Pancreatic Cancer Diagnosis

Pancreatic Cancer Diagnosis

MSK gastroenterologist, Makoto Nishimura, speaks with his colleagues before a procedure dressed in their scrubs.

The first step in treating pancreatic cancer is a correct diagnosis. Gastroenterologist Makoto Nishimura is one of many MSK experts in diagnosing pancreatic cancer.

Your MSK care team will get a clear understanding of the cause of your symptoms before you can start treatment.

To make their diagnosis, MSK experts learn about your medical history and general health. They use the results of many tests to diagnose pancreatic cancer. They find out the size of the tumor, and whether it has spread to other parts of the body.

This information helps them learn the stage of pancreatic cancer. Staging describes the tumor’s size, location, and whether it has spread.

You may have had tests that already show signs of pancreatic cancer. MSK Rapid Diagnosis can quickly get an accurate cancer diagnosis so you can start treatment right away.  We review results from any imaging tests you already had. We’ll also review medical information from your primary care doctor. 

How MSK tests and diagnoses pancreatic cancer

MSK diagnoses cancer using many new technologies that we developed or improved. We’re always researching ways to diagnose cancer with greater accuracy, which lets us improve treatment results.

Learn more about how we diagnose cancer. 

MSK uses many types of tests and procedures to diagnose pancreatic cancer. They include:

  • Imaging tests
  • Pathology and lab tests, such as blood tests
  • Diagnostic procedures, such as a biopsy procedure
  • Genetic tests

We may recommend you have 1 or more of the following tests:

Pancreatic cancer blood tests

We make a diagnosis of pancreatic cancer based on several tests, including blood tests.

Blood tests can find tumor markers linked to pancreatic cancer. If your blood has these markers, that does not mean you have pancreatic cancer. There is no blood test that can screen for pancreatic cancer. Signs of pancreatic cancer may not always show up in a blood test.

Here are the blood tests that help us diagnose pancreatic cancer. We also use these blood tests to monitor the disease and how well treatment is working. 

Liver (hepatic) function: This test measures blood for the level of bilirubin, a substance made by the liver. A high level can mean there’s a tumor blocking the bile duct.

CA 19-9 blood tests for pancreatic cancer: People with pancreatic cancer often have a higher level in their blood of a protein called CA 19-9. Usually, people have between 0 and 37 units/milliliter (U/mL) of CA 19-9 in their blood. A range higher than that can be a tumor marker for pancreatic cancer.

Not all types of pancreatic cancer cause higher levels of CA 19-9. Other conditions that are not cancer also can cause a higher level of this protein. That’s why we do not rely just on this blood test to diagnose pancreatic cancer.

If you have pancreatic cancer, you will keep having blood tests of your CA 19-9 level. Monitoring the level tells us how well treatment is working, or if cancer came back after treatment.

Carcinoembryonic antigen (CEA): CEA is a protein. The CEA level in people who do not smoke is under 2.5 nanograms per milliliter (ng/mL). The CEA level in people who smoke is under 5.0 ng/mL.

The level of CEA in the blood often rises in people with cancers of the gastrointestinal tract. If the level is higher than 2.9 ng/mL, this can be caused by other conditions that are not cancer. Your doctor will order other tests to get more information.

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Diagnostic imaging tests for pancreatic cancer

Doctors use imaging tests to help find and diagnose disease, recommend treatments, and monitor how well you respond to therapy. You may have more than 1 imaging test, because each kind gives us different information.

Imaging tests help us learn more about the tumor. They also can tell us whether cancer cells have spread to nearby tissues or other parts of the body. 

Computed tomography (CT) scans make 3D images of areas inside your body. The images can show organs, bones, muscles, tumors, and soft tissue. A CT scan can show where a tumor is located, its size, and if it has spread outside of your pancreas. CT scans also are known as CAT scans.

Magnetic resonance imaging (MRI) scans make very detailed 3D images of areas inside your body. MRI is different from a CT scan. It uses radio waves, a powerful magnet, and a computer to take pictures. MRI also is used to look at bone, organs, tumors, muscles, and soft tissue. Your care team may schedule an MRI to get more images of your pancreas, as well as a CT scan.

Magnetic resonance cholangiopancreatography (MRCP) uses radio waves, a powerful magnet, and a computer to take pictures of the pancreatic and bile ducts. Pancreatic ducts are small channels that carry digestive enzymes to the intestines. It’s often where tumors start.

Positron emission tomography (PET) scans are a type of nuclear medicine scan. They show how much glucose (sugar) is used in different areas of your body. Cells use glucose for energy. Cancer cells often use more glucose than healthy cells. A PET scan can help us find pancreatic cancer cells by showing areas that use more glucose.

During a PET scan, a small amount of radioactive glucose is injected (put) into your vein. A machine then takes detailed, computerized pictures of areas where the glucose is being used.

Endoscopic ultrasound  (EUS) uses ultrasound waves to make very detailed pictures of the pancreas. This procedure uses a flexible tube called an endoscope. You will have anesthesia, which is medication to make you sleep.

During your EUS, your doctor may also do a biopsy procedure to take a sample. The endoscope can be used to get samples of pancreatic cells and fluid. The samples are  studied under a microscope by a pathologist, a doctor who diagnoses diseases. 

Endoscopic retrograde cholangiopancreatography(ERCP). This procedure helps your doctor see your bile ducts and pancreatic ducts without surgery. 

Your doctor will use an endoscope, a thin, flexible tube with a camera on the end. The endoscope lets them find the opening where your bile duct and pancreatic duct meet your small intestine. Then they will inject (put) contrast dye into your bile duct or pancreatic duct.

During this procedure, your doctor:

  • Will take images with the camera to see if the pancreatic duct has narrowed or become blocked.
  • May do a biopsy to get a tissue sample from a growth in your pancreatic ducts. They will send the sample to a lab where a pathologist will check it for cancer.
  • May put a stent (thin, hollow tube) in your bile duct. The stent helps keep the pancreatic duct open and relieves jaundice.

Pancreatic Tumor Biopsy

Your physical exam, blood or lab tests, and imaging studies may suggest you have pancreatic cancer. If so, we may do a biopsy to confirm the diagnosis. 

A biopsy is a procedure to take a tissue sample from the pancreas. Most biopsies are done during an endoscopic ultrasound  (EUS) or endoscopic retrograde cholangiopancreatography  (ERCP).

Your doctor may recommend another test to get samples. They put a thin needle into the abdomen. They remove a small amount of tissue and fluid from the pancreas, or from wherever the cancer has spread. You will have anesthesia (medication to make you sleep) before this procedure.

MSK’s pancreatic biopsy process and what to expect

A doctor called a  pathologist  will examine the tissue sample under a microscope. They will tell the type of tumor and whether it’s benign (not cancer) or malignant (cancer). 

Each type of tumor does not respond the same way to a treatment. When we know the tumor type, we can target it with the treatments that work best on that type.

MSK pathologists are experts in diagnosing pancreatic cancer. Because of their expertise, they’re often asked to review biopsy tissue from labs other than MSK.

MSK uses very precise imaging methods to guide biopsy procedures. This lets us examine cysts and tumors in areas of the body that were impossible to reach safely before. 

Pancreatic cancer and tumor genetic testing

It’s important to get information about the genetic changes (mutations or variants) in the pancreatic tumor. Tumor genetic profiling tests show whether cancer is caused by genetic changes. We can choose drugs that target the molecular changes in a tumor. The first step is to learn which gene mutations the tumor has.

MSK offers next-generation DNA sequencing tests:

  • MSK-IMPACT® looks for mutations in tumor cells that are linked to cancer. This information helps us choose the right treatment. MSK-IMPACT also does germline testing for inherited cancers.  
  • MSK-ACCESS® looks for tumor mutations through a blood test. MSK-ACCESS is often used when it’s hard to do a tumor biopsy or if waiting for a biopsy delays treatment.  


MSK created a genetic test MSK-IMPACT ®. This next-generation DNA sequencing test looks for mutations in tumor cells. We use this genomic profiling for pancreatic cancer. 

This test can find mutations and other important changes in the genes that are found in both rare and common cancers. Using just a small tissue sample, this advanced sequencing test looks for genetic changes in 505 genes. These changes could be causing the cancer cells to grow. 

Liquid biopsy for pancreatic cancer

MSK developed a liquid biopsy test called MSK-ACCESS. Most liquid biopsies look for only a few mutations linked to 1 type of cancer. MSK-ACCESS is very different because it can be used for any kind of advanced cancer. 

When cancer cells die, they break apart and release their DNA into the blood. This is called cell-free (cf) tumor DNA. Using a blood sample, the liquid biopsy test looks for this DNA to find common cancer mutations.

It can find small amounts of cell-free (cf) tumor DNA in the blood. It looks for mutations in 129 genes that are known to cause cancer.

Liquid biopsies are one of the methods used to support targeted therapy.  

Germline testing for inherited (genetic) cancers

Next-generation sequencing tests offered at most other hospitals only test tissue from your tumor. MSK-IMPACT goes an extra step. It also analyzes some of your normal tissue, usually through a blood sample.

There’s a reason that MSK studies this normal tissue, too. We can tell whether you were born with the mutations, or if the mutations happened during your lifetime. 

Somatic mutations happen during your lifetime and are present in the tumor but not in normal cells. 

Mutations in the genes you were born with (inherited) are called germline mutations. These inherited mutations are more likely to respond to certain treatments.