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 * Diagnosing Pancreatic Cancer **
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How is pancreatic cancer diagnosed? In addition to a complete medical history and physical examination, diagnostic procedures for pancreatic cancer may include the following

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= ** Blood tests ** = A substance called CA 19-9 is released into the blood by exocrine pancreatic cancer cells and can be detected by blood tests. But by the time blood levels are high enough to be consistently detected by available methods, the cancer is no longer in its early stages. This is why the test is not recommended for routine screening of people without symptoms or a known diagnosis of cancer. The CA 19-9 test is sometimes used during treatment to see if the therapy is working or after treatment to see if the cancer has recurred (come back). Another substance, carcinoembryonic antigen (CEA), can help detect advanced pancreatic cancer in some people. But it isn't sensitive enough to find the cancer early and is not recommended as a screening test.

= Radiologic Studies = •Ultrasound (Also called sonography.) - a diagnostic imaging technique that uses

high-frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen such as the liver, pancreas, spleen, and kidneys and to assess blood flow through various vessels. The ultrasound may be performed using an external or internal device:

◦Transabdominal ultrasound - the physician places an ultrasound device on the abdomen to create the image of the pancreas.

◦Endoscopic ultrasound (EUS) - the physician inserts an endoscope, a small, flexible tube with an ultrasound device at the tip, through the mouth and stomach, and into the small intestine. As the physician slowly withdraws the endoscope, images of the pancreas and other organs are made.

•Computed tomography scan (CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

•Magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

•Endoscopic retrograde cholangiopancreatography (ERCP) - a procedure that allows the physician to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. The procedure combines x-ray and the use of an endoscope - a long, flexible, lighted tube. The scope is guided through the patient's mouth and throat, then through the esophagus, stomach, and duodenum. The physician can examine the inside of these organs and detect any abnormalities. A tube is then passed through the scope, and a dye is injected which will allow the internal organs to appear on an x-ray.

•Percutaneous transhepatic cholangiography (PTC) - a needle is introduced through the skin and into the liver where the dye (contrast) is deposited and the bile duct structures can be viewed by x-ray.

•Positron emission tomography (PET) - a type of nuclear medicine procedure. This

means that a tiny amount of a radioactive substance, called a radionuclide (radiopharmaceutical or radioactive tracer), is used during the procedure to

assist in the examination of the tissue under study. Specifically, PET studies evaluate the metabolism of a particular organ or tissue, so that information about the physiology (functionality) of the organ or tissue is evaluated, as well as its biochemical properties. Thus, PET may detect biochemical changes in an organ or tissue that can identify the onset of a disease process before anatomical changes related to the disease can be seen with other imaging processes such as computed tomography (CT) or magnetic resonance imaging (MRI).

= Surgical Procedure = •Pancreas biopsy - a procedure in which a sample of pancreatic tissue is removed

(with a needle or during surgery) for examination under a microscope.

= ** Genetic testing ** = Inherited DNA changes are thought to cause as many as 10% of pancreatic cancers. Because these inherited cases are sometimes linked with other cancers, determining whether a patient's relatives are at increased risk is not simple. Talking to someone with experience in hereditary cancer syndromes such as a genetic counselor, geneticist, or an oncologist (doctor who specializes in caring fr people who have cancer) is often helpful. The American Cancer Society strongly recommends that any person considering genetic testing talk with a genetic counselor, nurse, or doctor qualified to interpret and explain the test results before they proceed with testing. It is important for people to understand and carefully weigh the benefits and risks of genetic testing before these tests are done.

For people in families at high risk of pancreatic cancer, there are newer tests for detecting early pancreatic cancer that may help. One of these is called endoscopic ultrasound. This test would not be used to screen the general public but might be used in someone with a strong family history of pancreatic cancer. Using endoscopic ultrasound, doctors have been able to find early, treatable pancreatic cancers in some members of high-risk families. In addition, interested families may wish to participate in ongoing research studies aimed at investigating the genetic factors and possible role of screening methods in those with a family history of the disease.



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