Diagnosis
If you experience one or more of the symptoms linked to pancreatic cancer and wish to be seen by a UCSD physician, or if your doctor has referred you to Moores UCSD Cancer Center, your medical history will be taken, you will receive a thorough physical examination, and you’ll be scheduled for laboratory and imaging tests. A biopsy (the removal of a small sample of the tumor with a fine needle) may also be taken during one of the imaging exams. If pancreatic cancer is diagnosed, the information gathered will pinpoint the location, size and stage of the cancer. This information will help your medical team design your specific treatment plan.
If you've already been diagnosed with pancreatic cancer, our physicians will take your medical history, examine you, evaluate the tests you’ve already received, and order additional tests as needed.
Advanced imaging techniques for pancreatic cancer
Pancreatic cancer is usually diagnosed with tests and procedures that produce pictures of the pancreas and the area around it.
Endoscopic Ultrasonography
In this procedure, you will receive intravenous sedation so that an endoscope (a thin, lighted tube) can be inserted into the abdominal area, next to the pancreas. The endoscope has a special miniaturized ultrasound built onto the tip, so that physicians can detect even the smallest of growths. This procedure also differentiates between a tumor and a non-cancerous stone that might be blocking the bile duct. If the physician sees a pancreatic mass, a needle can be inserted into the mass to take a biopsy, which is immediately evaluated by a pathologist who is right there, in the room with you. UCSD physicians are regional experts in Endoscopic Ultrasound.
CT (Computed Tomography) scan
During a CT scan, a series of detailed pictures are taken of areas inside the body, from different angles. UCSD’s high-quality, multidetector CT scanners are able to obtain detailed images of the pancreas and adjacent organs and vessels. You will receive an intravenous (IV) contrast injected into your vein, allowing radiologists to precisely determine the extent of the cancer and any involvement of adjacent organs.
MRI (Magnetic Resonance Imaging)
In selected patients, an MRI scan may be performed instead of, or in addition to the CT scan. UCSD is a leader in MRI, with multiple scanners available to provide high resolution imaging of the pancreas. An MRI provides detailed information about all parts of the pancreas, including areas that are hard to see on a CT scan, such as pancreatic ducts and channels that can be involved by cancer. As with a CT scan, you will receive an intravenous (IV) contrast injected into your vein.
Staging
In order to plan treatment, it is best to know the size, location and stage of the cancer.
The American Cancer Society recommends the American Joint Committee on Cancer (AJCC) TNM system of staging:
- T describes the size of the primary tumor, measured in centimeters
- N describes the spread to nearby lymph nodes
- M indicates whether the cancer has metastasized (spread) to other organs.
The numbers and/or letters after TNM provide more detail about each of these factors. According to the National Cancer Institute, these numbers are:
- Stage 0 – the cancer is found only in the lining of the pancreas
- Stage I – the cancer is only in the pancreas, if IA the tumor is 2 centimeters or smaller, IB if larger than 2 centimeters
- Stage II – in IIA, the cancer may have spread to nearby tissue and organs; in IIB, it has also spread to nearby lymph nodes
- Stage III – the cancer has spread to major blood vessels near the pancreas and may have spread to nearby lymph nodes
- State IV – the cancer may be of any size and has spread to distant organs, such as the liver, lung and peritoneal cavity