A patient with symptoms & signs of a pancreatic tumor may be 1st seen by family physician, internist, and general surgeon or directly by gastroenterologist. Specialist pancreatic surgeon is usually the last ring in the chain unfortunately and hence patients quite often come with a stent in the biliary system, which could be avoided.
Apart from a routine complete blood count investigations like liver function tests & abdominal USG are asked for as a rule. Once USG confirms suspicion then rest of the investigations like CT scan or MRI scan of abdomen and often a EUS are asked.
Remember that an abdominal US scan is likely to miss an early pancreas cancer. Therefore if clinical picture & LFTs are in favor of pancreatic cancer (e.g. obstructive jaundice) patient will be sent for a pancreas specific CT scan which is fast & accurate. An MRI of abdomen is also equally useful & can be done.
Sometimes both are necessary when the tumor is cystic & nature of tumor (? cancer) is uncertain. A EUS is most useful in doubtful cases and a EUS guided biopsy or aspiration of cyst fluid for analysis will be done whenever possible.
There are not many blood tests to diagnose any form of pancreatic cancer. Levels of a tumor marker CA 19.9 in the blood are measured and if they are significantly high, it raises a strong suspicion of biliary or pancreatic cancer. However it can rise even with noncancerous obstruction of bile duct.
In case of cystic tumor, estimation of levels of CarcinoEmbryonicAntigen or CEA & mucin in the cyst fluid aspirated during an EUS is useful to diagnose mucinous tumors.
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Consult Best Pancreatic Cancer Specialists – Dr.D.R. Kulkarni (HPB Surgeon) from India. Dr. D. R. Kulkarni is a Consultant HPB Surgeon at many renowned hospitals in city of Mumbai for last 10 years. At present he is attached to Lilavati Hospital, S.L.Raheja Hospital & Asian Institute of Oncology.