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Overview

Despite so much progress made on cancer in recent years, pancreatic remains the toughest cancer to beat. It accounts for about 7.5 percent of all cancer deaths in the U.S., and, of those who have it, about 9 percent survive five years after diagnosis. The disease can be insidious because it has few early symptoms and can therefore be difficult to diagnose.

What is pancreatic cancer?

The pancreas sits behind stomach and in front of the spine and produces digestive juices, including enzymes and hormones, to help the body break down and store food. Though its causes aren’t yet known, pancreatic cancer occurs more often in people who are obese or overweight, smoke and/or drink alcohol in excess.

According to Yale Medicine pathologist Guoping Cai, MD, most cases of pancreatic cancer fall into one of two types:

Non-adenocarcinoma: This is the rarer form with tumors such as pancreatic neuroendocrine tumor accounting for only about 10 percent of all cases. This is often the less aggressive form of the disease.

Adenocarcinoma: It attacks exocrine (enzyme-producing) ductal cells in the pancreas. When pancreatic cancer spreads, typical sites include the liver, peritoneum and lung. “Most pancreatic cancer is ductal adenocarcinoma, the most aggressive form of the disease,” Dr. Cai says. 

How is pancreatic cancer diagnosed?

Early pancreatic cancer has few, if any symptoms, so the disease is often not diagnosed until the later stages, Dr. Cai says. That is one reason the mortality rate is so high. Advanced pancreatic cancer can cause weight loss, digestive symptoms, abdominal pain and jaundice.

If a doctor suspects that a person might have pancreatic cancer, either because of what’s discovered when a patient had other medical tests, or, because of symptoms, a series of medical tests will be performed.

Those may include imaging procedures such as computerized tomography (CT) scan, magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS), along with an endoscopic retrograde cholangiopancreatography (ERCP) and biopsy to obtain tissue samples.

What is pathology’s role in diagnosing pancreatic cancer?

The Yale Medicine Department of Pathology provides rapid onsite evaluation for patients having a biopsy for suspected pancreatic cancer. That means that a pathologist is present to perform immediate analysis of the tissue sample or samples as they are taken.

This has several important advantages. “The purpose of this is to make sure the biopsy itself has enough material for diagnosis and also so we can assess what kind of tumor we are dealing with, which affects how the specimen will be handled," Dr. Cai says. “Yale Medicine is one of the few medical centers in the nation where we take this extra step to make sure that the diagnosis is correct.”

If a malignancy is found, rapid onsite evaluation helps with determining which stage the cancer has reached. “The interventional gastroenterologist can look around and see if the cancer has spread and, if so, we can biopsy those sites, too,” he says. The best scenario is learning that the tumor has not spread. If that’s the case, it can be surgically removed which, Dr. Cai says, presents the best odds for a cure.

What types of lab studies are performed after pancreatic cancer is diagnosed?

In the lab, the sample or samples will be prepared for further analysis. Those studies include immunostaining, molecular test and flow cytometry if a lymphoma is suspected. The latter is a test that counts and sorts different types of cells dependent on the cell size and cell surface antigen expression.

Immunostaining is used to gather information, which is important for further classification of non-adenocarcinoma tumors. Molecular test such as KRAS mutation analysis may help the diagnosis of ductal adenocarcinoma.

What makes Yale Medicine's approach to diagnosing pancreatic cancer unique?

Yale Medicine’s commitment to rapid onsite evaluation for patients with suspected pancreatic cancer is an important differentiator. “This enables us to gather information that has many implications for treatment that is both better and more cost effective,” Dr. Cai says. This approach is not used everywhere. “It can be a lengthy procedure, and it may not seem like that is economically sound. But, we believe it is the best for patient care," he says. "But it is economically more sound than if the patient has to undergo repeat procedures—not to mention the stress and human cost.”