| History: The individual usually reports a vague pain in the upper region of the abdominal cavity that classically spreads through the back. Other symptoms can include rapid and marked weight loss; a yellow discoloration (jaundice) of the skin, whites of the eyes (sclera), and mucous membranes; persistent back pain that worsens while eating or lying down; weakness and loss of energy (asthenia); signs of low blood sugar (hypoglycemia) such as fatigue, shakiness, chills, headaches, and anxious feelings; loss of appetite (anorexia); difficulty digesting fatty foods; nausea and/or vomiting; constipation; light-colored stool; and dark-colored urine. Physical exam: Examination of the abdomen may reveal abdominal extension due to an enlarged liver, upper abdominal mass, or enlarged gallbladder. Examination of the skin and whites of the eyes (sclera) may reveal jaundice. Lymph nodes may be enlarged. Tests: There is no single specific test for detection of pancreatic cancer and diagnosis is most often determined by multiple tests. Computer-aided x-ray analysis (computed tomography or CT scan) is usually the first step and may be complemented by other tests using low-energy radio waves and strong magnets (MRI) or high-frequency sound waves (endoluminal ultrasonography or ultrasound) to visualize the tumor.
The pancreatic and bile ducts may also be visualized to determine if they are narrowed or obstructed by the tumor. This is done with a fiberoptic device (endoscope) passed through the mouth in ever-narrowing tubing (cannula) into the stomach, through the duodenum, and into the small intestine (endoscopic retrograde cholangiopancreatography or ERCP). This procedure serves two purposes: (1) the pancreatic cells floating in digestive juices can be removed for microscopic inspection and examined for their ability to secrete digestive juices (pancreatic function test), and (2) an opaque dye can be injected through the cannula into the pancreatic duct or bile duct (transhepatic cholangiography) allowing x-rays to show whether or not ducts have narrowed or are blocked. The pancreatic duct may also be visualized by injecting a contrast dye directly into a vein (intravenous cholangiography) and viewed radiographically.
A pancreatic tissue biopsy (percutaneous needle biopsy) may be taken with the aid of an x-ray device to examine deep structures (fluoroscope) and microscopically look for signs of cancer cells. Low levels of the digestive enzyme trypsin in pancreatic juice may indicate cancer of the pancreas. Blood tests for pancreatic cancer include those for carcinoembryonic antigen (CEA), pancreatic oncofetal antigen (POA), and carbohydrate antigen 19-9 (CA 19-9). |
Source: Medical Disability Advisor