How do you diagnose it?

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How do you diagnose it?

Types of Cancer

Pancreatic Cancer

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Pancreatic cancer can be extremely difficult to diagnose. The location of the pancreas - hidden behind organs such as the stomach, small intestine, liver, gallbladder, spleen and bile ducts - compounds the complexity.

Patients typically undergo a number of diagnostic tests before a definitive diagnosis of cancer can be made. Once a diagnosis of pancreatic cancer has been reached, the oncologist will need to "stage" your cancer - or determine how far the tumor has spread - to devise the best treatment plan. Staging is based on information gathered from the diagnostic tests described below, or any additional tests that may have been ordered, including routine laboratory tests. Pancreatic cancer staging is based on the TNM classification system, which assesses the extent of the primary tumor, lymph node involvement, and any distant metastases. Classification ranges from Stage 0 (early-stage) to Stage IV (advanced). A detailed discussion of the various stages of pancreatic cancer and the appropriate treatment options for each can be found at: www.cancer.gov/cancerinfo/pdq/treatment/pancreatic/patient/.

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Frequently the first test ordered when evaluating a patient for pancreatic cancer is a CT scan (computed tomography) computer-enhanced x-ray procedure, which provides a high level of structural detail by recording cross-sectional images from many different angles. CT is an excellent tool for assessing the location of any tumors present in the pancreas, and for determining if there has been any spread to other organs.

A new, state-of-the-art diagnostic tool now available at John Muir Health is an integrated CT and PET scanner. PET (Positron Emission Tomography) scanning entails the injection of a special radionuclide glucose that migrates to areas of high metabolic activity, which are suggestive of cancer. The combination of these two important diagnostic tools arms the physician with an unprecedented level of useful information.

Endoscopic ultrasound is an innovative new diagnostic test that brings together the technologies of endoscopy and ultrasound to provide important information on the spread of the cancer. During the procedure, an endoscope- a flexible, lighted fiber-optic viewing tube - bearing a small ultrasound probe is inserted into the mouth and guided down the esophagus. The ultrasound probe bounces sound waves off tissues and organs, which produces images projected on a screen. Because of the location of the pancreas, obtaining tissue samples for biopsy has historically entailed highly traumatic - and sometimes unnecessary - open surgery for the patient. Thanks to the advent of an innovative new technique called fine needle aspiration biopsy, now available at John Muir Health, tissue samples can be easily obtained without invasive surgery. Under the visual guidance of a CT scan or endoscopic ultrasound, a needle is inserted through the skin into the pancreas, and a small amount of tissue is extracted. These specimens are evaluated under a microscope by our highly experienced, board-certified pathologists to determine if cancer cells are present in the pancreas.

If a diagnosis of pancreatic cancer cannot be confirmed after these tests - and suspicious symptoms still merit further testing - surgical exploration is sometimes necessary. Patients typically undergo a minimally invasive procedure known as laparoscopy, in which a thin, lighted tube (the laparoscope) is inserted via a series of small incisions in the abdominal wall. Images of the pancreas are projected onto a screen in the operating room, enabling the surgeon to assess the pancreas and adjacent organs. If pancreatic cancer is confirmed, the patient can proceed to open surgery. If laparoscopy reveals that the cancer is too extensive for surgical removal, the patient can proceed to chemotherapy and radiation, while being spared the prolonged recuperation that would have been entailed by conventional exploratory surgery.

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