About the Pancreas |
What is Cancer? |
Pancreatic Cancer |
Patients who have symptoms of unexplained weight loss, continuous diarrhea, new abdominal
mid-back pain, or new onset of adult diabetes should visit a doctor, who will obtain more
information about the person, perform a physical exam, and perhaps order laboratory tests.
If a disease of the pancreas is suspected, the doctor usually orders procedures that can
produce pictures of the pancreas. Pictures or images can help the doctor diagnose cancer
of the pancreas and understand whether it has spread or not. By fully understanding the
location and extent of the cancer, doctors can decide how to treat it.
Methods of obtaining pictures or images of the pancreas are as follows:
CT scans are commonly used to evaluate the pancreas and the rest of the abdomen. A CT scanner
is an x-ray machine linked with a computer. The machine takes x-rays as the patient lies on a
bed in the machine and the computer puts the x-rays together to produce detailed pictures. If
a suspicious tumor is seen at CT scan, it may be possible for the doctor to obtain a sample of
the tumor by using a long needle that is guided by the CT scanner. CT scanning are best for
detecting cancers that are larger or equal to 2cm in size (approximately one inch).
Endoscopic ultrasonography (EUS) uses high-frequency sound waves to make images of the pancreas.
To make these EUS images, a patient lies on a bed, is sedated, and swallows a flexible tube with
an ultrasound probe on the end of it. The ultrasound probe is placed into the stomach and the
small intestine adjacent to the pancreas. The physician can evaluate the ultrasound images and
take photographs if needed. The procedure usually takes about 30-40 minutes and can give a very
sensitive and detailed look at the pancreas. If a tumor is present, it may be possible during the
procedure to get a small tissue sample using a needle guided into the tumor.
ERCP is a method for taking x-rays of the pancreatic ducts and bile ducts that hook up to the main
pancreatic duct. The patient lies down on a bed and is made very sleepy; a long, flexible tube (endoscope)
is passed through the mouth down into the stomach, and then into the small intestine. The doctor then
injects contrast solution into the main pancreatic duct and takes x-rays. This is another very sensitive
test for evaluating the pancreas. It is also possible during this test to get a very small sample of
tumors, or abnormal looking ducts, using a tiny brush.
Magnetic Resonance Imaging (MRI) is a powerful magnet linked to a computer. The MRI machine is very large,
with space for the patient to lie in a tunnel inside the magnet. The machine measures the body's response
to the magnetic field, and the computer uses this information to make detailed pictures of areas inside
the body. The information gained is similar to the information gained at ERCP, except that it is not quite
as sensitive in picking up very small changes. Samples of the tumor can not be obtained at this procedure.
Other tests besides the ones listed above may be used together or in place of the tests listed. Physicians
will try to make the patient as comfortable as possible, while the tests are being performed. Pictures of
the pancreas and nearby organs provide important clues as to whether a person has cancer. However, getting
a sample of the tumor or suspicious area is the only sure way for the doctor to learn whether pancreatic
cancer is present. Samples can be obtained using a needle (CT and EUS) or by using a brush (ERCP) or at
surgery [see surgical biopsies below]. The larger the sample of tissue the easier it is for the pathologist
to make an accurate diagnosis. A pathologist looks at the tissue under a microscope, whether it is from a
needle, brush, or surgical biopsy, to check for cancer cells. Occasionally it is not possible to obtain a
sample of a suspected cancer.
Biopsies can be obtained at surgery using one of two techniques. In one type of surgery, called laparoscopy
the doctor inserts a lighted flexible tube into the abdomen through a couple of one inch incisions. In
addition to removing tissue samples to be examined under the microscope, the doctor can see inside the
abdomen to determine the location and extent of the disease. During laparoscopy, the doctor can decide
whether a larger operation is needed to remove the tumor or to relieve symptoms caused by the cancer. This
type of operation is relatively easy on the patient because they heal up quickly.
In some cases, a laparotomy is necessary to make a diagnosis. In this operation, the doctor makes a large
incision (6-10 inches) and directly examines the organs in the abdomen. If cancer is found, the doctor can
go ahead with further surgery. (The types of surgery done to treat pancreatic cancer are described in the
"Treatment Methods" section.)