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Tumors of the pancreas are extremely difficult to diagnose, because the organ sits deep in the abdomen. Several diagnostic tests may be performed to determine if there is a tumor in the pancreas. Although various imaging techniques may reveal a mass in the pancreas, the most accurate way to diagnose pancreatic cancer is by studying a tissue sample under the microscope. Understanding the stage (the severity) of the tumor is essential in choosing the right treatment.
Tests to diagnose and screen for pancreatic cancer include three-dimensional imaging of the pancreas:
CT Scan (Computerized Tomography)
This is an imaging test that combines special X-ray equipment with sophisticated computers to produce multiple images of the inside of the abdomen. It is very useful in detecting any spread of the cancer to the liver or nearby lymph nodes. A CT scan is often performed to monitor patients after treatment to determine whether the cancer has recurred, is changing in size, or, has metastasized. Johns Hopkins employs state-of-the-art CT scanners with 3D image processing.
Magnetic Resonance Imaging (MRI)
Magnetic resonance imaging (MRI) uses radiofrequency waves and a strong magnetic field rather than x-rays to provide remarkably clear and detailed pictures of internal organs and tissues. The technique has proven very valuable for the diagnosis of a broad range of conditions, including cancer. Johns Hopkins uses state-of-the-art 3T MR scanners for optimal imaging.
Endoscopic Ultrasound (EUS) and Fine Needle Biopsy
This is a technique in which a doctor passes a thin, lighted tube called an endoscope from the patient's mouth through the stomach, and into the first part of the small intestine. At the tip of the endoscope is a device that uses ultrasound, sound waves that produce patterns of echoes as they bounce off internal organs. These ultrasonic patterns can help identify small cancers that cannot be detected by a CT scan. Using X-ray or ultrasound techniques to help guide the needle, a doctor inserts a very thin needle into the pancreas to remove cells to be studied under the microscope.
Endoscopic Retrograde Cholangiopancreatography (ERCP)
This is a technique in which a doctor passes a thin, lighted tube called an endoscope from the patient's mouth through the stomach and into the first part of the small intestine. A smaller catheter tube is then inserted through the endoscope into the bile ducts and pancreatic ducts. Dye is injected through the catheter into the ducts, allowing X-rays to capture pictures showing whether the ducts are narrowed or blocked by a tumor.
Percutaneous Transhepatic Cholangiography (PTC)
This is a technique used to take pictures of the bile ducts that drain the liver. Dye is injected through a thin needle inserted through the skin into the liver, allowing X-ray images to be taken. Unless there is a blockage, the dye should move freely through the bile ducts. From the pictures, the doctor can tell whether there is a blockage from a tumor or other condition.
This is a blood test that is useful in assisting with initial diagnosis. The higher the CA19-9 level, the larger the tumor and the less chance that the tumor can easily be cut back. In evaluating treatments, a decreasing or stable CA19-9 level generally indicates an improved chance of survival, while an increasing level indicates the progression of disease.