Seeing your doctor and being diagnosed
When you go to see your doctor, explain your symptoms in full. It may help to write everything down before you go to ensure you tell them everything, including which symptoms you have noticed, when they started, when and how often they happen.
Tell your doctor about any existing illnesses you have (particularly pancreatitis), and any family history of cancer.
Take a friend or relative along for support if needed. Sometimes it is hard to remember all the questions you wanted to ask or to take in everything the doctor is telling you; having someone there can really help.
Your doctor might do a general examination and will refer you for tests.
Testing and diagnosis
Once your doctor suspects pancreatic cancer, it is likely to you will referred for one or more of the below tests to make the diagnosis.
You will almost certainly be sent for blood tests initially to check your blood cell levels, how well your liver and kidneys are working, and your general health.
Blood tests can also check for tumour markers (a substance produced in the body as a result of cancer). CA19-9 is a marker that may be used to help diagnose pancreatic cancer. However, not all pancreatic cancers produce tumour markers.
Imaging tests (e.g. CT scan or MRI scan)
Imaging tests, such as a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan, are used to create pictures of your internal organs, including your pancreas.
A CT scan, also sometimes known as a CAT scan, will require you to lie on a narrow table, which will slide into a large hole in the centre of the scanning machine. CT scans use radiation but are painless and should only take a few minutes.
An MRI machine is similar, but uses a magnetic field instead of radiation. The table slides into a longer, narrower tunnel, which may sometimes feel a little claustrophobic. The procedure is painless and takes anywhere between 15 and 90 minutes.
Endoscopic ultrasound (EUS) (an ultrasound of the pancreas)
Sometimes, if the CT or MRI scan is inconclusive, another test called an endoscopic ultrasound (or an endoluminal ultrasonography) (EUS) will be carried out. It involves a thin, flexible tube (endoscope) being passed down your throat, and into your stomach in order to take pictures of the pancreas. Your doctor may also collect a sample of cells (biopsy) during an EUS. EUS is now often used in the staging of pancreatic cancer. You may be given a sedative before the procedure to make you more comfortable.
A laparoscopy is a surgical procedure, in which a small cut is made to the abdomen, which allows the surgeon to insert a special camera instrument called a laparoscope with which (s)he can look directly into your abdomen.
For this procedure you would have a general anaesthetic, so you will feel no pain or discomfort. However, after the surgery, you may feel some mild discomfort for the next few days, and you may be given painkillers for this.
A biopsy is an important part of the diagnosis, as it involves taking a physical sample from a suspected tumour, which can be tested to see if it’s cancerous (malignant) or non-cancerous (benign). However, a biopsy is not always required in order to make the decision to operate on the tumour; CT imaging is often enough.
A biopsy can be carried out during an EUS, an ERCP (a procedure that uses an endoscope and X-rays to look at the bile duct and the pancreatic duct) or laparoscopy.
A biopsy sample can also be obtained by inserting a needle through your skin and into your pancreas under ultrasound or CT guidance.