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Diagnosis & Treatment

Pancreatic Cancer

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Diagnosis

How is Pancreatic Cancer Diagnosed?

Pancreatic cancer can be diagnosed in several different ways. Depending on the specific case, imaging tests, biopsies, and blood tests may all be used for diagnosis after completing a physical exam and reviewing personal and family history.

Some of the most common pancreatic cancer diagnostic tests include:

Imaging tests

Doctors may use the following imaging tests to get a full view of your body’s internal organs and structures:

Ultrasound

Ultrasounds emit high-frequency sound waves into the body. These sound waves then bounce off organs and bodily structures, resulting in “echoes” that can then be turned into images, allowing doctors to analyze whether cancer is present within certain areas of the body.

Endoscopic ultrasounds involve inserting a thin, flexible tube — called an endoscope — down the esophagus in order to reach the stomach. This provides images of the pancreas. If it’s unclear what is causing a person’s pain or other symptoms related to the abdomen, an abdominal ultrasound may be done first to determine if cancer is present.

Computerized tomography (CT) scan

Combining multiple X-ray images taken from different angles, CT scans offer cross-sectional, detailed views inside the body. CT scans can provide a clear view of the pancreas and show if the cancer has already spread beyond the pancreas to other parts of the body.

If your doctor already thinks you may have pancreatic cancer, a special type of CT scan may be used, called a multiphase CT scan. Also referred to as a pancreatic protocol CT scan, this imaging test allows doctors to take numerous sets of CT scans. You’ll be given an intravenous (IV) contrast beforehand to highlight the pancreas, allowing the doctor to see the tumor’s location in relation to nearby blood vessels and organs.

Magnetic resonance imaging (MRI) scan

Involving large magnets, radiofrequencies, and a computer, MRIs can create detailed images of the body’s organs and structures. An MRI may be used to determine the size of a tumor. The patient will receive imaging dye intravenously or in a pill to provide a detailed view of different pancreatic tissues.

Positron emission tomography (PET) scans

PET scans are also sometimes used for pancreatic cancer diagnosis. This kind of test uses a small amount of radioactive material inside the body, which highlights areas where cancer cells are present. PET scans and CT scans are sometimes done simultaneously, allowing doctors to see areas of higher radioactivity (indicating cancer) on the PET scan, while viewing more detailed images from the CT scan. This can help determine the stage of the cancer.

Cholangiopancreatography

A cholangiopancreatography may also be used for pancreatic cancer screening. This allows doctors to view the bile ducts and pancreatic ducts, checking for blockages, dilation, and narrowing. This helps determine whether a pancreatic tumor may be blocking a duct. There are a few different kinds of cholangiopancreatography:

  • Magnetic resonance cholangiopancreatography (MRCP) — Using a standard MRI scanner, MRCPs offer a non-invasive method of viewing the pancreatic and bile ducts. This test can’t be used to obtain biopsies of tumors.
  • Endoscopic ultrasound (EUS)- A medical professional will use a fine needle biopsy to confirm that a pancreatic mass seen on the MRI is malignant.
  • Endoscopic retrograde cholangiopancreatography (ERCP) — Although no longer performed for diagnostic purposes, it is performed for the purpose of therapy to unblock an obstructed duct or in the case that a diagnosis can not be made by another method of biopsy such as EUS FNA.
  • Percutaneous transhepatic cholangiography (PTC) — During a PCT, a hollow, thin needle is inserted through the skin into a bile duct within the liver. Contrast dye is also injected through the needle to highlight these specific areas of the body. As the needle passes through the bile and pancreatic ducts, X-rays are taken. If needed, fluid or tissue samples can also be obtained, and stents can be inserted in a blocked bile duct. PTC is more invasive than ERCP and is typically only used if ERCP can’t be done, or has already been done but failed to produce satisfactory images.

Blood tests

Blood tests can also help determine whether pancreatic cancer is present within the body. One of the following blood tests may be used to aid in diagnosis:

Liver function tests

Testing for liver function allows doctors to assess what’s causing jaundice. In particular, the levels of bile can help determine whether jaundice is being caused by liver disease or by a bile flow blockage, such as from a tumor. This can then help determine if cancer may be present.

Tumor markers

A different kind of blood test may be used to show whether tumor markers are present in the blood. Sometimes referred to as cancer markers or biomarkers, tumor markers are substances found in the blood, tissues, and urine produced in response to cancer. High levels of these markers may indicate cancer. These types of blood tests cannot be used alone to determine if someone has pancreatic cancer, but instead are typically used in tandem with other diagnostic tests.

How is Pancreatic Cancer Treated?

Treatment

At NewYork-Presbyterian, you will receive comprehensive pancreatic cancer care based on the latest scientific breakthroughs. We offer the most advanced imaging and other diagnostic methods and a full range of therapies — all individualized to your cancer’s site, stage, and molecular profile. Our cancer care includes novel treatments that may be difficult to find elsewhere.

The care of patients with gastrointestinal malignancies is complex and requires specialized expertise across disciplines. NewYork-Presbyterian physicians routinely discuss cases in multidisciplinary tumor board meetings on a weekly basis to optimize the care of our patients across disciplines, taking into account all available approaches. As a result, you will receive the optimum personalized care for your cancer, often involving a team of physicians.

Taking a holistic approach to pancreatic cancer treatment, we assess the entire body — not just the areas where cancer is present. This helps us ensure the best outcomes for our pancreatic cancer patients. To minimize discomfort and help ensure quality of life during cancer treatment, our expert medical team will also treat any side effects or relieve symptoms experienced as a result of your treatment.

Minimally invasive and reconstructive surgery

We use minimally invasive surgical approaches whenever appropriate — including laparoscopic and robotic surgery — resulting in smaller incisions, a shorter hospital stay, and a faster recovery. If you need a more extensive operation, our surgeons also have the expertise to perform those procedures.

We also offer reconstruction when appropriate, such as the creation of a J-pouch in patients with colorectal cancer who undergo removal of the large intestine. We are developing and testing the next wave of minimally invasive surgical procedures, including endoscopic techniques performed entirely inside the digestive tract and requiring no external incisions.

Advanced interventional techniques

Interventional radiologists specialize in minimally invasive, targeted treatments. At NewYork-Presbyterian, our interventional radiologists and interventional endoscopists perform thousands of procedures each year. We have all of the necessary imaging and procedural facilities to offer the most comprehensive, cutting-edge interventional oncology care.

Examples of interventional approaches for digestive cancers include:

  • Interventional biopsy to retrieve tissue for analysis without surgery.
  • Embolization to block flow in blood vessels feeding a tumor, such as liver tumors.
  • Ablation to destroy a tumor with radio waves, light-sensitive drugs, or extreme temperatures.
  • Interventional endoscopy to relieve obstructions, remove superficial tumors, and insert stents in a blocked bile duct or an esophagus narrowed by cancer.

Chemotherapy

The correct application of chemotherapy around the time of surgery and for advanced pancreatic cancer can dramatically improve a patient’s life, reduce symptoms, and improve the quality of life. Our world-class medical oncologists are well-versed in both standard and investigational chemotherapy approaches to provide the right care at the right time.

You may receive chemotherapy alone or in combination with other therapies, such as radiation and surgery. We give intravenous chemotherapies in our warm, supportive infusion centers, where we can monitor your side effects and address your comfort. Options include:

  • Presurgical chemotherapy. Some patients receive chemotherapy before pancreatic cancer surgery to shrink the tumor. Your doctor will let you know if this is an option for you.
  • Chemotherapy after surgery. Many patients with digestive cancers receive anticancer chemotherapy drugs after surgery to kill any remaining cancer cells. You may receive one drug or a combination of medications.
  • Targeted therapies. We treat some digestive cancers with targeted therapies, which work by shutting down certain proteins that cancer cells need to grow. Examples of targeted therapy drugs include trastuzumab for some stomach cancers, cetuximab, and bevacizumab for colorectal cancer, sorafenib for liver cancer, and erlotinib for pancreatic cancers.
  • Immunotherapy. These treatments harness the power of the immune system to fight cancer. There are many types of immunotherapy drugs used to treat other cancers that are now being evaluated in clinical trials for patients with digestive cancers including colon, pancreas, stomach, and liver cancers.
  • Heated intraperitoneal chemotherapy. This special technique combines chemotherapy and surgery in one procedure and is used primarily to destroy any unseen cancerous tissue in the abdomen after all visible tumors have been removed.

Precise radiation therapy

NewYork-Presbyterian’s radiation oncologists use 3D imagery to deliver radiation to digestive cancer cells while reducing radiation exposure to nearby healthy tissue. This approach allows us to treat tumors that in the past may have been too close to vital organs. Our radiation therapy units feature the latest highly precise radiation delivery equipment. We offer external beam radiation therapy (such as intensity-modulated radiation, 3D conformal radiation, and stereotactic body radiotherapy) as well as brachytherapy (the implantation of radioactive seeds within or next to a tumor).

Clinical trials

As active members of the international cancer research community and national cooperative cancer networks, our oncologists design, conduct, and lead clinical trials of promising new treatments for digestive cancers, including metastatic disease. You may have the opportunity to receive an innovative therapy by participating in one of these pivotal studies.

FAQs

FAQs

The survival rate of pancreatic cancer will depend on the stage at which it is diagnosed. Most cases of pancreatic cancer are diagnosed at later stages, meaning the survival rate is low. The five-year relative survival rate (the percentage of people in a study or treatment group alive five years after being diagnosed with or starting treatment) for all stages combined is 11%.

Some early warning signs of pancreatic cancer include jaundice (yellowing of the skin and eyes), pain or discomfort in the abdomen or back, weight loss or lack of appetite, and sudden onset of diabetes. Pale, floating, dark, or tarry stools are also common.

Because the pancreas is located deep within the body, behind the stomach, it’s usually hard to spot tumors early. People usually have no symptoms in the early stages. For these reasons, treatment typically begins in stages with more advanced pancreatic cancer. Once it is diagnosed, the tumors are difficult to treat and don’t respond as well as other types of cancer. This results in a poor pancreatic cancer prognosis for most patients.

Early diagnoses of pancreatic cancer are usually the result of genetic testing. For people with a family history of pancreatic cancer, other types of cancers, or certain hereditary conditions, testing can be used to identify gene mutations that may cause cancer. Genetic tests show whether you have certain hereditary conditions that may increase your risk of pancreatic cancer, and from there, you can consult with your doctor about how to proceed.

Pancreatic cancer accounts for about 3% of all cancer diagnoses in the United States, and about 7% of all cancer deaths. It’s slightly more common in men than in women. The average lifetime risk of developing pancreatic cancer is approximately one in 64, though some people may have personal or family risk factors that increase their risk.

In most cases, exact pancreatic cancer causes are unknown. However, the cell mutations that cause it can be inherited or acquired. Inherited gene mutations, called germline mutations, can be passed down from generation to generation. Acquired gene mutations, on the other hand, refer to DNA changes that occur throughout a person’s lifetime; these cannot be passed down from a parent to a child. Family and personal history (such as a history of smoking) can increase one’s risk of developing pancreatic cancer.

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Trust NewYork-Presbyterian for Pancreatic Cancer Treatment

The experts at NewYork-Presbyterian treat all types of pancreatic cancer. Our team works closely with every patient to understand any symptoms they may be experiencing, discuss diagnostic testing options, and create a detailed, personalized treatment plan.

As part of our commitment to best-in-class cancer care for all patients, NewYork-Presbyterian holds multidisciplinary clinics and tumor boards every week, bringing together specialists from various treatment modalities to discuss your unique treatment needs and develop a comprehensive and customized course of action.