Tests for pancreatic cancer
You usually have several tests to check for pancreatic cancer. This might include some or all of the following:
- blood tests
- urine test
- different types of scans
- taking samples of cells (biopsies)
Tests your GP might do
Most people start by seeing their GP when they have symptoms. Your GP can do some tests to help them decide whether you need a referral to a specialist. They might:
- do some blood tests
- test your wee (urine)
- feel, look and listen for any changes in your body (physical examination)
- send you for an ultrasound or CT scan
Blood tests
Your GP might arrange for you to have blood tests. You usually have these at your GP practice or your local hospital. Blood tests can give an idea of your general health and if certain systems in your body are working normally, such as your liver or kidneys.
Urine test
You may have to give a urine sample to be sent away for testing. This is to check whether your symptoms could be due to 
.
Physical examination
Your doctor will ask you to lie down. They will look at your skin and eyes to check for signs of jaundice. They will feel your tummy (abdomen) for any areas that are swollen or might not feel normal. And if you have any pain, they will feel those areas.
They might also listen to your chest and abdomen to find out if they sound normal. For example, they can listen for signs of fluid collecting, or if your digestive system is working.
Ultrasound scan
Ultrasound scans use high frequency sound waves to create a picture of a part of the body. An abdominal ultrasound scan shows up blood flow and changes in your tummy, including abnormal growths.
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If you have symptoms such as jaundice, an ultrasound scan can show if there is a blockage in the bile ducts.
CT scan
A CT scan is a test that uses x-rays and a computer to create detailed pictures of the inside of your body. It takes pictures from different angles. The computer puts them together to make a 3 dimensional (3D) image. CT (or CAT) stands for computed (axial) tomography.
Doctors use a CT scan to help them to show whether there are any changes in the pancreas or nearby structures, such as the liver.
Tests your specialist might do
Depending on the results of your tests, your GP might refer you to a specialist. This is usually a gastroenterologist. This is a doctor that specialises in diseases of the . They usually do all the necessary tests until you have a diagnosis.
If tests show you have pancreatic cancer, you may have other scans to give more information about its size and whether it has spread. This is called staging the cancer.
Pancreatic cancer is often diagnosed late. This is because it doesn’t usually show symptoms in the early stages. Only a small number of people are able to have surgery to remove their cancer. If tests show this might be possible you usually see a surgeon next.
Most people can’t have their pancreatic cancer removed with surgery, so you see a medical oncologist. This is a doctor who specialises in pancreatic cancer.
The tests the specialists might do include:
- CT scan or ultrasound scan if you haven’t had one of these already
- biopsy
- endoscopic ultrasound (EUS)
- magnetic resonance cholangio pancreatography (MRCP)
- endoscopic retrograde cholangio pancreatography (ERCP)
- MRI scan
- PET-CT scan
- tests for tumour markers
- testing for gene, DNA and protein changes
Biopsy
The most sure way of diagnosing pancreatic cancer is by taking a sample of cells (biopsy) and looking at them under a microscope.
Doctors don't usually take biopsies from the pancreas if they think that the cancer could be removable with surgery (resectable). In that case, your likely diagnosis will be made by the doctor examining you and reviewing your scans and tests. A confirmed diagnosis can be made when the tumour is removed.
There are several different ways your doctor can take a biopsy. The type your doctor uses will depend on the position of the tumour in the pancreas. The tests used to take a biopsy include:
- endoscopic ultrasound (EUS)
- ERCP
- ultrasound guided biopsy
- CT scan guided biopsy
- using a tube put through the skin of your tummy (laparoscopy)
Some people have a biopsy during a small operation (laparotomy), but today this is rare. A laparotomy is when your surgeon makes a cut in the skin of your abdomen to take a tissue sample from the pancreas. You are more likely to have a laparoscopy because it is a much smaller operation.
Endoscopic ultrasound (EUS)
You might have this test to find out if you have pancreatic cancer. Or you might have it to see how big the cancer is and whether it has spread.
This test combines ultrasound and endoscopy to look at the areas around your food pipe, stomach, pancreas and nearby .
To do the test your doctor uses a long flexible tube called an endoscope. It has a tiny camera and light on the end and an ultrasound probe attached. The ultrasound scan uses high frequency sound waves to create a picture of the inside of your body.
They can also take biopsies during this test.
MRI and MRCP scan
An MRI is a scan that creates pictures using magnetism and radio waves. It stands for magnetic resonance imaging. MRI scans create pictures from angles all around the body and shows up soft tissues very clearly.
MRCP is a type of MRI scan that you have in the MRI scanner. It stands for magnetic resonance cholangio pancreatography. It uses magnetic fields to give detailed pictures of your pancreas, gallbladder and bile ducts.
Doctors use these scans to show up abnormal areas in the abdomen. You might have one or both of these scans to find out if you have pancreatic cancer.
If you have already been diagnosed with pancreatic cancer, you might have a scan to find out the size of the cancer and whether it has spread.
ERCP
Endoscopic retrograde cholangio pancreatography (ERCP) is a test to help doctors look at the pancreas, liver, gallbladder and bile ducts. They do this by putting a tube into your mouth and down into the area between the stomach and small bowel to look at the pancreas.
An ERCP can help confirm a diagnosis of pancreatic cancer, by taking samples of any abnormal areas. Or they can use this procedure to put in a small tube (stent) for a blocked bile duct.
PET-CT scan
A PET-CT scan combines a CT scan and a PET scan. PET stands for positron emission tomography. The PET scan uses a mildly radioactive drug to show up areas of your body where cells are more active than normal.
The CT scan takes a series of x-rays from all around your body and puts them together to create a 3 dimensional (3D) picture.
You might have a PET-CT scan to find out more about the cancer, for example if it has spread outside the pancreas. It may also help your doctors decide whether surgery is possible.
Testing for tumour markers for pancreatic cancer
Tumour markers are substances that might be raised if there is a cancer. They’re usually proteins. They can be found in the blood, urine or body tissues.
Some tumour markers are only produced by one type of cancer. Others can be made by several types. Some markers are found in non cancerous conditions as well as cancer.
Doctors might use tumour markers to monitor how well your cancer treatment is working or check if the cancer has come back.
If you have pancreatic cancer your doctor might test for tumour markers such as:
- carcinoembryonic antigen (CEA)
- cancer antigen 19-9 (CA19-9)
Testing for gene and protein changes in pancreatic cancer
Some pancreatic cancers have changes (mutations) in particular and proteins. To test for these changes your doctor uses a sample of your pancreatic cancer tissue from a biopsy. Or they may use a sample of the cancer from if you had surgery to remove it.
Knowing this can help your doctor:
- understand the type of pancreatic cancer you have
- make decisions about treatment
