There are different ways of taking a sample of cells (biopsy) to check for pancreatic cancer.
Why you need a biopsy
The most sure way of diagnosing pancreatic cancer is by taking a sample of cells (biopsy) and looking at them under a microscope.
Your doctor takes a biopsy by putting a needle into the area of suspected cancer.
Specialists don't usually take biopsies if they think that the cancer could be removable with surgery (resectable). In that case, your diagnosis will be made by the doctor examining you and reviewing your scans and tests. A confirmed diagnosis can be made when the tumour is removed during surgery.
Your specialist might want to do a biopsy if you have a cancer that can't be removed with surgery. Then they can find out exactly what kind of cancer it is and whether you can have treatment to slow down its growth.
Different ways of taking a biopsy
There are several different ways your doctor can take a biopsy. The type your doctor uses will depend on the position of the tumour in the pancreas.
Endoscopic ultrasound is an ultrasound scan done from inside the body. Your doctor may call it endoluminal ultrasound or by the initials EUS.
The doctor puts a flexible tube called an endoscope down your throat. It contains a small ultrasound probe. The ultrasound picture helps the doctor to see any areas that might be cancer. They can then guide a small needle into these areas to take the biopsy.
ERCP stands for endoscopic retrograde cholangio pancreatography. It shows the liver, bile ducts, pancreas and gallbladder. Your doctor passes a tube called an endoscope down your throat to take x-rays of the pancreas and gallbladder. The endoscope has a small camera and light at the end.
The doctor can see if there are any growths or other abnormal looking areas in the pancreas or gallbladder and can take biopsies.
You doctor can use an ultrasound or CT scan to see exactly where the tumour is. You have a local anaesthetic injection in the skin over the pancreas so that the area goes numb. Your doctor then puts a fine needle through the skin and into the tumour. They can take out a small piece of tissue.
You feel pressure when the needle goes in, but it shouldn't be painful because of the local anaesthetic.
This test is called a laparoscopy. Your doctor uses a thin, flexible tube called a laparoscope to look inside the tummy (abdomen). The tube has a light and camera attached.
You are most likely to have this done under a short general anaesthetic. Once you are asleep, your doctor makes several small cuts (incisions) in the skin of your abdomen. They pump gas into the abdomen so they can see the organs in the abdomen more clearly. This gas won't do any harm and gradually disappears after the test.
Your doctor might use an ultrasound through the laparoscope. This helps to show exactly where the tumour is. Your doctor can then take a biopsy.
After this test is over, you have stitches or steristrips holding the wounds closed. The cuts heal within a week or so.
This test is called a laparotomy. Your surgeon makes a cut in the skin of your tummy (abdomen) to take a tissue sample from the pancreas.
Today this is rare, and you are more likely to have a laparoscopy because it is a much smaller operation. You usually have to stay in hospital for a few days after a laparotomy.
Some surgeons send the biopsy to the laboratory while you are still under anaesthetic. If the laboratory confirms that you have pancreatic cancer your surgeon might carry on and remove the cancer.
This is a safe procedure but your nurse will tell you who to contact if you have any problems afterwards. Your doctors will make sure the benefits outweigh the possible risks.
You might have other tests to diagnose the cancer or to find out whether it has spread.