• 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 with the latest technology. 

    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 

    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. 

    Beginning with your first appointment at the Pancreaticobiliary Tumor Center at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), our specialists care for you and manage your diagnosis as a team.

    • Focused expertise: Our surgical, radiology, and pathology teams specialize in cancer imaging and diagnostics. This gives us in-depth experience with the disease process and an extraordinary depth of knowledge.
    • Our Center has a team of radiologists and pathologists who specialize in the diagnosis and evaluation of pancreatic cancer, specializing in gastrointestinal and pancreatic malignancies.

    Rapid response

    We know the importance of making an early diagnosis and help move you quickly through the testing process. If a diagnosis is determined, your clinical team will work with you to create and oversee a personalized treatment plan.

    Interdisciplinary Pancreatic Cystic Tumor (IMPACT) Clinic

    Fluid-filled tumors of the pancreas, or pancreatic cysts, are some of the most commonly diagnosed pancreatic masses. Women are at slightly higher risk for developing pancreatic cystic tumors, though they are common in men as well. While most pancreatic cysts are benign, some may lead to cancer. Members of the Pancreaticobiliary Tumor Center have extensive expertise in evaluating patients with pancreatic cystic tumors in order to determine an individual patient's risk and appropriate treatment.

    As individuals have more CT scans and MRIs, and as imaging technology improves, doctors are discovering a greater number of cysts that are found in the pancreas — usually through diagnostic imaging for other conditions. Up to two percent of people who have an MRI of their abdomen will have one or more pancreatic cysts.

    Care for people with pancreatic cysts

    If you have a pancreatic cyst, you should be evaluated to determine the best treatment. At our clinic, you are seen by a multidisciplinary team with a full panel of specialists for evaluation during one visit. Your scans are studied by pancreatic radiologists with expertise in reviewing CT scans and MRIs focused on the pancreas.

    • You may have a specialized endoscopic procedure to biopsy the cyst.
    • The fluid will be sent for testing to determine the type of cyst and if there is evidence of cancer in the cyst.
    • If you are at higher risk, a surgical oncologist will speak with you about the possibility of surgery to remove the cyst and part of the pancreas.

    Research on pancreatic cysts

    Certain types of cysts have a high correlation with cancer, and others do not. Our researchers are studying biopsy testing methods to improve accuracy in differentiating between types of cysts. Researchers are also studying better markers that determine if a cyst is cancerous.

    Initial diagnosis

    It is important to be seen quickly if you have a suspected or diagnosed pancreatic cancer, so that a diagnosis and treatment plan can be implemented. We are committed to seeing patients within days to assist with timely diagnosis and treatment planning.

    Tests and procedures to detect, diagnose, and stage pancreatic cancer are all usually done at the same time. Upon diagnosis, our entire specialty team meets to determine the optimal treatment plan for you.

    Endoscopy

    We use advanced endoscopic techniques to evaluate tumors, including:

    • Endoscopic ultrasound (EUS): A procedure to look through the wall of the nearby stomach and intestine using an endoscope (a thin, tube-like instrument with a light and a lens for viewing) that is inserted through the mouth, to form an image of body tissues and check for signs of cancer. This gives us the highest resolution imaging available and guides whether – and how – we conduct a 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. 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 bile 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. Samples may also be taken.

    Our Advanced Endoscopy Research

    Learn more about advanced endoscopic research at Brigham and Women's Hospital that has led to new techniques and devices.

    Radiology

    Diagnosis and treatment planning are highly dependent on correct interpretation of complex imaging studies. Our team of 13 radiologists is highly specialized, focusing exclusively on these malignancies. This specialization and high volume of pancreaticobiliary imaging allows a far greater depth of familiarity with pancreaticobiliary tumors than can be found in most centers.

    We have imaging protocols that are tailored specifically to pancreatic cysts and tumors. Our methods detect subtle changes which may determine whether a tumor can be considered for surgical resection.

    Our pancreatic cancer protocols — many of which we ourselves have developed — allow our team to understand how large the primary tumor is and if it has invaded other structures, such as blood vessels or organs.

    Common radiology procedures include:

    • Chest x-ray: An x-ray of the organs and bones inside the chest.
    • CT scan (computed tomography 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 images 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 may show up brighter in the image 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 performed.

    Radiology Research

    Our team regularly publishes its findings about the use of imaging for diagnosis, treatment response, and clinical management of cancer.

    • Our team has published hundreds of articles on cancer imaging in the past several years.
    • We are investigating new approaches to cancer imaging, including dual energy CT. This research can optimize our understanding of this kind of cancer and inform the decision of whether or not to operate.
    • We are studying the impact of new treatments such as immunotherapy and those that attack tumor blood vessels on how we see tumors on imaging studies.

    Pathology

    Because reaching a decision about whether or not your tumor can be surgically removed is critical, pathologists play an important role in not only diagnosing if you have cancer, but also in determining how far it has progressed.

    • Our team of gastrointestinal pathologists has subspecialists in pancreatic pathology and a strong expertise in identifying the multiple types of pancreatic tumors.
    • During diagnostic procedures, pathologists work closely with surgeons and endoscopists to evaluate tissue samples.
    • By evaluating the specimens during the biopsy through a process called cytology, doctors can potentially avoid repeat diagnostic procedures.
    • Our pathologists also evaluate biopsies from patients whose samples were taken elsewhere, and therefore function as a vital second opinion in making an accurate cancer diagnosis.

    For a premalignant pancreaticobiliary diagnosis

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

    The wide range of pancreatic cystic tumors includes such diagnoses as:

    • IPMN (intraductal papillary mucinous neoplasm)
    • MCN (mucinous cystic neoplasm)
    • SPEN (solid and papillary epithelial neoplasm)

    Some of these premalignant diagnoses require surgical treatment to prevent the development of cancer. The recommendation for surgery for premalignant tumors, suspected cancers, or proven cancers is determined upon review in multidisciplinary diagnostic pancreaticobiliary conferences with specialized pancreatologists, pancreatic surgeons, and gastrointestinal radiologists.

    For suspected tumors

    It can be difficult to come to a definitive diagnosis in some patients. 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 you are evaluated by an experienced team of gastroenterologists, pathologists, surgeons, medical oncologists, and radiologists who have expertise in the evaluation of suspected tumors. Our experience and expertise allow us to make the appropriate diagnosis.

    For diagnosed pancreatic cancer

    Depending on the stage of the cancer, you will meet with the appropriate team that may include a surgical oncologist, medical oncologist, and/or radiation oncologist.

    Recommendations on treatment are thoroughly reviewed at our weekly diagnostic pancreaticobiliary conference by our complete team, which has extensive expertise in complex cases, and then discussed with the patient and their family.

    Staging

    If you have a cancerous tumor, an important initial step is staging to determine if it is contained in the pancreas or has spread elsewhere. We use protocols specifically tailored to pancreatic cancer to understand how large the primary tumor is and how far it has spread to other structures, such as blood vessels or other organs.

    In certain cases, staging will consist primarily of imaging studies and possibly biopsies. In other cases, surgeons may need to perform minimally invasive surgical techniques to determine whether a tumor has spread.

    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.
    • 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

    It is important to be seen quickly if you have been diagnosed with pancreatic cancer so that an appropriate treatment plan can be made. We see patients for initial diagnosis or second opinions within days. We provide evaluation and diagnostic services for people who:

    • Have a pancreatic cyst
    • Have a suspected pancreas tumor or abnormal test results concerning for a pancreas tumor
    • Have received a diagnosis of pancreatic cancer and want to be treated at our Center
    • Have received a diagnosis of pancreatic cancer and would like a second opinion

    Our team often coordinates with providers at other hospitals to:

    • Conduct specialized scans
    • Recommend a treatment plan
    • Perform surgery, if feasible
    • Continue in an advisory role
    • Evaluate if a patient may be eligible for a clinical trial

    Next: How We Treat Pancreatic Cancer 

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  • Make an Appointment

    • For adults:
      877-442-3324 (877-442-DFCI)
    • For children:
      888-733-4662 (888-PEDI-ONC)
    • Or complete the online form.
  • Pancreaticobiliary Tumor Center

    • Learn how the Pancreaticobiliary Tumor Center at Dana-Farber/Brigham and Women's Cancer Center brings together the resources and focus of our patient caregivers and scientists, to advance research and treatment of pancreatic and biliary tract diseases.
  • Find a Pancreatic Cancer Clinical Trial

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