How doctors detect pancreatic cancer in average-risk adults.
Pancreatic cancer is notoriously difficult to diagnose early, as widespread screening isn’t available and symptoms often remain silent until the cancer has already progressed.
“The classic presentation of a patient with pancreatic cancer is that of jaundice — yellowing of the skin and eyes — without abdominal pain,” said Dr. Marcus C. Tan, a surgical oncologist at Vanderbilt-Ingram Cancer Center. “There may be other symptoms as well, but these are non-specific, such as weight loss, loss of appetite and new-onset diabetes.”
When a provider suspects pancreatic cancer, they typically order a CT scan of the pancreas, which provides highly detailed images to look for abnormalities. Sometimes, pancreatic cancer is discovered incidentally when imaging is performed for other reasons, such as evaluating kidney stones.
Understanding Pancreatic Cancer
Diagnostic process: biopsy and staging
If imaging reveals a suspicious mass in the pancreas, the next step is a biopsy. Performed endoscopically, this procedure involves removing a small sample of tissue from the lesion, which is then examined under a microscope to determine whether or not it’s cancer.
If cancerous, the next step is staging the disease. When staging pancreatic cancer, doctors look for signs of metastasis, or cancer spread, which often requires additional testing. For instance, if imaging shows multiple lesions — such as those in the liver — a biopsy of a metastatic lesion can confirm the spread of the disease.
Confirming metastasis helps determine the cancer’s stage, which is critical for developing a treatment plan.
If imaging and biopsy confirm that the cancer is localized and hasn’t spread, the best treatment is a combination of surgery and chemotherapy. If the cancer in the pancreas does not involve surrounding blood vessels, then surgery may be performed first, followed by chemotherapy. If the cancer does involve surrounding blood vessels, the first treatment will be chemotherapy for four to six months followed by surgery.
“When important blood vessels next to the pancreas are involved, chemotherapy is recommended before surgery,” Tan said. This approach aims to shrink the tumor, improving the chances for a safer and more complete surgical resection.
Can it be detected early?
“If we can find better ways to identify high-risk patients and detect cancer earlier, we’ll be able to intervene sooner and improve outcomes.”
Pancreatic cancers that are detected incidentally, meaning they’re found on imaging performed for a different reason, may be diagnosed at early, more treatable stages. This, however, is the exception rather than the rule.
“The main problem with pancreatic cancer is that it’s generally detected very late,” Tan said. “More than 80% of pancreatic cancer patients present with disease that’s so advanced that cure is unlikely.”
That’s why researchers, including those at Vanderbilt Health, are focused on developing ways to detect pancreatic cancer sooner through screening efforts.
One ongoing study focuses on screening patients at increased risk for pancreatic cancer, such as those with chronic pancreatitis, new-onset diabetes or pancreatic cysts. This research aims to identify cancer earlier, when it is more treatable, and to better determine which patients are at the highest risk and need closer monitoring.
“There’s still a long way to go, but research like this gives us hope,” Tan said. “If we can find better ways to identify high-risk patients and detect cancer earlier, we’ll be able to intervene sooner and improve outcomes.”
Personalized Care for Cancer
The experts at Vanderbilt-Ingram Cancer Center work to provide a precise diagnosis and effective treatment options for pancreatic cancer. The team combines advanced research, technology and techniques with compassionate care to create a personalized treatment plan that is right for each patient.
