Diagnosis of a pancreatic tumour is on imaging, most commonly with a CT or MRI scan. If a cancer is suspected, additionally tumour markers CA 19-9 and CEA may be performed. Although these tumour markers may indicate the presence of a cancer, a normal level does not exclude a cancer, nor is a raised level confirmative of one.
In the case of PNET, the tumour markers that are associated with it are Chromogranin A and Pancreatic polypeptide. Furthermore, when a pancreatic neuroendocrine cancer is suspected, further imaging with a radionuclide scan may be performed to examine if the cancer has spread. Confirmation of the type of tumour may be obtained through a biopsy. This is commonly done via endoscopy with the aid of an ultrasound (endoscopic ultrasound-EUS).
Pancreatic ductal adenocarcinoma
This is the most common cancer of the pancreas. Tumours in the head of pancreas often cause jaundice whilst those in the rest of the pancreas cause abdominal pain as the predominant symptom.
Pancreatic Neuroendocrine Tumour (PNET)
Most PNET are small and nonfunctional. The most common functional tumour is an Insulinoma, which produces insulin in an excessive manner. This can cause fainting and sweating spells due to low blood sugar levels. Surgery is indicated for functional tumours. For non-functional tumours, the indication for surgery is based on the risk of cancer which is related to the size of the tumour, and also on the risk profile of the patient as well as the risks associated with the surgical procedure required.
Cystic tumour of the pancreas
This entity is also known as cystic neoplasm of the pancreas. Cystic tumours in the pancreas can be benign, malignant or potentially malignant. When a cystic tumour in the pancreas is deemed to be benign, surgery is performed when symptoms are present that are attributable to the tumour. Else such tumours can be left alone. When a cystic tumour is deemed malignant, surgery is indicated. When a cystic tumour is deemed to be potentially malignant, the treatment will depend on the magnitude of the risk of turning malignant, the safety profile of the surgery that is required, the fitness of the patient for surgery as well as the age of the patient. Very often, this category of cystic tumour is further assessed with an endoscopic ultrasound (EUS).
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