the cancer has spread, or metastasised, to distant parts of the body (M). This may be expressed as, for example, T1, N0, M0. This information is used to help decide the best treatment.
T1 | The tumour is only in the pancreas and is 2cm or less in size |
T2 | The tumour is only in the pancreas and is more than 2cm but less than 4cm in size |
T3 | The tumour greater than 4cm in size or has spread to the duodenum or bile duct |
T4 | The tumour has spread to nearby tissue |
N1 | The tumour has spread into 1-3 lymph nodes |
N2 | The tumour has spread into 4 or more lymph nodes |
M1 | The tumour has spread to distant parts of the body |
Staging using numbers
Stage 1 | The cancer is only in the pancreas |
Stage 2 | The cancer is usually larger and may have started to grow into the duodenum, bile duct or tissues around the pancreas or there may be cancer in the lymph nodes near the pancreas |
Stage 3 | The cancer is growing outside the pancreas into nearby major blood vessels or nerves but has not spread to other parts of the body |
Stage 4 | The cancer has spread to other parts of the body such as the lungs or liver (metastatic cancer) |
Prognosis (Life expectancy)
Like any cancer there are many things that can impact on survival rates, so it is best to talk to your cancer specialist for guidance about your own care and outcomes. Remember, even with a pancreatic cancer diagnosis, no one can know for certain how long anyone will live. Estimates of life expectancy are based on historical data, however treatments are becoming more effective over time which changes these estimates.
Prognosis is usually improved the earlier the cancer is detected. Your doctor will be able to give you the best idea of prognosis.
Often, statistics talk about survival rates which are taken from an average of other patients. These are usually described in 1, 5 and 10-year survival rates. A 10-year survival rate means that someone has not died 10 years after having cancer, however many people live much longer than this.
Click here to view pancreatic cancer statistics related to morbidity (number of diagnoses) and mortality (survival rate). Remember that everyone is different, and statistics are only a guide:
Click here to view pancreatic cancer statistics related to morbidity (number of diagnoses) and mortality (survival rate). Remember that everyone is different, and statistics are only a guide.
In general, pancreatic endocrine tumours tend to have a better prognosis than exocrine tumours (PDAC) which can be very aggressive and difficult to treat.
Each year, 758 people are diagnosed with pancreatic cancer. That is equivalent to about 15 people for every 100,000. This rate is increasing year on year.
Unfortunately, although pancreatic cancer treatments are becoming more effective, pancreatic cancer has a poor long-term survival rate and it is the 5th most common cause of cancer death in New Zealand as it is usually diagnosed once it has spread.
Pancreatic cancer generally has an overall survival rate of 20.4% at one year, 6.5% at 5 years and 6.6% at 10 years.
Around 537 New Zealanders die from pancreatic cancer each year.
If diagnosed early, it can be cured. Prompt investigation of symptoms is important to ensure pancreatic cancer is diagnosed and treated as early as possible.
Currently there is no screening programme for pancreatic cancer and so the need to come together to improve diagnosis outcomes is growing more urgent.
Ministry of Health data shows a 40 percent increase in rates of pancreatic cancer in the two decades to 2017. Additionally, incidence is higher among men than women in New Zealand, and 80% higher among Māori than non-Māori.
Remember that everyone is different, and statistics are only a guide.
Seeking a second opinion
Following diagnosis, some people choose to request a second opinion because they want to have peace of mind that they have explored all options and opinions available to them before starting treatment. If you would like to know more about your care team and how to seek a second opinion, click this link.
Asking for a second opinion can feel uncomfortable and awkward however be reassured that it is not unusual.
Second opinions are requested for a variety of different reasons. Some people seek a second opinion because they want to have peace of mind that they have explored all options and opinions available before starting treatment. Some people may have heard about a treatment and want another doctor’s opinion about it. Some people feel that the communication with their doctor is difficult and they would like to speak to someone who may have a different approach.
If you do want a second, or even third, opinion, make sure to let your GP know in advance to that they can share any tests or assessments that have been done so far.
You can seek a second opinion by either:
Asking your Oncologist
Asking your GP to refer you for a second opinion
It is also a good idea to check with your GP or Oncologist whether seeking a second opinion would delay treatment.
Below is an example of how you might start the conversation with your doctor to request a second opinion.
“I think I would like to seek a second opinion to make sure that I have covered all my bases before starting treatment. Can you help me with that?”
Useful Websites & Patient Support
Information on these pages was collated with grateful assistance from the PanCare Foundation.
DISCLAIMER: Information provided by the Gut Cancer Foundation should be discussed with your healthcare professional and is not a substitute for their advice, diagnosis, treatment, or other healthcare services. In some cases, information has been gathered from Australian sources and should be discussed with New Zealand health care professionals.
