If a person is suspected to have pancreatic cancer due to the presence of signs and symptoms, pancreatic cancer investigations are required to confirm the diagnosis of the disease. Further, these pancreatic cancer investigations can help in determining the extent of invasion or spread of the disease to other body parts, which in turn help in choosing an appropriate treatment option. Following are some commonly used diagnostic tools for pancreatic cancer:
1.Endoscopic retrograde cholangiopancreatography (ERCP): This is a diagnostic technique which utilizes an endoscope – a long, flexible, slender tube usually equipped with a camera, a light source, and some special instruments for biopsy or surgery. The endoscope is passed down to duodenum to locate the ampulla of Vater (an opening of the common bile duct in the duodenum). A dye is then injected into the common bile duct via a catheter and several x-ray images are taken to detect any abnormality in the pancreatic duct or bile duct. If required, a stent can be placed in the bile duct or pancreatic duct. Also, biopsy samples can be collected from abnormal areas diagnosed during the examination.
2.Endoscopic Ultrasound: In this technique, an ultrasound device is used along with an endoscope, to determine the location and the size of a tumor in the pancreas and to detect any involvement of nearby lymph nodes/blood vessels. This technique is sensitive enough to find small lesions (<2 cm) in the pancreas and can accurately predict the size of the tumor. It can distinguish between solid and cystic lesions in the pancreas, and also enables the collection of biopsy samples from the affected area via a special biopsy instrument in conjunction with the endoscope.
3.Laboratory Tests for Biopsy Samples: Biopsy samples contain a small number of cells or a tiny piece of tissue collected from the affected area or lymph node with the help of a biopsy needle or other biopsy instrument. It may be collected endoscopic-guided or CT-guided. These samples provide very useful information about the cancer cells such as the type of cancer, the severity of cancerous changes involved, and the presence of specific defective genes or proteins.
4.Tumor marker – An elevated level of carbohydrate antigen (CA) 19-9 is generally associated with pancreatic cancer, but it is of little value in detecting early-stage disease. However, this marker is generally used for assessing the efficacy of the treatment/surgery and the progression/recurrence of the disease.
5.Imaging Tests: These tests are generally employed after the establishment of the pathological diagnosis. They help to detect the spread of disease to distant body parts and assess the stage of the disease so that an appropriate treatment option can be selected. Alternatively, these tests are employed after treatment to evaluate the treatment efficacy and to detect disease response, progression, or recurrence.
-Computed tomography (CT) scan: In this technique, detailed cross-sectional images of body organs are generated using x-rays, with or without a contrast medium. It can help diagnose the spread of disease to nearby/distant lymph nodes and other organs, and may also be used to guide a biopsy needle into the affected area.
-Magnetic resonance imaging (MRI) scan: This technique provides detailed images of tissues inside the body using radio waves, strong magnetic field, and gadolinium contrast. It can accurately diagnose the extent of invasion and spread of disease to nearby/distant body parts.
-Positron emission tomography (PET) scan: This technique uses a radioactive substance (e.g.fluorodeoxyglucose [FDG]) that is given intravenously prior to the procedure. Cancer cells absorb larger amounts of the radioactive substance than normal cells. The areas of higher radioactivity indicate cancerous tissue on the PET scan. Thus, this technique can diagnose spread of disease to distant body parts. It is usually combined with CT scan (PET/CT).
6.Laparoscopy: In this technique, incisions are made at appropriate places and a hollow flexible device equipped with a camera and a light source is inserted through the incision. This technique can be utilized to collect biopsy samples from the affected areas, and are very useful in the diagnosis of radiographically occult disease and in determining the extent of disease spread to the liver or peritoneum.
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