pUseful to know:
- Pancreatic cancer is quite rare (up to 7% of cases).
- In 10% of cases, pancreatic cancer is hereditary.
- Diagnosis of pancreatic cancer at the early stages is difficult.
- Symptoms of pancreatic cancer are similar to those of non-oncological diseases of the gastrointestinal tract.
Patients at risk should undergo regular screening.
Pancreatic cancer belongs to those tumors that are difficult to diagnose. It is a very aggressive type of cancer, occurring relatively rarely - no more than 7% of all cases of cancer.
Diagnosis at the early stages of tumor development is difficult. Usually, the symptoms appear at the last stage: patients suffer from severe pain in the abdomen and back, quickly lose weight, jaundice (yellow skin and eyes), so that it is impossible to ignore the signs of the disease.
Screening (early diagnosis) of pancreatic cancer
In patients with a high risk of developing a tumor and in the absence of symptoms, Endoscopic ultrasound (EUS) is indicated.
Endo-ultrasound is a procedure for examining the pancreas, which combines ultrasound and endoscopy. It makes possible to provide a thorough examination and assessment of the internal organs of the gastrointestinal tract "from within" (as with endoscopy). The ultrasonic sensor at the end of the endoscope provides the specialist with detailed information about all changes in this area that traditional ultrasound (through the front abdominal wall) does not see.
For the procedure, the endoscope is inserted through the mouth (the patient must swallow the device). It is performed on an empty stomach with the possibility to use sedatives to relax a patient.
If you are allergic to a medication, tell your doctor before starting the procedure.
Ultrasonic waves emitted by the sensor are reflected from the pancreas and other organs of the digestive tract, forming an image. Endo-ultrasound takes from 15 to 45 minutes and allows to establish the presence of pathological changes in the pancreas, its vessels, lymph nodes.
It is also possible to perform an annual MRI of the abdominal cavity if patients are at risk.
Are you at risk? Check it in the article Cancer of the pancreas: causes and symptoms.
MRI allows distinguishing any small changes in the pancreas, surrounding organs, blood vessels, and even detect the smallest tumors with their precise location.
Modern methods of pancreatic cancer diagnosis
The first step in establishing a diagnosis is collecting information about the patient (medical history). Since in 10% of cases pancreatic cancer is a hereditary disease it is important for a doctor to know about the similar illnesses of a patient's relatives.
No matter in what part of the gland cancer is (the tail, body, head or bile duct) diagnostic methods are the same.
Computed tomography of the pancreas
Computed tomography (CT) often is the first (primary) diagnostic procedure that is prescribed for assessment of pancreatic disease. When examining the pancreas, computed tomography with contrasting and angiography is used. CT is also useful for needle guidance for aspiration biopsy of the pancreas.
With a computer tomography, the resectability (an opportunity of removal) of a tumor is defined. Surgery might be a good treatment option in 70-85% of cases.
Computed tomography, combined with positron emission tomography (PET-CT), has a high sensitivity in the definition of distant metastases.
Endoscopic retrograde cholangiopancreatography (ERCP)
Cholangiopancreatography is suitable for detecting a pancreatic tumor that is blocking a duct. It can also be used to help plan surgery. This test uses an endoscope (thin, flexible tube) with a camera to obtain images of the abdominal cavity. The endoscope is inserted through the mouth and stomach into the duodenum. Sometimes, a catheter is injected, which introduces a contrast in the pancreas and bile ducts.
The procedure takes from 30 to 90 minutes and can be performed when a patient is sedated.
Magnetic resonance imaging (MRI)
There are two types of MRI used in pancreatic cancer diagnosis:
- Magnetic resonance cholangiopancreatography
Magnetic resonance cholangiopancreatography (MRCP) is a type of MRI that makes clear images of the pancreas and bile ducts. The procedure takes about 10 minutes.
- Magnetic resonance angiography
MR angiography (MRA), which looks at blood vessels to check if blood flow in a particular area is blocked or compressed by a tumor.
Laparoscopy of the pancreas
Laparoscopy is a surgical procedure in which a laparoscope is inserted through a tiny incision in the abdominal cavity. This method is indicated for the precise staging of the disease in case of doubt. The procedure allows identifying metastases in the peritoneum (peritoneal carcinomatosis, metastases in the liver).
Laparoscopy is performed under general anesthesia and takes about 30 minutes.
In most cases, the only way to be sure it is cancer is to take a small sample of tumor and look at it under the microscope - biopsy.
The material for analysis can be taken from different points of the pancreas.
There are three types of biopsy:
- Fine needle aspiration biopsy under the control of endoscopy (Endoscopic biopsy)
The procedure is carried out by a thin needle attached to the endoscope. The device is inserted through the mouth. The process is guided by endoscopic ultrasound (EUS). A doctor directs the needle to the right place, taking a piece of the tumor.
- Fine needle aspiration biopsy under CT control (Percutaneous (through the skin) biopsy)
After computer tomography, an expert receives the image of a pancreas. Then inserts a thin needle through the skin to remove a small piece of a tumor. This type of pancreatic biopsy is performed under local anesthesia.
The best option is a biopsy under the control of endoscopy since this procedure is safer.
- Surgical (laparoscopic) biopsy
Nowadays surgical biopsy is rarely performed. It can be used if cancer has spread beyond the pancreas and there is a need to perform a biopsy of other organs in the abdomen.
Blood tests are not a method of diagnosing pancreatic cancer itself but are used to search for signs of disease, to check the functioning of organs and to determine the effectiveness of treatment.
A general blood test establishes the total number of blood cells in the sample. A small or increased number of them indicates the presence of abnormalities.
A biochemical blood test measures the level of chemicals in the blood, the change of which signals a problem in the body. A high level of bilirubin in the blood is a sign of pancreatic disease.
A test of liver function is often used in the diagnosis of pancreatic cancer metastases. The test measures the parameters of hepatic enzymes; their abnormal amount makes it possible to establish that the liver function is impaired.
The blood test for the potential tumor marker CA 19-9 is also a screening procedure. Some studies show that it is possible to detect an increase in CA 19-9 two years before other symptoms will show.
The analysis on CA 19-9 is an important factor in the prognosis and pancreatic cancer treatment evaluation but is not used to confirm the diagnosis.
hENT1 (Human equilibrative nucleoside transporter 1 is one of the key enzymes in the metabolism of pancreatic cancer cells). It is a marker of sensitivity to the primary chemotherapeutic drug for pancreatic cancer - gemcitabine.
How to treat pancreatic cancer?
The main methods of treatment of pancreatic cancer are:
- targeted therapy.