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Medical Author:

Timothy Kuo, MD

Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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On physical exam, the doctor may feel a mass in the center of the abdomen. However, pancreatic cancer is seldom diagnosed using a physical exam, and the absence of any abnormalities should not dissuade the doctor from obtaining an imaging test if the symptoms of pancreatic cancer are present and persistent. The main imaging tests used to help detect pancreatic cancer are as follows:

• Abdominal ultrasound: This may be the initial test if a person has abdominal pain and jaundice. This test is effective at looking for gallstones, a common condition that presents with similar symptoms as that of pancreatic cancer. If a pancreatic tumor is seen on ultrasound, a CT scan is still necessary to obtain more information.
• Abdominal computed tomography (CT): This is the test of choice to help diagnose pancreatic cancer. A CT scan can locate small tumors in the pancreas that might be missed by ultrasound. In addition, a CT scan can accurately show whether the mass has extended beyond the pancreas and what the relation is to nearby blood vessels and organs -- information vital to a surgeon planning an operation to remove the cancer. If a pancreatic tumor is suspected, then a specialized CT scan, called a pancreatic protocol scan, is preferred prior to surgery.
• Other tests include MRI, positron emission tomography (PET scan), and endoscopic techniques.

If a tumor is seen in the pancreas, the doctor may want to perform a biopsy so that a pathologist can confirm that the mass is cancer. A biopsy can be performed in the following ways:

• Percutaneous biopsy: This refers to a biopsy performed by inserting a needle through the skin into the body. A radiologist usually performs this procedure while using an ultrasound or CT scanner to guide the needle into the tumor. The procedure is generally painless.
• Endoscopic biopsy: A gastroenterologist performs this procedure by inserting a flexible tube with a camera at the tip (called an endoscope) through the mouth, into the stomach, and then into the duodenum. From here, a needle biopsy can be obtained with guidance from an ultrasound at the tip of the endoscope. A person is heavily sedated for this procedure, and it is generally painless.

If a tumor is seen in the pancreas and little doubt exists that the tumor is cancer, a surgeon may choose to remove the cancer completely without first obtaining a biopsy.

Once the diagnosis of pancreatic cancer is confirmed, routine blood studies are also performed to assess overall liver and kidney function.

In addition, a blood test called CA 19-9 is obtained. CA 19-9 is often produced by pancreatic cancers, and its level is elevated in 80% of pancreatic cancer cases. Checking the CA 19-9 levels can be a useful gauge of how the treatment is working. After treatment, the doctor may check the CA 19-9 levels regularly as one indicator of whether the cancer has returned. However, CA 19-9 is not an absolute test for pancreatic cancers, and other conditions may cause a rise in the CA 19-9 levels. Likewise, a normal CA 19-9 level is not a guarantee that the cancer has not returned.

The optimal treatment of pancreatic adenocarcinoma depends on the extent of the disease. The extent of cancer can be divided into the following three categories:

• Localized: The cancer is completely confined within the pancreas.
• Locally advanced: The cancer has extended from the pancreas to involve nearby blood vessels or organs.
• Metastatic: The cancer has spread outside the pancreas to other parts of the body.

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