NCCN Guidelines for Patients
Pancreatic Cancer, Version 1.2017
An FNA 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 pancreas.
CT or ultrasound-guided FNA
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 or ultrasound for guidance. This is
called a CT or ultrasound-guided FNA biopsy. The
CT scan takes many pictures of a part of the body
from different angles using x-rays. An ultrasound is
a test that uses sound waves to take pictures of the
inside of the body. Your doctor will use the pictures
from these imaging tests 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.
It is called local because this anesthesia causes a
loss of feeling in a small area of the body.
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 are removed with a small
brush at the end of the endoscope. These samples
are called brushings.
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
or ultrasound-guided FNA biopsy. After an EUS-FNA
biopsy, your throat may be sore and you may feel
bloated. Talk to your doctor about any side effects
The cancer stage is a rating by your doctors of
how far the cancer has grown and spread. Which
treatment is best for you depends on how far the
cancer has spread. There are two ways that may
be used to stage or classify pancreatic cancer.
The AJCC (
system groups pancreatic cancer into five stages
(stage 0 – stage IV). The stages are defined by the
growth of the primary tumor and its spread to other
sites in the body. In the AJCC system, cancer may
be staged twice. Thus, it is based on tests before
surgery and then based on tests of tissue removed
during surgery. Some doctors use this staging
system to plan treatment.
However, most NCCN doctors do not use the AJCC
staging system. Rather, they classify pancreatic
cancer and plan treatment based on the results of
imaging and other tests done before surgery. Imaging
tests provide the key information used to determine
the clinical stage of pancreatic cancer.