Pancreatic cancer, what kind of tests should I have run

Tests for Pancreatic Cancer: What to Expect

I'm glad you're asking about this—understanding what tests your care team recommends is an important part of your treatment planning. Let me walk you through the main tests used for pancreatic cancer.

Imaging Tests (Pictures of Your Pancreas)

According to NCCN Guidelines, imaging is the most important first step. Your doctors will likely use:

Pancreatic Protocol CT or MRI Scan

• This is the standard imaging test that best shows if there's a tumor and where it's located
• CT scan: Takes detailed cross-sectional pictures using X-rays; takes several minutes
• MRI scan: Uses magnetic fields and radio waves; takes 30-90 minutes but may show small tumors better than CT
• You'll receive contrast (dye) injected into your vein to make images clearer

Additional Imaging (if needed)

• CT of your chest and pelvis to check if cancer has spread
• PET/CT scan (combines imaging with a radioactive tracer) if distant spread wasn't found on the first scan
• MRI of the liver if CT doesn't clearly show spread

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Blood Tests

Liver Function Tests

• Measure proteins, enzymes, and bilirubin (a chemical that makes bile yellow)
• Help show if the pancreas is blocking bile ducts
• Important for treatment planning

CA 19-9 Tumor Marker

• This is a protein that pancreatic cancer cells release into the bloodstream
• Important to know: High CA 19-9 can mean cancer is present, BUT it's not perfect:
  • Some people with pancreatic cancer have normal CA 19-9 levels
  • High levels can also be caused by other conditions (blocked bile ducts, gallstones, pancreatitis)
• Your team will track this over time to see if treatment is working

According to NCCN Guidelines, these blood tests are essential for staging and treatment planning.

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Biopsy (Tissue Sample)

A biopsy is the only way to confirm you have cancer. Your doctor will collect tissue samples for testing. Methods include:

EUS-Guided Biopsy (preferred method)

• An endoscope (thin flexible tube with camera) is guided through your mouth down to your stomach
• An ultrasound probe on the tip creates detailed images of the pancreas
• A needle can collect tissue samples through the scope
• Less invasive than other methods

Imaging-Guided Biopsy

• A needle is guided through your skin using CT or ultrasound
• Often used if cancer has spread to the liver

Note: If surgery will be your first treatment, your doctor may collect the biopsy sample during surgery instead.

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Endoscopic Tests (Looking Inside)

Endoscopic Ultrasound (EUS)

• Combines an endoscope with ultrasound to see the pancreas clearly
• Can help stage the cancer and obtain tissue samples
• Requires fasting and sedation

ERCP (Endoscopic Retrograde Cholangiopancreatography)

• Mainly used to treat blocked bile ducts
• Can also help identify cancer growth
• Allows doctors to place a stent (small tube) to keep ducts open

Laparoscopy

• A surgeon makes small cuts in your abdomen and inserts a camera
• Used if your team suspects cancer has spread but imaging didn't show it
• Requires general anesthesia

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Genetic Testing

According to NCCN Guidelines, all pancreatic cancer patients should have genetic testing. This includes:

Germline Testing (inherited mutations)

• Blood or saliva sample tests for inherited gene mutations
• Checks for mutations in genes like BRCA1, BRCA2, PALB2, and others
• Important because some inherited mutations qualify you for specific treatments
• Helps identify if family members are at risk

Molecular/Tumor Profiling (biomarker testing)

• Tests the cancer cells themselves for specific mutations
• Currently done mainly for advanced and metastatic pancreatic cancer
• Can identify mutations like:
  • KRAS mutations (found in ~87% of pancreatic cancers)
  • BRCA mutations (qualify for PARP inhibitors)
  • Microsatellite instability (may qualify for immunotherapy)
  • NTRK, RET, or HER2 alterations (have targeted treatments available)

According to CancerPatientLab expert Dr. [removed] Strickler, "Every pancreatic cancer patient should ask their doctor: 'Have you done the molecular profiling on my cancer? Can I see the report?'"

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Questions to Ask Your Care Team

Based on NCCN Guidelines, here are important questions:

1. Which tests will I have, and in what order?
2. Do any of these tests have risks I should know about?
3. What do I need to do to prepare for each test?
4. How soon will I get results, and who will explain them to me?
5. Can I get copies of my pathology report and all test results?
6. Have you done genetic testing and molecular profiling on my cancer?
7. Will I have access to an online patient portal with my results?

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Why This Matters

These tests serve three critical purposes:

• Confirm you have pancreatic cancer
• Stage the cancer (how far it has spread)
• Identify specific mutations that may qualify you for targeted treatments

According to NCCN Guidelines, a highly experienced multidisciplinary team at a high-volume cancer center should manage your care and decide which tests and treatments are right for your specific situation.

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This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.