The pancreas, located behind the stomach and extending across the front of the spine, produces the endocrine hormones insulin and glucagon to control blood sugar and store energy. This organ also creates pancreatic enzymes, which aid the body in digesting food in the small intestine.

Pancreatic cancer originates from either the endocrine or exocrine cells of the pancreas. Dr. Kim Thi Be Diep, from the Oncology Department at the Oncology Center, Tam Anh General Hospital Ho Chi Minh City, states that approximately 90% of pancreatic cancer cases arise from exocrine cells, primarily from the epithelial cells lining the pancreatic ducts. Most pancreatic cancers are pancreatic ductal adenocarcinomas.

When evaluating patients suspected of having pancreatic cancer, doctors consider their medical history, symptoms, and conduct a general examination. They may also order various diagnostic tests to determine the cause.

Blood tests assess liver function by measuring the concentrations of substances synthesized or metabolized by the liver, such as liver enzymes and bilirubin. Abnormal increases or decreases in these markers can suggest liver damage or bile duct obstruction, for example, due to a tumor compressing the bile duct.

Dr. Diep consults patients on pancreatic cancer diagnostic methods. Illustration photo: Tam Anh General Hospital.

CT scans and MRIs help doctors clearly visualize the structure of the pancreas, bile ducts, and surrounding organs. These imaging techniques are crucial for detecting tumors and assessing their size, invasion, and metastasis.

PET/CT scans use radioactive tracers, typically ^18F-FDG, injected intravenously. This substance accumulates in tissues with high glucose metabolism, helping to identify areas suspicious for cancer cells. Cancer cells often have an increased need for glucose, so they absorb more tracer and appear as regions of increased uptake, or hypermetabolic regions, on PET images.

However, according to Dr. Diep, not all areas of increased uptake indicate cancer, as some benign conditions like inflammation or infection can also cause similar uptake.

Endoscopy involves using a flexible tube, called an endoscope, equipped with a light source and camera at its tip. It is inserted into the body to directly observe internal structures and detect lesions. Some related techniques include:

Endoscopic ultrasound combines endoscopy and ultrasound to provide a detailed assessment of the pancreas and adjacent structures, and it can facilitate fine needle aspiration (FNA) biopsy.

Endoscopic retrograde cholangiopancreatography is primarily used for interventions like placing stents to drain bile in cases of bile duct obstruction. It can also aid in diagnosis in some situations.

Laparoscopy is a minimally invasive surgical method that helps stage the disease, particularly peritoneal metastasis, and can support treatment.

Biopsy involves taking tissue or cell samples for microscopic examination. Based on the observation of cell morphology and immunohistochemistry results, doctors determine the cell type of the sample and confirm the presence of cancer.

However, not all biopsy samples are sufficient to definitively conclude whether the cells are benign or malignant. Sometimes, patients require more than one biopsy using different methods or from various sites, such as metastatic organs or lymph nodes. Based on these biopsy results, medical oncologists advise patients on treatment options.

Biopsy methods include fine needle biopsy guided by endoscopic ultrasound and percutaneous biopsy guided by ultrasound or computed tomography (CT).

gene testing can be performed in pancreatic cancer patients to detect germline mutations inherited from parents. This test typically uses blood or saliva samples. Individuals carrying a mutation can pass this gene to their children, and other family members may also carry the mutation.

Biomarker testing includes gene testing and the analysis of gene products, such as proteins. This test is often performed in patients with advanced or metastatic pancreatic cancer to identify mutations or molecular characteristics relevant for treatment selection. The results guide targeted or immunotherapy, but are not used for definitive cancer diagnosis.

Nguyen Tram