How Is Cancer of the Pancreas Diagnosed?
List of Pancreas Cancer Symptoms- Jaundice
- Pain
- Weight loss
- Digestive problems
- Gallbladder enlargement
- Blood clots or fatty tissue abnormalities
- Diabetes mellitus
Jaundice: At least half of all people with pancreatic cancer develop jaundice. Jaundice occurs in all cases when the cancer is at the ampulla of Vater. Jaundice is a yellowing of the eyes and skin due to staining by bilirubin, a dark green-colored substance made in the liver. Bilirubin accumulates in these tissues and in the blood.
Pain: Pain in the abdomen or back is a common sign of advanced pancreatic cancer of the pancreas. The cancer will often spread to the nerves surrounding the pancreas. This causes some of the pain. It may be constant or may come and go. Of course, many noncancerous diseases as well as several other types of cancers can also cause abdominal or back pain that can be confused with cancer of the pancreas.
Digestive problems: If cancer blocks the release of the pancreatic juice into the intestine, a person may not be able to digest fatty foods. The undigested fat may cause stools to be unusually pale, bulky, greasy, and to float in the toilet. The cancer may also wrap around the far end of the stomach and partly block it. This will cause nausea, vomiting, and pain that tend to be worse after eating.
Weight loss: Unintended or unexpected weight loss is common in patients with cancer of the pancreas. These people also complain of being very tired and having little or no appetite.
Blood clots or fatty tissue abnormalities: Sometimes, the first clue that there is a pancreatic cancer is the development of a blood clot in a large vein. These clots can sometimes travel to the lungs and cause trouble with breathing.
Gallbladder enlargement: Sometimes the cancer will block the bile duct. This causes bile to accumulate in the gallbladder, which then becomes enlarged. Sometimes the examining doctor can feel this enlargement. It can also be detected by imaging studies.
Another possible clue: is the development of uneven texture of the fatty tissue underneath the skin. This is caused by the release of the pancreatic enzymes that digest fat.
Diabetes mellitus: Rarely, exocrine cancers of the pancreas cause diabetes mellitus, high blood sugar, because they destroy the insulin-making cells. More often, there are slight problems with sugar metabolism that do not cause symptoms of diabetes but can still be recognized by certain blood tests.
History and Physical Exam:
A thorough medical history should be taken to check for any pancreatic cancer risk factors, and obtain information about pain, how long it has been present, its severity, its location, and what makes it worse or better, weight loss, tiredness, and other symptoms.
A thorough physical examination will focus mostly on the abdomen to check for any masses or fluid accumulation. The skin and the white part of the eyes will be checked for jaundice, yellow discoloration. Sometimes, cancer of the pancreas spreads to the liver. This makes the liver enlarge and can be felt by the doctor when he or she examines the abdomen. The cancer can also spread to lymph nodes above the collarbone and other locations. These areas should be examined carefully to look for swelling that might indicate spread of a cancer.
Can Cancer of the Pancreas Be Found Early?
The main reason for the poor prognosis of cancer of the pancreas is that very few of these cancers are found early. Because the pancreas is located deep inside the body, early tumors cannot be seen or felt by health care providers during routine physical examinations. There are currently no blood tests or easily available screening tests that can accurately detect early cancers of the pancreas.
A substance called CA 19-9 is present in the cells of cancers of the pancreas. It is also released into the blood by these cells and can be detected by blood tests. However, by the time blood levels are high enough to be consistently detected by available methods, the cancer is no longer in its early stages. This test is sometimes used after treatment of the pancreas to see if the tumor has recurred. But it is not recommended for routine screening of people without symptoms or a known diagnosis of cancer. Another substance called carcinoembryonic antigen can detect advanced pancreatic cancer in some people. But, it is not sensitive enough to find the cancer early.
Another important reason that most pancreatic cancers are found at an advanced stage is that patients usually have no symptoms until the cancer has spread to other organs.
As many as 10% of pancreatic cancers are thought to result from inherited factors. These are transmitted by genes that have not yet been discovered. Because familial pancreatic cancer is sometimes associated with other cancers, determining whether a patient's relatives are at increased risk is not simple. Consultation with a genetic counselor or an oncologist with experience in hereditary cancer syndromes is often helpful.
There are new tests for detecting early pancreatic cancer that may help these people. One of these is called endoscopic ultrasound. The other is combined PET and CT scanning. Both of these are complicated and expensive. They would not be used to screen the general public but might be used in someone with a strong family history of pancreatic cancer.
The American Cancer Society strongly recommends that any person considering genetic testing talk with a genetic counselor, nurse, or doctor qualified to interpret and explain these test results before they proceed with testing. It is important for people to understand and carefully weigh the benefits and risks of genetic testing before these tests are done. Testing is expensive and is not covered by some health plans. There is concern that people with abnormal genetic test results will not be able to get health insurance, or their coverage may cost much more than average.