Pancreatic Cancer Program
Diagnosing Pancreatic Cancer
Some symptoms of pancreatic cancer are:
The head of the pancreas is located close to the common bile duct and small bowel (duodenum) so tumors located in the head of the pancreas may grow and block these structures. Bile duct blockage can lead to jaundice in 70-85% of patients with tumors in the head of the pancreas. Symptoms of jaundice include:
- yellowing of the skin
- yellowing of the whites of the eyes
- light-colored (clay colored) bowel movements
- dark-colored urine
- Nausea, Vomiting, Weight Loss
Stomach emptying can be delayed when the small bowel is compressed. This causes a feeling of fullness and contributes to symptoms of nausea and vomiting. These symptoms are initially present in 35-45% of patients with pancreatic cancer. Patients sometimes have a loss of appetite and nausea that leads to weight loss.
In advanced disease, up to 5% of patients have tumors that cause complete blockage of the small bowel. In this case, surgery may be done to bypass the blockage and improve digestion.
In more advanced disease, patients can have a feeling of being tired and fatigued. There are many causes of fatigue in patients with cancer.
- Abdominal Pain
75-90% of patients with pancreatic cancer have abdominal pain. This may be described as cramping or gas-like pain. Pain may also spread, or radiate, to the back and shoulders.
- Blood Clots
There is an increased risk for blood clots in patients with pancreatic cancer. A blood clot can be a first symptom of pancreatic cancer. The cancer itself causes changes in the blood that increases the risk for blood clots. Some clots have no symptoms, but swelling, pain and redness can be present in the area of clot.
The onset of diabetes or difficulty in controlling blood sugar levels is also associated with pancreatic cancer. Diabetes may be diagnosed before or after the diagnosis of pancreatic cancer. Diabetes occurs when the body does not produce enough of the hormone, insulin, or is unable to use insulin properly. Insulin helps your body regulate the blood sugar level, so without it blood sugar levels are often high.
- Pancreatic Insufficiency
The pancreas secretes digestive enzymes, or juices, into the small intestine. These juices help digest food in the intestines. Patients with pancreatic cancer may not have adequate amounts of these enzymes, and food isn't digested normally. This is called pancreatic insufficiency.
Symptom include diarrhea and cramping often after eating. This happens because food passes through the digestive tract not fully digested. As the indigestible food passes through, it pulls water into the intestines, causing diarrhea and cramping.
How is it diagnosed?Patients with symptoms suspicious for pancreatic cancer will undergo tests to determine the cause of these symptoms. Below are some test and procedures used for diagnosis:
- Ultrasound of the abdomen
An ultrasound can identify a tumor or mass in the pancreas or bile duct system that may be causing blockage or jaundice.
- Endoscopic Ultrasonography (EUS)
The EUS test is done with a lighted tube that is inserted through the mouth and placed into the stomach. Ultrasound images of the pancreas are obtained through the stomach wall. It is highly sensitive for diagnosing pancreatic cancer. EUS is particularly useful for detecting small (less than two centimeters) tumors which may not be well visualized by CT. It can also identify tumors that may involve important blood vessels. The procedure can provide details about the arteries and veins next to the pancreas.
A biopsy with a small or 'fine' needle aspiration (FNA) of the tumor may also be performed during an EUS to diagnose pancreatic cancer. Intravenous sedation is used for this procedure.
- ERCP (endoscopic retrograde cholangiopancreatography)
An ERCP is done with a lighted tube called an endoscope to look at the bile ducts. It can also be used to place a stent or tube to open a blocked bile duct for drainage. Intravenous sedation is most commonly used for this procedure. The patient is not awake during the test. This procedure helps to determine what is causing the blockage.
Some causes of these blockages include ampullary tumors, cholangiocarcinoma (bile duct cancer), inflammation or cancer of the pancreas. Bile duct juice and tissue samples may be obtained and sent to the pathologist to evaluate for cancer cells.
- Computed Tomography (CT)
The CT scan can show small tumors as well as important blood vessels that the tumor might be growing into or around. A CT scan can also look at surrounding organs for spread (metastasis) of the cancer into the lymph nodes, liver and other areas. The doctor may suggest a pancreatic mass CT to be done at the UM for the first clinic visit to better assess the tumor for size, location and involvement of surrounding vessels and organs. This is a special CT scan done at the Cancer Center that examines the pancreas very closely. A special dye is used for the CT, to give additional information to the radiologist; therefore a temporary IV (intravenous catheter) will be placed prior to the scan.
- Interventional Radiology
In some cases the radiology department can perform needle biopsies using the CT or ultrasound technique to locate the mass (tumor) and obtain a tissue sample through the abdomen for a diagnosis. At the UM Interventional Radiology department, there are specialists who may be consulted to do one of these procedures.
Diagnosing pancreatic cancer can be a challenge. It is often difficult to get an adequate biopsy for the pathologist to look at under the microscope. It is frustrating for the patient and the doctor who want to move ahead quickly in making a diagnosis and beginning treatment.
What are the types of cancer found in the pancreas?There are many different types of pancreatic tumors; however, pancreas cancer is mainly (95%) ductal adenocarcinoma. This type of pancreatic cancer arises from the lining of the pancreatic duct which is the exocrine part of the pancreas that produces the digestive juices.
Tumors may arise from the endocrine part of the pancreas in approximately 5% of cases. This is sometimes referred to as Islet (insulin producing) cell or neuroendocrine cancer. Even rarer tumors are sometimes found, such as sarcomas or lymphomas.
For more informationContinue reading about how pancreatic cancer is treated at the U-M Cancer Center on the Treatment web page; or print our Pancreatic Cancer Patient Handbook.
If you still have questions, please contact the Cancer AnswerLine™ by telephoning 800-865-1125.
Last update 6/2007
Developed by the staff of the Multidisciplinary Pancreatic Cancer Program at the U-M Comprehensive Cancer Center. In addition, the GI Oncology Program, Patient Education Program, Gastrointestinal Surgery Department, Medical Oncology, Radiation Oncology and Surgical Oncology contributed.
This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. The aim is promoting active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.