Your doctor suspects pancreatic cancer, he or she may have you undergo one or more of the following tests:
Imaging tests that create pictures of your internal organs - These tests help your doctors visualize your internal organs, including the pancreas. Techniques used to diagnose pancreatic cancer include ultrasound, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and, sometimes, positron emission tomography (PET) scans
Using a scope to create ultrasound pictures of your pancreas - An endoscopic ultrasound (EUS) uses an ultrasound device to make images of your pancreas from inside your abdomen. The device is passed through a thin, flexible tube (endoscope) down your esophagus and into your stomach in order to obtain the images.
Removing a tissue sample for testing (biopsy) - A biopsy is a procedure to remove a small sample of tissue for examination under a microscope. Most often the tissue is collected during EUS by passing special tools through the endoscope. Less often, a sample of tissue is collected from the pancreas by inserting a needle through your skin and into your pancreas (fine-needle aspiration).
Blood test - Your doctor may test your blood for specific proteins (tumor markers) shed by pancreatic cancer cells. One tumor marker test used in pancreatic cancer is called CA19-9. It may be helpful in understanding how the cancer responds to treatment. But the test isn't always reliable because some people with pancreatic cancer don't have elevated CA19-9 levels, making the test less helpful.
If your doctor confirms a diagnosis of pancreatic cancer, he or she tries to determine the extent (stage) of the cancer. Using information from staging tests, your doctor assigns your pancreatic cancer a stage, which helps determine what treatments are most likely to benefit you.
The stages of pancreatic cancer are indicated by Roman numerals ranging from 0 to IV. The lowest stages indicate that the cancer is confined to the pancreas. By stage IV, the cancer has spread to other parts of the body.
The cancer staging system continues to evolve and is becoming more complex as doctors improve cancer diagnosis and treatment.
Don't hesitate to ask your doctor about his or her experience with diagnosing pancreatic cancer. If you have any doubts, get a second opinion.
Treatment for pancreatic cancer depends on the stage and location of the cancer as well as on your overall health and personal preferences. For most people, the first goal of pancreatic cancer treatment is to eliminate the cancer, when possible. When that isn't an option, the focus may be on improving your quality of life and limiting the cancer from growing or causing more harm.
Treatment may include surgery, radiation, chemotherapy or a combination of these. When pancreatic cancer is advanced and these treatments aren't likely to offer a benefit, your doctor will focus on symptom relief (palliative care) to keep you as comfortable as possible for as long as possible.
Operations used in people with pancreatic cancer include:
Surgery for tumors in the pancreatic head - If your cancer is located in the head of the pancreas, you may consider an operation called a Whipple procedure (pancreaticoduodenectomy).
The Whipple procedure is a technically difficult operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder, part of the bile duct and nearby lymph nodes. In some situations, part of the stomach and colon may be removed as well. Your surgeon reconnects the remaining parts of your pancreas, stomach and intestines to allow you to digest food.
Surgery for tumors in the pancreatic body and tail - Surgery to remove the left side (body and tail) of the pancreas is called distal pancreatectomy. Your surgeon may also need to remove your spleen.
Surgery to remove the entire pancreas - In some people, the entire pancreas may need to be removed. This is called total pancreatectomy. You can live relatively normally without a pancreas but do need lifelong insulin and enzyme replacement.
Surgery for tumors affecting nearby blood vessels - Many people with advanced pancreatic cancer aren't considered eligible for the Whipple procedure or other pancreatic surgeries if their tumors involve nearby blood vessels. At highly specialized and experienced medical centers, surgeons may offer pancreatic surgery operations that include removing and reconstructing affected blood vessels.
Each of these surgeries carries the risk of bleeding and infection. After surgery some people experience nausea and vomiting if the stomach has difficulty emptying (delayed gastric emptying). Expect a long recovery after any of these procedures. You'll spend several days in the hospital and then recover for several weeks at home.
Extensive research shows pancreatic cancer surgery tends to cause fewer complications when done by highly experienced surgeons at centers that do many of these operations. Don't hesitate to ask about your surgeon's and hospital's experience with pancreatic cancer surgery. If you have any doubts, get a second opinion.
Chemotherapy uses drugs to help kill cancer cells. These drugs can be injected into a vein or taken orally. You may receive one chemotherapy drug or a combination of them.
Chemotherapy can also be combined with radiation therapy (chemoradiation). Chemoradiation is typically used to treat cancer that hasn't spread beyond the pancreas to other organs. At specialized medical centers, this combination may be used before surgery to help shrink the tumor. Sometimes it is used after surgery to reduce the risk that pancreatic cancer may recur.
In people with advanced pancreatic cancer and cancer that has spread to other parts of the body, chemotherapy may be used to control cancer growth, relieve symptoms and prolong survival.
Radiation therapy uses high-energy beams, such as those made from X-rays and protons, to destroy cancer cells. You may receive radiation treatments before or after cancer surgery, often in combination with chemotherapy. Or your doctor may recommend a combination of radiation and chemotherapy treatments when your cancer can't be treated surgically.
Radiation therapy usually comes from a machine that moves around you, directing radiation to specific points on your body (external beam radiation). In specialized medical centers, radiation therapy may be delivered during surgery (intraoperative radiation).
Traditional radiation therapy uses X-rays to treat cancer, but a newer form of radiation using protons is available at some medical centers. In certain situations, proton therapy can be used to treat pancreatic cancer and it may offer fewer side effects compared with standard radiation therapy.
Clinical trials are studies to test new treatments, such as systemic therapy, and new approaches to surgery or radiation therapy. If the treatment being studied proves to be safer and more effective than current treatments, it can become the new standard of care.
Clinical trials for pancreatic cancer might give you a chance to try new targeted therapy, chemotherapy drugs, immunotherapy treatments or vaccines.
Clinical trials can't guarantee a cure, and they might have serious or unexpected side effects. On the other hand, cancer clinical trials are closely monitored to ensure they're conducted as safely as possible. And they offer access to treatments that wouldn't otherwise be available to you.
Talk to your doctor about what clinical trials might be appropriate for you.
Supportive (palliative) care:
Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care is not the same as hospice care or end-of-life care. Palliative care is provided by teams of doctors, nurses, social workers and other specially trained professionals. These teams aim to improve the quality of life for people with cancer and their families.
Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing medical care. It's often used while undergoing aggressive treatments, such as surgery, chemotherapy and radiation therapy.
When palliative care is used along with other appropriate treatments — even soon after the diagnosis — people with cancer may feel better and live longer.