Diagnosis of Pancreatic Cancer

Early diagnosis of pancreatic cancer is still difficult, and often requires a combination of laboratory tests and imaging tests to make a diagnosis.

1. Laboratory examination

There are no obvious changes in the early stage. In pancreatic head cancer, obstructive jaundice may occur, and the average serum bilirubin quantitative test is 6mg/dL. As the disease progresses, the bilirubin quantitative generally continues to increase, reaching 10mg/dL, and can reach 30mg/dL in severe cases. Serum amylase and lipase increase, and some patients have increased blood sugar and urine sugar. In late-stage patients, the plasma protein value decreases, and the white/globulin ratio is inverted.

2. Ultrasound

B-ultrasound examination is a simple, non-invasive and painless examination method that can directly display images and can be repeated for many times. It is suitable for the initial screening of pancreatic cancer and cancer surveys. When there is obstructive jaundice in pancreatic head cancer, 95% can show dilation of the intrahepatic and extrahepatic bile ducts and enlargement of the gallbladder. The accuracy rate of B-ultrasound in determining the site of extrahepatic obstruction of pancreatic cancer is 94.4%, so it can be used as the preferred tool for pancreatic cancer examination.

3. CT

CT examination can directly display images, and the diagnosis rate of bile duct dilatation is 100%. CT can show local protrusions or irregular masses in the pancreas, with uneven density, irregular center, and low-density areas with blurred boundaries. CT can also show the invasion of pancreatic cancer into the surrounding superior mesenteric artery/vein, portal vein, inferior vena cava, and splenic vein. When there are peripancreatic lymph nodes and liver metastases, CT can clearly show them.

4.ERCP

The ERCP findings of pancreatic cancer depend on the location of the tumor in the pancreas. For most pancreatic ductal epithelial carcinomas, pancreatic ductography shows the following changes: irregular dilatation of the pancreatic duct, abrupt interruption of the upper pancreatic duct, irregular stenosis of the pancreatic duct, manifested as localized irregular stenosis of the main pancreatic duct, and abrupt interruption of the main pancreatic duct and the common bile duct.

5.PTC

When used for pancreatic head cancer with obstructive jaundice, it can show dilatation of the intrahepatic and extrahepatic bile ducts, obstruction of the lower common bile duct, and the obstructed end can be rounded, smooth, or nodular filling defects. The common bile duct is displaced inward due to the advancement of the tumor.

6. Selective celiac artery angiography

It can show that the artery is compressed and eroded by the tumor and is narrowed, displaced or interrupted, and the tumor site is pathologically tortuous. Hepatic artery angiography is helpful in determining the intrahepatic metastasis of pancreatic cancer, and the capillary phase shows a round filling defect.

7. Endoscopic Ultrasound (EUS)

The probe can be placed in the stomach and duodenum to display the tumor location, infiltration depth, and lymph node metastasis.