NCCN Guidelines for Patients
Pancreatic Cancer, Version 1.2014
Tests for pancreatic cancer
Imaging tests may fail to show pancreatic cancer.
Thus, your doctor may want you to have a biopsy.
A biopsy is the removal of a small sample of tissue
from the body for testing. The biopsy sample will be
sent to a lab so a pathologist can examine it with
a microscope for cancer cells. A pathologist is a
doctor who’s an expert in testing cells and tissues
for disease. Lab tests often find cancer cells if any
are present in the tissue sample. If no cancer cells
are found, a biopsy sample may be taken from a
different spot of the pancreas if your doctors still think
there’s cancer. There is more than one type of biopsy
that may be used. The types of biopsies used for
pancreatic cancer are described next.
An FNA (
spiration) biopsy is the type of
biopsy used most often to confirm pancreatic cancer.
This type of biopsy uses a very thin needle to remove
the tissue sample. There are two main ways to
perform an FNA biopsy.
An FNA biopsy can be done during EUS with a thin
needle attached to the end of the endoscope. This is
called an EUS-guided FNA biopsy or EUS-FNA. For
this type of biopsy, the endoscope is passed through
the mouth and throat down into your stomach.
An ultrasound probe at the end of the endoscope
bounces sound waves off organs and tissues to make
a picture of the inside of your body. Your doctor uses
these pictures to guide the endoscope and needle
to the right spot. Then the needle is inserted through
your stomach or duodenum and into the tumor in your
A second way to perform an FNA biopsy is to insert a
thin needle through the skin and into the tumor using
a CT scan for guidance. This is called a CT-guided
FNA biopsy. The CT scan takes many pictures of a
part of the body from different angles using x-rays.
Your doctor will use the pictures from the CT scan to
find the tumor in your pancreas and guide the needle
to the right spot. For this type of biopsy you will be
given local anesthesia—a loss of feeling in a small
area of the body caused by drugs.
Besides FNA, a biopsy of the tumor may also be done
during surgery or laparoscopy. During ERCP, samples
may be removed from the pancreatic duct. In this
case, the samples—called brushings—are removed
with a small brush at the end of the endoscope.
A biopsy is often done in less than 1 hour. It is
generally a safe test. Before a biopsy, you may be
asked to stop eating, stop taking some medicines, or
stop smoking. You may have some pain after a CT-
guided FNA biopsy. After an EUS-FNA biopsy, your
throat may be sore and you may feel bloated.