Diagnosing Pancreatic Cancer

Dr. Brett Sheppard reviews an image with nurse practitioner Erica Degenhardt
Dr. Brett Sheppard (right), a pancreatic cancer surgeon and co-director of OHSU’s Brenden-Colson Center for Pancreatic Care, examines a scan with nurse practitioner Erica Degenhardt.

Our gastroenterologists, pathologists and other doctors offer exceptional expertise in diagnosing pancreatic cancer. You can be confident that your diagnosis will be fast and accurate.

You’ll find:

  • Gastroenterologists who do hundreds of diagnostic procedures a year.
  • Expert radiologists who offer precise CT scans specifically designed for pancreatic cancer.
  • Minimally invasive techniques to gain tissue samples for analysis (biopsy).
  • On-site pathologists who can examine your tissue sample during your procedure.
  • Cancer surgeons who can immediately consult with your gastroenterologist to guide next steps.
  • Team-based care, with specialists working together to make sure you don’t have to unnecessarily repeat a test or treatment.

This page is devoted mostly to exocrine pancreatic tumors, which make up about 95% of cases. Read about diagnosing pancreatic neuroendocrine tumors at the bottom of the page.

Exam and medical history

Your doctor will start with a physical exam and talk with you about your symptoms and medical history. The doctor will ask about your family history to assess your risk of pancreatic cancer. If the doctor suspects pancreatic cancer, these are the most common tests you might have:

CT scan

Computed tomography uses an X-ray beam that circles the body to create 3D and cross-sectional views. You are given a dye by IV to better show any cancer on scans.

At the Knight Cancer Institute, we do pancreatic-protocol CT scans.

This creates a series of images in very thin slices for a more detailed look. Our radiologists and other doctors have spent years making sure these scans are as accurate as possible. We often find important information when we redo scans from elsewhere.

Endoscopic ultrasound (EUS)

anatomy of the pancreas and surrounding organs - diagram used to illustrate diagnosing pancreatic cancer with endoscopic ultrasound (EUS)
In EUS, a thin, flexible tube with a camera is guided down the throat (esophagus) into the stomach and top part of the small intestine (duodenum).

This minimally invasive procedure takes about an hour to 90 minutes.

It enables doctors to take a close look at your pancreas, liver, blood vessels, lymph nodes and other tissue without an incision.

At the Knight Cancer Institute, our interventional endoscopists (gastroenterologists with special training) each do several procedures a day, or hundreds a year.

Our team offers the most experience and expertise with EUS in Oregon.

How it’s done

You are placed under deep sedation and monitored by an anesthesiologist. An interventional endoscopist guides an endoscope down your throat and into your stomach and the top part of your small intestine (duodenum).

The pancreas is nestled next to these organs, letting the endoscopist examine it head to tail. An ultrasound device at the scope’s tip bounces sound waves off your organs and other tissues to create high-resolution images. 

Why it’s done

An EUS, combined with a CT scan, gives doctors a detailed picture of any cancer and whether it has spread. The endoscopist can guide a needle through the scope to take tissue samples. The doctor will also examine your stomach and small intestine for other issues, such as a developing blockage.

Teamwork

At OHSU, our on-site pathologist (an expert in cells and diagnosing disease) can look at tissue during the procedure to make sure the endoscopist got enough. This helps you avoid a second test. The pathologist does a complete examination later. A cancer surgeon can also be consulted during the procedure to guide next steps.

Our doctors, including surgeon Kevin Billingsley, M.D., bring a precise eye to each diagnosis. Here, Dr. Billingsley reviews a patient scan for pancreatic cancer.
Our doctors, including surgeon Kevin Billingsley, M.D., bring a precise eye to each diagnosis.

Biopsy

Your care team extracts a small tumor sample. A pathologist examines it under a microscope. This doctor can detect cancer cells and see what type or types they are.

Biopsy types include:

  • Endoscopic biopsy: The doctor doing your EUS or ERCP guides an instrument through the endoscope to take a tissue sample during the procedure.
  • Surgical biopsy: On occasion, doctors might want samples from several organs if they suspect your cancer has spread. They can use laparoscopy, with small incisions in your abdomen, to insert small instruments. 

Other tests

Blood tests

Blood tests alone aren’t enough for a diagnosis. Doctors can look at your blood to check:

  • The level of bilirubin, a dark yellow-brown substance. A high level can indicate that a tumor is blocking bile flow.
  • For tumor markers — proteins that can signal the presence of cancer.

Other imaging tests

  • Abdominal ultrasound: If you come to your doctor with symptoms in your belly, your doctor might start with an abdominal ultrasound. This uses sound waves from a wand pressed against your belly to create images of your insides.
  • MRI: This test uses powerful magnets and radio waves to create detailed images of inside your body.

Molecular profiling

When appropriate, we have a patient’s tumor analyzed at the molecular level. Doctors can sometimes match cancer cells’ genetic traits with a therapy. While this area shows promise, however, it remains at the experimental stage. Pancreatic tumors are so complex that finding one trait to attack still leaves many others. 

Diagnosing pancreatic neuroendocrine tumors

Tests for PNETs include (see more detailed descriptions above):

  • An exam and medical history
  • Blood tests to check levels of hormones, sugar and a molecule called chromogranin A. Having a high chromogranin A level can signal presence of a PNET.
  • CT scan
  • PET scan, in which you are injected with a slightly radioactive sugar that is absorbed by cancer cells. A special scan shows where cancer may have spread.
  • Somatostatin receptor scintigraphy, a scan that uses a small amount of injected radioactive substance to highlight tumors.
  • EUS and ERCP, which create images using thin tools guided down your throat to your stomach. This also enables the doctor to take tissue samples.
  • Biopsy, or analysis of a tumor sample. 

Learn more

For patients

Call 503-494-7999 to:

  • Make an appointment
  • Seek a second opinion
  • Ask questions

Location

Parking is free for patients and their visitors.

Center for Health & Healing Building 2
3485 S.W. Bond Ave.
Portland, OR 97239
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