The best methods for diagnosing pancreatic cancer
Pancreatic cancer may go unnoticed for many years. That is why early diagnosis of an insidious tumor is of great importance. We will tell you what examinations will help to detect cancer in time and start treatment

Pancreatic cancer (PC) can be asymptomatic for a long time, and when it makes itself felt, as a rule, it is already incurable.

Pancreatic cancer is most often found at stages 3-4. The chance of detecting the disease at an early stage does not exceed 3,8%1. But even if the diagnosis was made in a timely manner, the chances of a complete cure remain quite low.

For several years, PCa may not manifest itself in any way, or a person may experience symptoms of other diseases, such as pancreatitis. This may be a decrease in appetite and weight loss, weakness, fatigue, abdominal discomfort, loose stools. Other signs of pancreatic cancer may include upper abdominal pain, jaundice, itching, nausea and vomiting, and fever.2.

In any case, to understand the cause of such symptoms, it is necessary to consult a doctor. To establish a diagnosis, doctors collectively use various laboratory and instrumental methods, since each has its own pros and cons.

Blood test

Patients with suspected pancreatic cancer are advised to perform a complete blood count, biochemical blood test (total protein, urea, creatinine, bilirubin, amylase, transaminases, electrolytes and glucose) and analysis for tumor markers.

If the cancer is localized in the head of the pancreas, an increase in bilirubin (a breakdown product of red blood cells) is often noted in the tests. If the tumor originates in the body or tail, hyperglycemia and glucosuria (increased blood glucose and presence of glucose in the urine) may occur.2.

Fecal analyzes

When pancreatic cancer is suspected, doctors sometimes recommend a pancreatic elastase test (or an elastase-1 test). This is an enzyme that is produced in the pancreas and then passes through the intestines with minimal changes and is concentrated in the feces.  

A low level of the enzyme indicates a lack of function of the gland. This may indicate the development of a tumor, but not necessarily. Such a test is used in the diagnosis of other serious diseases – cystic fibrosis, chronic pancreatitis, diabetes mellitus. And for the diagnosis of prostate cancer, it can be considered auxiliary, since the result does not guarantee the presence or absence of a tumor.

EGDS

It is recommended that all patients with pancreatic cancer undergo esophagogastroduodenoscopy to assess how far the tumor has spread.

With the help of EGDS, you can examine the condition of the stomach, duodenum and esophageal mucosa. Very often, with pancreatic cancer, these organs are deformed. In addition, EGDS allows you to detect the germination of the tumor in the duodenum.

Abdominal ultrasound

If it is impossible to perform CT or MRI, it is recommended to undergo a comprehensive ultrasound examination – ultrasound of the retroperitoneal space and small pelvis. The goal is the same – to assess the spread of the tumor to other organs.

It’s important

Classical ultrasound is difficult if the patient is obese. Also, with the help of ultrasound it is impossible to understand exactly whether the tumor can be removed or not.

If additional examination is necessary, endosonography of the pancreatobiliary zone (one of the ultrasound methods) is recommended. During the study, the pancreas and bile ducts are studied.

The study is carried out from the inside using a special device – an ultrasonic endoscope, at the end of which there is an ultrasonic sensor. The sensitivity of the method ranges from 48 to 90%3, and with its help you can find and examine small tumors – up to 2 cm in diameter.

MRI

Patients with pancreatic cancer are also recommended to undergo magnetic resonance imaging of the abdominal cavity and small pelvis. MRI is performed when there is a suspicion of liver metastases that could not be confirmed or ruled out by other methods.

Tumor biopsy

When performing a biopsy, the doctor takes a sample of tissue for examination to confirm the presence of a malignant tumor and study it in more detail before surgery. However, this is not the most accurate diagnostic method. A negative biopsy result does not completely exclude the presence of prostate cancer.4.

Without fail, a biopsy with subsequent examination of the material is prescribed for patients whose treatment is planned to begin with a conservative stage – drugs and other non-surgical methods. Also, a biopsy is prescribed if there is a possibility that the results of instrumental diagnostics are false positive.

A less traumatic way is to puncture the tumor with a thin needle (percutaneous or endoscopic biopsy). However, there is evidence that biopsy may contribute to the development of complications and the spread of tumor cells.4.

By the way, surgical intervention in some cases can be performed without morphological confirmation, that is, without positive biopsy results.

Computed tomography

The most effective and frequently used method is multispiral computed tomography (MSCT) with bolus contrast enhancement. This means that a special contrast agent is injected into a vein during the procedure.

MSCT allows you to study the organs of the abdominal cavity, chest and small pelvis in order to confirm or refute the diagnosis and assess the prevalence of the tumor process. If the patient has an intolerance or allergy to the contrast agent, an MRI is usually ordered.

Diagnostic laparoscopy

Diagnostic laparoscopy is usually indicated when there is a suspicion that the tumor has spread through the peritoneum or if the diagnosis cannot be confirmed by other methods.

This is a minimally invasive surgical procedure that does not require large incisions. A tiny video camera called a laparoscope is inserted into the abdomen through a small opening. The image from the camera is transmitted to the monitor and enlarged several times. This allows you to study the state of the pancreas, examine in detail even small tumor foci, as well as explore changes in neighboring organs. During laparoscopy, tissue is often taken for a biopsy.

genetic research

In the process of malignant changes in the epithelium of the pancreas, mutations of key genes occur. First of all, we are talking about the KRAS gene. Further, mutations appear in the CDKN2, TP53, SMAD4/DPC4, and BRCA2 genes. Genetic research allows to observe the development of the tumor process.

Also, all patients with pancreatic cancer are recommended to undergo a molecular genetic study of mutations in the BRCA1, BRCA2 and PALB2 genes.2. For this, either blood tests or a biopsy of the tumor tissue are performed. The presence or absence of these mutations significantly influences the choice of treatment tactics, such as chemotherapy protocols.

ECHR

Endoscopic retrograde cholangiopancreatography is an x-ray method for examining the pancreas, bile and pancreatic ducts. Here, a contrast agent is used, which is injected through an endoscope and a special catheter into the bile and pancreatic ducts.5.

This diagnostic method is resorted to only if other methods (ultrasound, CT) turned out to be uninformative. This manipulation requires serious preparation (including a number of tests). As in the case of CT, this diagnostic method is not suitable for a person with intolerance to radiopaque substances.

PET-CT

This is a modern method for diagnosing oncological diseases, including pancreatic cancer. With its help, it is possible to establish the presence of malignant tumors, even small ones (from 5 mm). Also, the technique allows to detect distant metastases with an accuracy of up to 87%.

The method is a combination of positron emission tomography (PET) and computed tomography (CT). To do this, a special radiopharmaceutical is introduced into the body, which accumulates in internal organs and tissues and changes its color where there are malignant tumors and metastases.

Color changes and localization of pathological foci are clearly visible on the pictures taken during the procedure. The radiopharmaceutical is not absorbed in the body and is excreted naturally after 1-2 days. Despite all the advantages of the PET/CT method, it cannot be used instead of CT in the initial assessment of tumor extent.

Popular questions and answers

Pancreatic cancer is quite widespread and difficult to diagnose and treat. Therefore, it is important to know the main points. Our expert answers questions oncologist of the highest category, Ph.D. Oleg Zarubenkov.

What are the symptoms of pancreatic cancer?

– The first symptoms of prostate cancer may be: causeless loss of appetite and weight loss, fatigue, weakness, abdominal discomfort, frequent loose stools, signs of diabetes. Other symptoms may be pain in the right or left hypochondrium (depending on the location of the tumor), yellowness of the skin, itching, nausea and vomiting, and fever.

How to determine the stage of pancreatic cancer?

— The stage of pancreatic cancer is determined by the international system of classification of malignant tumors TNM. To do this, it is necessary to clarify the size of the tumor, its local prevalence, the presence of metastases in regional lymph nodes and other distant organs (liver, lungs, peritoneum, ovaries, kidneys, etc.).

It is also necessary to determine whether the tumor is limited to the affected organ or has ingrowth into neighboring organs and structures. It is impossible to independently determine the stage of cancer, without an appropriate examination.

How long does it take for pancreatic cancer to develop?

– The rate of development of prostate cancer depends on the age of the patient, the histological type of tumor, the presence of concomitant pathology, genetic mutations in the body, and much more. Of course, these are not days and hours. More often, this is still a fairly long period, measured in months and years from the onset of a primary tumor mutation in a pancreatic cell.

How is pancreatic cancer treated?

— In patients with resectable stage I-III pancreatic cancer, combined treatment is recommended. It includes surgery and either adjuvant (post-surgery) or peri-surgical chemotherapy (which is given before and after surgery). Postoperative chemotherapy is recommended to achieve remission, but only if there are no contraindications. The recommended total duration of chemotherapy is at least 6 months, and sometimes more.

Often, in the presence of severe concomitant diseases, prostate cancer cannot be operated on. In such cases, symptomatic therapy, palliative drug anticancer treatment, as well as minimally invasive procedures are carried out to help eliminate the symptoms of jaundice or small bowel obstruction.

At the discretion of the attending physician, radiation therapy may be added to conservative treatment. This can shrink the tumor and make it operable.

Are there measures to prevent PCa?

– Risk factors for the development of pathology are: lack of vitamin D3, alcohol abuse and smoking, chronic pancreatitis, diabetes mellitus, obesity and low physical activity.

Therefore, the main methods of prevention of prostate cancer are a healthy, active lifestyle, rational nutrition. Necessarily – timely diagnosis and monitoring of predisposing and precancerous conditions and diseases.

Sources of:

  1. I’M WITH. Zimmerman. Pancreatic cancer: Terra incognita of modern gastroenterology // Clinical medicine. 2015. No. 10. pp. 5-13. https://cyberleninka.ru/article/n/rak-podzheludochnoy-zhelezy-terra-incognita-sovremennoy-gastroenterologii/viewer
  2. Pancreas cancer. Clinical guidelines. 2021. https://goo.su/RvrYSuW
  3. Norbert Hüser, Volker Assfalg, Daniel Hartmann, Daniel Reim, Alexander Novotny, Edouard Matevossian, Helmut Friess. Diagnosis and surgical treatment of pancreatic cancer // Experimental and Clinical Gastroenterology. 2011. No. 7. pp. 102-111. https://cyberleninka.ru/article/n/diagnostika-i-hirurgicheskoe-lechenie-raka-podzheludochnoy-zhelezy/viewer
  4. I.V. Mikhailov, V.N. Belyakovsky, V.A. Kudryashov, A.P. Dyatlov, Ch.A.A.D. Viracoon. Biopsy of pancreatic tumors before resection: pros and cons // Clinical Medicine. 2021. Volume 18. No. 1. pp. 62-69. https://cyberleninka.ru/article/n/biopsiya-opuholey-podzheludochnoy-zhelezy-pered-rezektsiey-za-i-protiv/viewer
  5. P.L. Shcherbakov, A.I. Parfenov, co-authors. Endoscopic retrograde cholangiopancreatography, standard of conduct // Experimental and Clinical Gastroenterology. 2009. №3. pp. 150-155. https://goo.su/VSimRGj

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