To give you the most effective treatment possible, Memorial Sloan Kettering doctors will want to make sure your diagnosis of cancer in the pancreas is correct. They will also want to establish the size of your tumor and whether it has spread to other areas of your body. This will help determine the stage of pancreatic cancer.

We use a variety of tests to find the most accurate information about a tumor and to decide on the best approach for you. We’ll perform a complete physical examination and review results from any previous imaging tests you may have had. We’ll also review any medical information from your primary care doctor.

We may recommend you have one or more of the following tests:

Blood Tests

Several blood tests can help guide diagnosis of and treatment for pancreatic cancer. These include:

• Liver (hepatic) function: This test is used to measure the level of bilirubin, a substance made by the liver, in your blood. A high level may indicate that you have a tumor that is blocking the bile duct.
• CA 19-9: People with pancreatic cancer often have an increased level of this protein in their blood, although it cannot be used alone to diagnose pancreatic cancer.
• Carcinoembryonic antigen: The level of this protein in the blood typically increases in people with cancers of the gastrointestinal tract.

We can also use blood tests to monitor the progression of disease and track the effectiveness of treatment over time.

Diagnostic Imaging Tests

We may use one or more of the following imaging tests to determine the extent of the tumor in the pancreas and whether cancer cells have spread to surrounding tissues or other parts of your body.

• CT scans are used to identify the precise location and extent of a pancreatic tumor.
• MRI provides information that complements what can be seen in a CT scan.
• Magnetic resonance cholangiopancreatography helps doctors see inside the pancreatic ducts (small channels that carry digestive enzymes to the intestines), where tumors often begin.
• Endoscopic ultrasound (EUS) uses ultrasound waves to obtain highly detailed pictures of the pancreas. The endoscope (a thin tube that a doctor inserts while you’re under anesthesia) can also be used to remove pancreatic cells and fluid for a biopsy (a test that studies a sample of tissue under a microscope).
• Endoscopic retrograde cholangiopancreatography (ERCP) involves the injection of a contrast dye through an endoscope before images are taken. This allows doctors to see if the pancreatic duct has narrowed or become blocked. Doctors also may use the endoscope to remove pancreatic cells for a biopsy and to guide placement of a bile duct stent, which keeps the pancreatic duct open, to relieve jaundice.

Biopsy

If your physical exam, lab tests, and imaging studies indicate you may have pancreatic cancer, we may perform a biopsy to confirm the diagnosis. A biopsy involves physically removing a small bit of tissue from the pancreas.

Biopsy is the gold standard for diagnosing pancreatic cancer. We get most biopsies by means of endoscopic ultrasound (EUS) or endoscopic retrograde cholangiopancreatography (ERCP).

Another test we may recommend involves inserting a thin needle into the abdomen to remove a small amount of tissue and fluid from the pancreas or site of metastasis, or place where the cancer has spread. This is done while you’re under anesthesia.

A doctor called a pathologist will examine the tissue sample closely under a microscope. He or she will determine what type of tumor tissue is there and whether it’s benign (noncancerous) or malignant (cancerous). Each type of tumor responds differently to therapy. So knowing which type of tumor you have helps your doctor select the most effective treatment for you.

MSK pathologists are experts in diagnosing pancreatic cancer. They are often asked to review biopsy tissue that other laboratories have drawn.

We use highly precise imaging technologies to guide biopsy procedures. This makes it possible to investigate cysts and tumors in areas of the body that were impossible to reach safely in the past.