It is possible to arrive at the diagnosis of a disease in several ways. Below we explain the different ways that can be combined to reach a diagnosis of pancreatic cancer.
Pancreatic cancer is a direct consequence of a defect in the division of the cells that make up this organ. They divided into two types depending on the function they perform:
- Exocrine function: they produce enzymes that are released into the digestive tract and break down nutrients.
- Endocrine function: they produce various hormones released into the blood, for example, insulin.
This is why pancreatic cancer can be of two types, exocrine or neuroendocrine. The diagnosis of pancreatic cancer differs between these two types, among other things, in the symptoms and signs.
According to the MSD Manual, “The prognosis of pancreatic cancer varies according to the stage but, in general terms, it is poor (5-year survival: < 2%), because many patients have advanced disease at the time of diagnosis.”
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Pancreatic Cancer Diagnosis by Signs and Symptoms
Depending on the lineage of the tumor, it will produce some symptoms or others.
To understand them, a short explanation about the circulation of bilirubin is necessary. Bilirubin is a pigment that breaks down hemoglobin. Under normal conditions, it circulates through the bile ducts (from the liver to the intestine). It thus provides coloration to the stool.
The pancreas is right next to the duodenum, which is where the bile ducts ultimately arrive. The growth of a tumor in this location causes obstruction. Thus, bilirubin stays in the liver, damaging it or passes to the skin or other organs. It is this that produces the symptoms listed below.
- To begin with, jaundice, which is the yellowing of the skin and mucous membranes.
- Acholia also appears, which are white stools, and colors, which is brown urine because the kidneys excrete bilirubin.
- May cause itchy skin.
- The above symptoms generally do not occur in neuroendocrine because they grow less. The growth and invasion of structures also cause stomach and back pain. Nausea and vomiting also experienced. Nonspecific symptoms of cancer are weight loss and poor appetite.
- Depending on which hormone is produced by the cell from which the tumor develops, some symptoms or others experienced.
Imaging Tests for Pancreatic Cancer
The following tests done to diagnose pancreatic cancer:
Computed Tomography (CT or CAT)
This test generally takes cross-sectional images using X-rays. There is a particular type of CT to view the pancreas, which is the pancreatic protocol CT. During the trial, intravenous contrast is introduced that reveals the areas that are most interesting to see.
Magnetic Resonance Imaging (MRI) for Pancreatic Cancer
In this case, images obtained by subjecting the body to radio waves and magnetic fields. There is also a superior MRI, which is MRI cholangiopancreatography, by which bile and pancreatic ducts are observed. With it, we could show a possible obstruction.
It is a technique that makes it possible to observe each structure inside the body by detecting the density of each one. This may be the first test to be done because it is quick and easy and does not involve exposing the person to radiation.
In the case of the pancreas, it may be less useful than previous tests as it offers less definition. However, an endoscopic ultrasound performed, placing the ultrasound at the end of an endoscope (a flexible tube that inserted into the intestine).
Taking the image from this point, very close to the pancreas, can significantly increase the definition of the picture. It is also possible to associate a biopsy with endoscopic ultrasound, accessing the tissue from this adjacent location.
Endoscopic Retrograde Cholangiopancreatography (ERCP)
In the course of this technique, the endoscope introduced into the common bile duct, which runs from the bile and pancreatic ducts to the beginning of the intestine. From here, the bile and pancreatic ducts accessed, and contrast introduced that makes it possible to see them better. Through this test, we can see if a possible pancreatic tumor obstructs any of these ducts.
Somatostatin Receptor Scintigraphy or Octreoscan
In this case, a hormone analog ( octreotide ) attached to a radioactive substance injected. This set adheres to the tumor and highlighted when the image taken, but only in the case of neuroendocrine.
Positron Emission Tomography (PET)
It uses a mechanism analogous to the previous one, but this time glucose bound to a radioactive substance injected. The tumor, having a lot of cellular activity, consumes a lot of glucose, and this reflected in the image. Today, a combined image between PET and CT took, significantly increasing the definition.
Analytical Tests for Pancreatic Cancer
The following analytical tests also commonly performed:
Hepatic function laboratory values may altered. The levels of some tumor markers also found elevated, such as:
- Carcinoembryonic antigen (CEA)
- Ca 19.9
In this case, the levels of certain hormones such as insulin, gastrin, glucagon, somatostatin, pancreatic polypeptide, and vasoactive intestinal peptide (VIP) may altered.
Biopsy for the Diagnosis of Pancreatic Cancer
A sample of the pancreas can also be taken and later analyzed in the medical department of Pathology and thus determine if it is a tumor or not. This can done percutaneously (through the skin), endoscopically, as discussed earlier, or surgically.
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