Diagnosis Process Explained
Initial Evaluation (Clinical Assessment):
The process starts with a physical exam and medical history, focusing on symptoms such as jaundice, abdominal pain, or weight loss.
Basic blood tests (including liver function tests) are ordered to check for bile duct obstruction or liver abnormalities.
These tests help identify if the symptoms could be due to a pancreatic or biliary problem rather than another cause.
Liver Function Tests (LFTs)
These assays measure enzymes and substances made by the liver, such as bilirubin, ALP (alkaline phosphatase), AST, and ALT. If a tumour in the pancreas blocks the bile duct, these levels—especially bilirubin—often rise, leading to jaundice (yellowing of the skin and eyes). High bilirubin or ALP levels can suggest a blockage, prompting imaging tests like a CT scan or ultrasound.
Pancreatic Enzyme Tests
These assays measure levels of amylase and lipase, enzymes made by the pancreas to help digest food. High levels may occur if the pancreas is inflamed (pancreatitis) or blocked. Persistent or mild elevation without another clear cause can lead doctors to investigate for pancreatic disease.
Tumour Markers
CA 19-9: A protein that is often elevated in people with pancreatic cancer. Useful for monitoring treatment response or cancer recurrence rather than for initial diagnosis (since other conditions can also raise CA 19-9).
CEA (Carcinoembryonic Antigen): Another marker that may be elevated in pancreatic and other gastrointestinal cancers. Used along with CA 19-9 to support diagnosis and track disease over time.
Blood Glucose (Sugar Levels)
Why it’s checked:New-onset or worsening diabetes can be an early sign of pancreatic cancer because the pancreas helps regulate blood sugar.
What results may show:Higher-than-normal glucose levels may lead doctors to look for pancreatic causes.
Complete Blood Count (CBC) and General Chemistry Panel
Why they matter: These tests check overall health, including anaemia, infection, or signs that organs aren’t working properly.
What results may show: They provide a baseline before imaging or treatment.
Initial Imaging Tests
CT scan (pancreatic protocol) is usually the first major imaging test. It provides detailed pictures of the pancreas, helping detect tumours, assess their size, and determine if cancer has spread. CT scans are quick, widely available, and highly accurate for detecting pancreatic masses.
Imaging Follow Up
MRI: If CT findings are unclear, an MRI or MRCP (Magnetic Resonance Cholangiopancreatography) is done to visualise the pancreatic and bile ducts more clearly. MRI/MRCP offers more detail on soft tissues and ducts, useful for differentiating cancer from other pancreatic diseases.
Endoscopic Ultrasound (EUS): EUS provides close-up imaging and allows fine-needle aspiration (FNA) for biopsy. This step confirms the diagnosis by obtaining tissue samples for microscopic examination, which is essential before treatment.
PET Scan: This may be used to check for spread (metastasis) when surgery is being considered. PET detects metabolically active cancer cells throughout the body, helping guide treatment planning.