Diagnostic Tests for Pancreatic cancer

Contents

Pancreatic cancer: Diagnostic Tests

The list of diagnostic tests mentioned in various sources as used in the diagnosis of Pancreatic cancer includes:

Physical exam
Blood tests
Urine tests
Stool tests
Bilirubin tests
CAT scan
Ultrasonography
- Transabdominal ultrasound
- EUS (Endoscopic ultrasound)
ERCP (endoscopic retrograde cholangiopancreatography)
PTC (percutaneous transhepatic cholangiography)
Biopsy
Fine-needle aspiration biopsy
Surgical biopsy
Pathology tests
Ultrasonography
Laparoscopy
Angiography

Pancreatic cancer Tests: Book Excerpts

Physical examination - Diabetes Mellitus

Home Diagnostic Testing

These home medical tests may be relevant to Pancreatic cancer:

Colon & Rectal Cancer: Home Testing
- Home Colorectal Cancer Tests
- Home Fecal Occult Bleeding Tests
Cancer-Related Home Testing:

Pancreatic cancer Diagnosis: Book Excerpts

Tests and diagnosis discussion for Pancreatic cancer:

If a patient has symptoms that suggest pancreatic cancer, the doctor asks about the patient's medical history. The doctor may perform a number of procedures, including one or more of the following:

Physical exam -- The doctor examines the skin and eyes for signs of jaundice. The doctor then feels the abdomen to check for changes in the area near the pancreas, liver, and gallbladder . The doctor also checks for ascites , an abnormal buildup of fluid in the abdomen.
Lab tests -- The doctor may take blood, urine, and stool samples to check for bilirubin and other substances. Bilirubin is a substance that passes from the liver to the gallbladder to the intestine. If the common bile duct is blocked by a tumor, the bilirubin cannot pass through normally. Blockage may cause the level of bilirubin in the blood, stool, or urine to become very high. High bilirubin levels can result from cancer or from noncancerous conditions.
CT scan (Computed tomography) -- An x-ray machine linked to a computer takes a series of detailed pictures. The x-ray machine is shaped like a donut with a large hole. The patient lies on a bed that passes through the hole. As the bed moves slowly through the hole, the machine takes many x-rays. The computer puts the x-rays together to create pictures of the pancreas and other organs and blood vessels in the abdomen.
Ultrasonography -- The ultrasound device uses sound waves that cannot be heard by humans. The sound waves produce a pattern of echoes as they bounce off internal organs. The echoes create a picture of the pancreas and other organs inside the abdomen. The echoes from tumors are different from echoes made by healthy tissues.
The ultrasound procedure may use an external or internal device, or both types:
- Transabdominal ultrasound : To make images of the pancreas, the doctor places the ultrasound device on the abdomen and slowly moves it around.
- EUS (Endoscopic ultrasound) : The doctor passes a thin, lighted tube (endoscope ) through the patient's mouth and stomach, down into the first part of the small intestine. At the tip of the endoscope is an ultrasound device. The doctor slowly withdraws the endoscope from the intestine toward the stomach to make images of the pancreas and surrounding organs and tissues.
ERCP (endoscopic retrograde cholangiopancreatography ) -- The doctor passes an endoscope through the patient's mouth and stomach, down into the first part of the small intestine. The doctor slips a smaller tube (catheter ) through the endoscope into the bile ducts and pancreatic ducts. After injecting dye through the catheter into the ducts, the doctor takes x-ray pictures. The x-rays can show whether the ducts are narrowed or blocked by a tumor or other condition.
PTC (percutaneous transhepatic cholangiography ) -- A dye is injected through a thin needle inserted through the skin into the liver. Unless there is a blockage, the dye should move freely through the bile ducts. The dye makes the bile ducts show up on x-ray pictures. From the pictures, the doctor can tell whether there is a blockage from a tumor or other condition.
Biopsy -- In some cases, the doctor may remove tissue. A pathologist then uses a microscope to look for cancer cells in the tissue. The doctor may obtain tissue in several ways. One way is by inserting a needle into the pancreas to remove cells. This is called fine-needle aspiration . The doctor uses x-ray or ultrasound to guide the needle. Sometimes the doctor obtains a sample of tissue during EUS or ERCP. Another way is to open the abdomen during an operation.

(Source: excerpt from What You Need To Know About Cancer of the Pancreas: NCI)

Diagnosis of Pancreatic cancer: medical news summaries:

The following medical news items are relevant to diagnosis of Pancreatic cancer:

Diagnostic Tests for Pancreatic cancer: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the diagnostic tests for Pancreatic cancer.

Diabetes Mellitus: Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)

Patients often present with similar physical findings in both type 1 and type 2 DM, owing to hyperglycemia. In the young child, failure to grow and gain weight can occur with type 1 DM. The child may be ill appearing, lethargic, and often have signs of dehydration (tachypnea, tachycardia, and low blood pressure). Ketone production will produce a fruity odor on the patient’s breath. The patient with type 2 DM tends to be obese (especially upper body obesity) and may appear fatigued and have muscle weakness or decreased vision. The neurologic examination may reveal painful feet and numbness. Monilial infections may be found in the vagina and pubic areas.

Testing

A. Type 1 diabetes. Not all children with hyperglycemia have diabetes. Some children with a severe illness (e.g., severe dehydration from diarrhea or asthma treated with corticosteroids) may have elevated serum glucose and ketosis. If the diagnosis is uncertain, a low serum insulin level along with hyperglycemia supports the diagnosis of DM and excludes all other diagnoses. Elevated glycosylated hemoglobin provides a strong circumstantial case for the diagnosis of DM, but it is not used alone for the diagnosis. Performing a glucose tolerance test is rarely necessary. However, it is imperative to obtain insulin levels along with the blood glucose values when it is performed.

B. Type 2 diabetes. The American Diabetes Association (ADA) diagnostic criteria for type 2 DM are either (a) symptoms of diabetes and a casual plasma glucose level of 200 mg/dl or greater, (b) a fasting plasma glucose level of 126 mg/dl or greater, or (c) a plasma glucose level of 200 mg/dl or greater 2 hours after an oral glucose load (75 g). A “casual” plasma blood glucose level is obtained at any time of the day without regard to the time of the last meal, and a “fasting” level is obtained after a fast of at least 8 hours. If the only criterion is hyperglycemia, confirmation should be made on a different day (1).

Diagnostic assessment

The presence of polyuria, polydipsia, polyphagia, and weight loss along with hyperglycemia and ketosis are sufficient to establish the diagnosis of type 1 DM. This provides an ample basis for beginning insulin therapy. Hyperglycemia can also occur during a severe illness. Therefore, the diagnosis of type 1 DM is not always clear. Low insulin levels may be needed to make the diagnosis. The key to the diagnosis of type 2 DM is the detection of hyperglycemia. Patients with symptoms of diabetes should have testing according to the ADA recommendations. Once the diagnosis is made, formulate a treatment program with the patient.

References

1. American Diabetes Association. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997;20:1183–1197.

2. National Diabetes Data Group. Diabetes in America, 2nd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, 1995. NIH publication 1468-1995.

3. Baker JR. Autoimmune endocrine disease. JAMA 1997;278:1931–1937.

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Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000