Imaging Tests 
CT scan (computed tomography)

This is a special type of x-ray that creates detailed pictures of the inside of the body. CT scans are useful in finding cancer and in seeing how far it has spread. CT scans can also be used to help guide a biopsy needle into the precise area that might be cancer (see below for more about biopsy). 

CT scans take longer than regular x-rays, but they are getting faster. You need to lie still on a table while they are being done.

PET scan (positron emission tomography)

PET scans use a form of sugar that contains a radioactive atom. Cancer cells absorb large amounts of this sugar. A special camera can show where these cells are. This test is useful to see whether the cancer has spread to the lymph nodes or other places.



PET/CT scan

This new test combines the 2 types of scans to even better pinpoint the tumor. This test may be especially useful for spotting cancer that has spread beyond the pancreas and can’t be removed by surgery. It may be useful for staging the cancer. And it may even be able to spot early cancer. Because the test is so new, it is still being studied.

Ultrasound

This test uses sound waves to produce pictures of the inside of the body. The pictures are combined by a computer to give a detailed image. This test can help tell what kind of a tumor is in the pancreas. Endoscopic ultrasound is done with a probe placed through the mouth or nose into the stomach. The probe can be pointed toward the pancreas. This gives a very good picture and is better than CT scans for spotting small tumors. Patients are sedated for this type of ultrasound.

MRI (magnetic resonance imaging)

This test uses radio waves and strong magnets instead of x-rays to create cross-sectional pictures of the body. MRI scans are helpful in looking at the brain and spinal cord. MRI scans take longer than CT scans—often up to an hour. Also, you have to lie inside a narrow tube, which can be upsetting for some people. The machine makes a thumping noise. Some places will give you headphones with music to block out the noise.

ERCP (endoscopic retrograde cholangiopancreatography)

In this test, a flexible tube is passed down the throat, all the way into the small intestine. The doctor can see through the end of the tube and find where the common bile duct opens into the small intestine. A small amount of harmless dye is then injected through the tube into the ducts. This dye helps outline the ducts on x-rays. The pictures can show narrowed or blocked ducts that might be caused by a cancer of the pancreas. The doctor doing this test can also put a small brush through the tube to get cells to look at under a microscope to see whether they appear to be cancer.

Angiography

This is a type of x-ray for looking at blood vessels. This test can show whether blood flow in an area is blocked or slowed by a tumor. It can also show if there are any abnormal blood vessels. The results help the doctor decide whether the cancer can be removed and to plan the surgery. 

There are several other tests, including blood tests, the doctor might conduct to learn more about a tumor. But the only way to know for sure if cancer is really present is with a biopsy. 

During a biopsy a sample of tissue from the tumor is removed and looked at under a microscope to see if there are cancer cells. There are several types of biopsies that might be done. In the past, a biopsy was often done as part of surgery. Now, however, the FNA (fine needle aspiration) biopsy is the more usual method. For this test, the doctor inserts a thin needle through the skin and into the pancreas to remove small pieces of tissue. Ultrasound might also be used to place the needle through the wall of the intestine into the tumor. This test can be done with the patient awake. It rarely causes side effects. 

Another approach is “keyhole surgery” (laparoscopy). The patient is sedated, and the surgeon inserts a small, thin instrument into the abdomen. It may be connected to a video display. The surgeon can look at the abdomen and see how big the tumor is and whether it has spread. 

Most doctors who treat people with pancreatic cancer try to avoid surgery unless it looks like an operation might be able to remove all the cancer. Even so, there are times when the doctor starts an operation only to find that the cancer has spread too far to be completely removed. In these cases, the doctor just takes a sample of the tumor and the rest of the operation is stopped.