MOLECULAR EXAMINATIONS
Pancreatic Cancer
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Pancreatic Cancer Types
There are several types of pancreatic cancer, depending on whether cancer started in the exocrine or endocrine part of the organ. Rarely, other types of pancreatic cancer, such as lymphoma and sarcoma, can occur.
Exocrine pancreatic tumors.
These are the most common types of pancreatic cancer. Αdenocarcinoma is the most common type of pancreatic exocrine tumor. This tumor usually firstly occurs in the pancreatic ducts, which is why it is called adenocarcinoma of the pancreatic ducts. Much less often, if the tumor starts in the alveoli, it is called alveolar adenocarcinoma.
Intraductal Papillary Mucinous Neoplasia (IPMN).
IPMN is a tumor that grows inside the pancreas and produces a viscous fluid called mucus. IPMN is not cancer when it first appears but can become cancer if not treated. Sometimes, an IPMN has already worsened and become cancerous at the time it’s diagnosed.
Rarer types of exocrine pancreatic tumors include alveolar cell carcinoma, adenosquamous carcinoma, colloid carcinoma, giant cell tumor, hepatoid carcinoma, mucinous cystic neoplasm, pancreatoblastoma, serous cystadenoma, signet ring cell carcinoma, solid pseudopapillary tumor, squamous cell carcinoma, undifferentiated carcinoma.
Endocrine tumors.
They are also called primitive neuroectodermal tumors (PNETs) or islet cell tumors. They are much less common than exocrine tumors and account for about 7% of pancreatic cancers. A pancreatic neuroendocrine tumor may or may not be working. A tumor that works produces hormones. A non-functional tumor does not produce hormones. A functional neuroendocrine tumor is named after the hormone that its cells usually produce, such as:
- Insulinoma
- Glucagonoma
- Gastrinoma
- Body statinoma
- VIPomaPPoma
If you need clarification on the outcome of your histological examination, please contact us.
For most types of cancer, a biopsy is the only surefire way for a doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue and sends it for histological examination to the pathology laboratory. If the biopsy is not possible, your doctor may suggest other tests to help with the diagnosis.
This list describes options for diagnosing this type of cancer. Not all of the tests listed below are used for every person. Your doctor will look at these factors while choosing a diagnostic test:
The type of cancer suspected
Your symptoms
Your age, general health, and family history
The results of previous medical examinations
the diagnosis must be confirmed by a tissue sample from the tumor obtained during a biopsy, fine-needle aspiration biopsy (FNAB), or surgery.
Biopsy..
A biopsy is the removal of a small amount of tissue for histological examination in the microscope. Other tests may indicate that there is cancer, but only a biopsy can make a clear diagnosis of colorectal cancer. The pathologist is a physician who specializes in interpreting laboratory tests and evaluating cells, tissues and organs for the diagnosis of diseases (histological examination). There are different ways of collecting a specimen of tissue:
Fine needle aspiration biopsy (FNAB). According to the FNAB, the gastroenterologist uses a fine needle inserted into the pancreas to absorb the damaged cells. This is usually done under ultrasound guidance (EUS) or transdermally, under axial scan (CT) scanning.
Biopsy with a needle or Tru-Cut to collect a larger piece of tissue. A larger piece of tissue may be useful, in addition to histological examination, for the molecular or genetic examination of the tumor. Needle biopsy is performed by a gastroenterologist.
If cancer has spread to other organs, a biopsy may also be needed from one of these other areas, such as the liver. Again, this can be done through the skin, as explained above, or less often, with surgery. This type of surgery can be done through a larger incision in the abdomen, called a laparotomy. Or it can be done by using much smaller incisions that provide openings for a tiny camera and surgical instruments, called a laparoscopic approach.
Molecular examination of the tumor..
Your doctor may recommend additional molecular testing in the tumor specimen to look for possible mutations in specific genes and proteins.
For pancreatic cancer, a test for microsatellite instability (MSI-high), and/or a test for genetic mutation called NTRK monitoring, can be done .
These tests can help doctors determine treatment options.
Additional diagnostic examinations:
- Physical examination
- Blood tests (cancer index CA19-9)
- CT scan (CT scan)
- PET scan
- Ultrasound
- Endoscopic Retrograde Cholangiopancreatography (ERCP)
- Percutaneous Transhepatic Cholangiography (PTC)
The following factors may increase a person’s risk of developing pancreatic cancer:
Age.
The risk of developing pancreatic cancer increases with age. Most people who develop pancreatic cancer are older than 45 years old. In fact, 90% are over 55 years old and 70% are over 65 years old. However, adults of any age can be diagnosed with pancreatic cancer.
Sex.
More men are diagnosed with pancreatic cancer than women.
Race/ethnicity.
People of color are more likely than Asians, Hispanics, or whites to develop pancreatic cancer. Ashkenazi Jewish people are also more likely to develop pancreatic cancer (see Family History, below).
Smoking.
People who smoke are 2 to 3 times more likely to develop pancreatic cancer than non-smokers.
Obesity and diet.
Regular consumption of high-fat foods is a risk factor for pancreatic cancer. Research has shown that obese and even overweight men and women are at higher risk of being diagnosed and dying from pancreatic cancer. Chronic, heavy alcohol consumption can also increase the risk of pancreatic cancer, most likely causing relapsing pancreatitis.
Diabetes.
Many studies have shown that diabetes, especially when a person has been suffering for many years, increases the risk of developing pancreatic cancer. In addition, the sudden onset of diabetes later in life may be an early symptom of pancreatic cancer. However, it is important to remember that this does not mean that all people who have diabetes or develop diabetes as adults develop pancreatic cancer.
Family history.
Pancreatic cancer is associated with genetic conditions that increase the risk of pancreatic cancer and other cancers. This is called familial pancreatic cancer. You and your family may be at risk if 2 or more first-degree relatives or at least 3 family members have been diagnosed with pancreatic cancer. First-degree relatives include parents, children, and siblings. ASCO encourages individuals diagnosed with pancreatic adenocarcinoma to talk with their doctor about their family history of cancer. Even without a strong family history, people diagnosed with pancreatic adenocarcinoma may want to be tested for hereditary pancreatic cancer or other cancers (see Heredit Array, a genetic predisposition examination for cancer).
Rare hereditary conditions.
Family members with certain unusual inherited conditions also have a significantly increased risk of developing pancreatic cancer, as well as other cancers. The main ones include:
Hereditary pancreatitis, which is a condition associated with relapsed pancreatitis and an increased risk of developing pancreatic cancer.
Peutz-Jeghers Syndrome (PJS)
Familial Malignant Melanoma and Pancreatic Cancer (FAMM-PC)
Heridarity Breast and Ovarian Cancer (HBOC)
Lynch’s syndrome
People with the following inherited conditions may also be at higher risk for pancreatic cancer:
Li-Fraumeni’s Syndrome (LFS)
Familial Adenomatous Polyposis (FAP)
Chronic pancreatitis.
Pancreatitis is inflammation of the pancreas, a painful pancreatic disease. Some research suggests that chronic pancreatitis may increase the risk of developing pancreatic cancer.
Chemical substances.
Exposure to certain chemicals such as pesticides, benzene, certain dyes, and petrochemicals may increase the risk of developing pancreatic cancer.
Bacteria.
A common bacterium called Helicobacter pylori causes inflammation and ulcers in the stomach. H. pylori infection increases the risk of stomach cancer and pancreatic cancer. However, the risk of developing pancreatic cancer is not as high as the risk of stomach cancer.
Hepatitis B.
Hepatitis viruses infect the liver. One study found that hepatitis B infection was twice as common in people with pancreatic cancer as in people without cancer.
Cirrhosis.
Cirrhosis develops when liver cells are damaged and replaced by scar tissue. Most types of cirrhosis are due to alcohol abuse. Other causes are viral hepatitis, hemochromatosis, and some other rare forms of chronic liver disease.
People with pancreatic cancer may experience the following symptoms. Sometimes people with pancreatic cancer do not have any of these ailments. Or, the cause of a symptom may be a different medical condition than cancer.
Doctors often say that pancreatic cancer is a “silent disease” because there are no early symptoms. Also, there are currently no specific tests that can reliably detect pancreatic cancer in people who do not have symptoms. When people have symptoms, they are often similar to symptoms of other medical conditions, such as ulcers or pancreatitis (see Risk Factors).
As cancer grows, symptoms may include:
Yellow skin and eyes, dark urine, itching, which are signs of jaundice caused by blockage of bile ducts
Pain in the upper abdomen or upper back
Painful swelling of the arm or leg due to a blood clot
The feel of burning in the stomach or other gastrointestinal upsets
The feel of “bloating” in the stomach
Floating stools with a particularly bad smell and unusual color due to the body’s inability to digest fats well
Weakness
Loss of appetite
Nausea and vomiting
Chills
Fever
Unexplained weight loss
If you are concerned about any changes you may experience, contact your doctor. Your doctor will ask how long and how often have you been experiencing the symptoms, among other questions.
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Frequently Asked Questions (FAQ)
If you have been diagnosed with pancreatic cancer (diagnosis based on histological or cytological examination), it is possible that the indications for determining the molecular profile of the cancer are met. This molecular examination aims to detect whether the tumor has mutations in genes (BRCA1, BRCA2) or a disorder in expressing to proteins (MMR/MSI, HER2, PD-L1) which are closely related to the development of cancer.
Based on the molecular profile determination, the Oncologist is given the opportunity to choose the optimal chemotherapeutic regimen, or immunotherapy, depending on the stage of the tumor
The test is performed on the biopsy material or surgical specimen (paraffin block) on which your histological examination was performed as well.
In case your sample is not already in the MicroDiagnostics’ Ltd archive, contact us to undertake its safe and fast transfer to our laboratory.
You will also need to complete the Consent Form easily and quickly
How can I get my sample to the lab?
By cash, bank card, or online interbank transaction
One of the primary concerns of microDiagnostics’ Ltd is the protection of your personal data as well as the strict adherence to the conditions protecting your genetic material and medical results.
In full compliance with the General Data Protection Regulation (GDPR) we ensure that you are aware and conscious for any examination will be conducted and we do not announce results via phone calls.