• Pancreatic Cancer

    Dana-Farber/Brigham and Women's Cancer Care

    How We Diagnose Pancreatic Cancer

    Timely and accurate diagnosis is key to effective pancreatic cancer treatment. Our diagnostic team includes pathologists, radiologists, gastroenterologists, and surgeons with extensive experience in confirming this diagnosis. We use our experience to plan and deliver the optimal combination of therapies for you. 

    Timely Appointments

    Patients with either suspected or proven pancreatic or biliary tumors should be seen as soon as possible, within several days, for timely diagnosis and treatment.

    Our new patient coordinators will work with you to quickly schedule appointments with our specialists.

    Phone: 877-442-DFCI or 877-442-3324
    Online: Complete the Appointment Request Form 

    Pancreatic cancer is usually diagnosed with tests and procedures that produce images of the pancreas and the surrounding area. Upon diagnosis the entire specialty team meets to determine the optimal treatment plan.

    Diagnostic Testing

    Dr. Sapna Syngal with a patientDr. Sapna Syngal, Director of the Gastrointestinal Cancer Genetics and Prevention Program, consults with a patient regarding her pancreatic cancer risk. 

    We employ a full spectrum of diagnostic procedures including endoscopy, radiology, and pathology. 

    In order to plan treatment, it is important to know the stage of the disease and whether or not the pancreatic tumor can be removed by surgery. Diagnostic tests and procedures to detect, diagnose, and stage pancreatic cancer are all usually done at the same.

    Endoscopy
    • Endoscopic ultrasound (EUS): A procedure in which an endoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted into the body, usually through the mouth or rectum to form a picture of body tissues and check for signs of cancer.
    • 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. An endoscope (a thin, lighted tube) is passed through the mouth, esophagus, and stomach into the first part of the small intestine. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken.
    Radiology
    • Chest x-ray: An x-ray of the organs and bones inside the chest.
    • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine.
    • 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.
    • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide 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. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
    • Percutaneous transhepatic cholangiography (PTC): A procedure used to x-ray the liver and bile ducts. This test is done only if ERCP cannot be done.
    Pathology
    • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. A biopsy of tumor cells is the gold standard for diagnosing pancreatic cancer.
    • Our gastrointestinal pathologists collaborate with our radiologists and gastroenterologists to ensure that there is enough tissue to evaluate for diagnosis and treatment.
    • After the tissue sample is taken, a gastrointestinal pathologist examines it under a microscope to determine the specific type of pancreatic tumor (there are approximately 20) to help the entire team decide upon the optimal treatment plan.

    For diagnosis of pancreatic cysts

    Pancreatic cysts are being discovered incidentally as the quality of radiology is improving. There is some concern that these cysts can turn into pancreatic cancer. Patients diagnosed with these cysts can be seen at a multidisciplinary clinic where the patient can see a full panel of specialists for evaluation during one visit.

    For a premalignant pancreatiocobiliary diagnosis

    Our Center has gastroenterologists who focus solely on pancreatic diseases, and pancreatic surgeons with extensive experience in the workup and management of premalignant pancreatic disease. This expertise is especially important for patients who have a complicated history or have not had a clear diagnosis.

    We also see patients with premalignant pancreaticobiliary diagnoses such as IPMN (Intraductal Papillary Mucinous Neoplasm), MCN (Mucinous Cystic Neoplasm), and SPEN (Solid and Papillary Epithelial Neoplasm). Many but not all of these premalignant diagnoses require surgery to prevent transformation into cancer. The recommendation for surgery for premalignant tumors, suspected cancers, or proven cancers comes with a review in our multidisciplinary weekly diagnostic pancreaticobiliary conference.

    Diagnostic Workups

    Before treatment can begin, you will have a diagnostic workup by a team consisting of a gastroenterologist, pathologist, radiologist and surgeon — all who specialize in the pancreas. This process ensures that your care is carefully coordinated to save precious time and achieve optimal results.

    For suspected tumors

    For many patients, it is difficult to come to a definitive diagnosis. For example, smaller tumors are difficult to diagnose without surgery, but are easier to treat surgically due to their small size. Therefore, it is essential that these patients are evaluated by an experienced team of gastroenterologists, pathologists, surgeons, medical oncologists and radiologists who have expertise in the workup of pancreatic lesions.

    Some patients with a suspected pancreatic tumor might have non-neoplastic or neoplastic pancreaticobiliary diagnoses. Our Center has gastroenterologists who focus solely on pancreatic diseases, both benign and malignant. This expertise enables our clinicians to guide patients through the most appropriate radiologic and advanced endoscopic procedures, with the goal of determining the diagnosis as quickly, accurately, and safely as possible.

    Patients will be seen by a gastroenterologist or surgical oncologist.

    For diagnosed pancreatic cancer

    Depending upon the stage of the cancer, patients meet with the appropriate combination of a surgical oncologist, medical oncologist, and radiation oncologist. The majority of patients, who do not have proven metastatic cancer, will be seen by a pancreatic surgeon to assess if the tumor can be removed surgically.

    Many patients with pancreatic cancer have their diagnosis confirmed before treatment. Some patients with suspected cancer will have their tumor surgically removed, which will both confirm the suspected diagnosis and treat the cancer.

    Decisions regarding diagnosis and treatment are thoroughly reviewed at our weekly diagnostic pancreaticobiliary conference by the complete team, which has extensive expertise in complicated cases.

    Staging

    The staging process is used to find out if cancer cells have spread within and around the pancreas. Pancreatic cancer can be assigned one of the following four stages:

    • Stage 1 — The tumor is less than 2 cm in diameter and is completely contained within the pancreas.
    • Stage 2 — The tumor has begun to grow outside of the pancreas, but has not invaded a major blood vessel. Stage 2 pancreatic cancer may have spread to nearby lymph nodes, but not to distant sites.
    • Stage 3 — The tumor is growing outside of the pancreas, and has moved into nearby large blood vessels or major nerves.
    • Stage 4 — The cancer has spread to other parts of the body, such as the liver or the peritoneum (inner lining of the abdomen).

    Second Opinions

    Our diagnostic team provides second opinions, including for challenging or difficult cases. We are happy to consult with primary care physicians or other specialists. Consider a second opinion for:

    • Confirmation of a diagnosis
    • An evaluation of an uncommon presentation
    • Details on the type and stage of cancer
    • Treatment options
    • Clinical trials

    Phone: 877-442-DFCI or 877-442-3324
    Online: Complete the Appointment Request Form 

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