FAQ

Typical Diagnostic Tests for Pancreatic Cancer may include:

• Physical exam and health history:  An exam of the body to check general signs of health including checking for signs of disease such as lumps or anything else that seems unusual. This will be included to be added to the other information, but rarely shows definitive information regarding a diagnosis without further testing.
• Tumor marker test: A procedure in which a sample of blood, urine, or tissue is checked to measure the amounts of certain substances called tumor markers, which are linked to types of cancer.  For this area of the body, the tumor markers, including Ca 19-9, are less reliable because the tumor may not release the substance, and inflammation or blockage can cause elevated levels. For this reason, it again is a piece of the puzzle and may be helpful to follow over time, but it does not make the diagnosis itself.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body including special images (MRCP) that can light up the bile and pancreatic ducts.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body taken from different angles. A pancreas protocol CT is recommended to see closer detail using images closer together and timing of the contrast to light up the important blood vessels.
• PET scan (positron emission tomography scan):  A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body, which includes busy working organs, and especially areas responding to the tumor, but also inflammation.
• Abdominal ultrasound: An ultrasound exam used to make pictures of the inside of the abdomen, particularly dilated bile ducts and gallbladder but is less detailed and less specific for diagnosis of the cause of these findings.  It may be an early study.
• Endoscopic ultrasound (EUS): Specifically upper EUS is a procedure in which an endoscope is inserted into the body through the mouth to get a closer ultrasound view of the pancreas from within the stomach and to gain access to put a small needle into the area to sample an area for biopsy.
• Endoscopic retrograde cholangiopancreatography (ERCP): A procedure used to X-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine, and procedures in that duct can be performed, such as clearing stones or debris and placing a stent (plastic or metal tube to allow bile to flow across an area of blockage).
• Percutaneous transhepatic cholangiography (PTC): A procedure used to X-ray the liver and bile ducts, and a drain or stent may be placed across a blockage if the area cannot be reached by ERCP.
• Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease and send biopsies as necessary.
• Biopsy: Removing a tissue sample for laboratory testing and to look at the area under a microscope for tumor or cancer cells.

There are other more specialized tests or procedures that may be needed based on specific details of each situation. These are often performed by the advanced GI endoscopist or interventional radiologist.

Yes.  Under some situations, more rarely, it may be necessary to remove the entire pancreas. Without a pancreas, the patient will require insulin to control their blood sugars and will need to take capsules of the type of digestive enzymes the pancreas normally makes to help digest their food and use nutrients. The spleen is usually also taken out with this procedure, so patients may take some vaccines and also, by direction of their doctor, usually use antibiotics when they have fever.

To decide whether surgery is the right option for each patient, three factors need to be considered:

• Is the tumor in the pancreas the only spot of disease? As much as may be detected on imaging tests, it is important to rule out the presence of a tumor that may have spread since surgery will involve the pancreas tumor only.  
• Does the tumor involve blood vessels that must remain in place? Some blood vessels can be reconstructed or repaired, whereas others cannot.
• Is the patient strong enough to undergo the surgery necessary?  This considers situations that may have arisen because of the tumor, like infection or poor nutrition, but also considers the patient's risk factors, including age and other illnesses.

Remember that chemotherapy is a general term that refers to many different medications. The term “neoadjuvant” refers to giving doses of the recommended medications and then repeating imaging to decide if surgery is the right next step. National guidelines are followed to determine which medications are indicated for each patient's tumor type, also based on other patient factors, such as other medical conditions. For pancreatic adenocarcinoma, there are two main treatment courses. The medical oncology doctor determines which group of the recommended medications is best for each patient based on several factors, including age, acute illness, chronic conditions, and how active patients can be.  

That depends on which portion of the pancreas is removed. If the right side stays in place, then the bile duct and intestine stay intact too. In that circumstance, the distal pancreatectomy, eating returns to normal, but sometimes the remaining pancreas is not enough to make enough digestive enzymes, and patients will need to take capsules containing these enzymes with their meals to replace the enzymes to help break down the nutrients in food.

If the right side of the pancreas is removed, the stomach is connected to the intestine, past where the troubled area was removed. The bile duct is connected to the side of the intestine, so the bile flows in that intestine to meet the food at the connection to the stomach. Whatever is left of the pancreas is connected too. As everything heals, the patient eats smaller meals, but more frequently, even 6-8 times per day to get adequate nutrition. Most patients typically are eating regular food with some guidelines by the time they leave the hospital.

All patients will lose some weight after the surgery just as their body heals, so they need special attention to the amount and types of foods they put in their body. That education is provided before and ongoing after surgery to meet each patient's specific needs. We want the weight to stabilize and nutrition to improve as soon as possible after surgery. The stomach learns to use these new connections during the healing and the patient is usually able to eat more as time goes by but may need to take some extra pancreas enzymes to break food down.