Tests for pancreatic cancer

Blood tests

You are likely to have blood tests to check your general health and see how well your liver and kidneys are working. Some blood tests look for proteins produced by cancer cells. These proteins are known as tumour markers.

Tumour markers

Many people with pancreatic cancer have higher levels of particular tumour markers in their bloodstream. The markers that doctors will look for are CA 19-9 (carbohydrate antigen) and CEA (carcinoembryonic antigen). On their own, however, these tumour markers can’t be used to diagnose pancreatic cancer. This is because some people with pancreatic cancer have normal levels of these markers, and other conditions can also raise the levels of these markers in the bloodstream.

It is normal for the levels of these tumour markers to go up and down a little. Your doctor will look for sharp increases and overall patterns. Raised levels can tell your doctor more about the cancer and, after diagnosis, can also show how well the treatment is working.

Imaging scans

Imaging scans are tests that create pictures of the inside of the body. Different scans can provide different details about the cancer.

You will usually have at least one of the following scans during diagnosis and treatment.

CT scan

Most people suspected of having pancreatic cancer will have a CT (computerised tomography) scan. This scan uses x-ray beams to take many pictures of the inside of your body and then compiles them into one detailed, cross-sectional picture.

A CT scan is usually done at a hospital or a radiology clinic. Before the scan, a liquid dye (called contrast) will be injected into a vein to help make the pictures clearer. The dye travels through your bloodstream to the pancreas and nearby organs and helps show up any abnormal areas. This may cause you to feel hot all over, may give you a strange taste in your mouth and you could feel as if you need to pass urine (pee). These reactions are temporary and usually go away in a few minutes, but tell your treatment team if you feel unwell.

The CT scanner is large and round like a doughnut. You will need to lie still on an examination table while the scanner moves around you. The scan itself is painless and takes only a few minutes, but getting it set up can take 10–30 minutes.

Endoscopic tests

Endoscopic tests can show blockages or inflammation in the common bile duct, stomach and duodenum. For these tests, you will have an endoscopy, a procedure that is usually done as day surgery by a specialist doctor called a gastroenterologist. The doctor passes a long, flexible tube with a light and small camera on the end (endoscope) down your throat into your digestive tract.

There are 2 main types of endoscopic tests:

Endoscopic ultrasound (EUS) – An EUS uses an endoscope with an ultrasound probe (transducer) attached. The endoscope is passed through your mouth into the small bowel. The transducer makes soundwaves that create detailed pictures of the pancreas and ducts. This helps to locate small tumours and shows if the cancer has spread into nearby tissue. A biopsy of the cancer can be taken at the same time.

Endoscopic retrograde cholangiopancreatography (ERCP) – An ERCP is used to take an x-ray of the common bile duct and pancreatic duct. The doctor uses the endoscope to guide a tube into the bile duct and insert a small amount of dye. The x-ray images show blockages or narrowing that might be caused by cancer. ERCP may also be used to put a thin plastic or metal tube (stent) into the bile duct to keep it open.

During an endoscopic procedure, the doctor can also take a tissue or fluid sample (biopsy) to help with the diagnosis.

You will be asked not to eat or drink (fast) for 6 hours before an endoscopic test. The doctor will give you medicine to help you relax and feel as comfortable as possible. Because of this medicine, you shouldn’t drive or operate machinery until the next day.

Having an endoscopic test has some risks, including infection, bleeding and inflammation of the pancreas (pancreatitis). These complications are not common. Your doctor will explain the risks before asking you to agree (consent) to the procedure.

MRI and MRCP scans

In some cases, you may also have another type of scan such as an MRI or MRCP scan. An MRI (magnetic resonance imaging) scan uses a powerful magnet and radio waves to create detailed cross-sectional pictures of the pancreas and nearby organs. An MRCP (magnetic resonance cholangiopancreatography) scan is a different type of MRI scan that produces more detailed images and can be used to check the common bile duct for a blockage (obstruction).

An MRI or MRCP takes about an hour and you will be able to go home when it is over. Before the scan, you may be asked not to eat or drink (fast) for a few hours. You may also be given an injection of dye (contrast) to highlight the organs in your body.

During the scan, you will lie on a treatment table that slides into a large metal tube that is open at both ends. The noisy, narrow machine makes some people feel anxious or claustrophobic. If you think you might be distressed, mention this beforehand to your doctor or nurse. You may be given medicine to help you relax, and you will usually be offered headphones or earplugs. Also let the doctor or nurse know if you have a pacemaker or any other metallic object in your body, as this can interfere with the scan.

MRIs for pancreatic cancer are not always covered by Medicare. If this test is recommended, check with your treatment team what you may have to pay.

PET–CT scan

Doctors sometimes use a PET (positron emission tomography) scan combined with a CT scan to help work out if the pancreatic cancer has spread or how it is responding to treatment.

It may take several hours to prepare for and complete a PET–CT scan. Before the scan you will be injected with a small amount of radioactive material, usually a glucose solution called fluorodeoxyglucose (FDG). Some cancer cells will show up brighter on the scan because they take up more of this solution than normal cells do.

PET–CT scans are specialised tests. They are not available in every hospital and may not be covered by Medicare, so talk to your medical team for more information.

Tissue sampling

If imaging scans show there is a tumour in the pancreas, your doctor may remove a sample of cells or tissue from the tumour (biopsy).

This is the main way to confirm if the tumour is cancer and to work out exactly what type of cancer it is. A specialist doctor called a pathologist will examine the sample under a microscope to check for signs of cancer. Sometimes, the results are not clear and a second biopsy is needed.

A biopsy can be taken in different ways, including:

With a needle – A sample of cells may be collected with a fine needle (fine needle biopsy), or a tissue sample may be collected with a larger needle (core biopsy). A fine needle or core biopsy can be done during an endoscopic procedure. Another method is to insert the needle through the skin of the abdomen, using an ultrasound or CT scan for guidance. You will be awake during the procedure, but you will be given a local anaesthetic so you do not feel any pain.

During keyhole surgery – Also called a laparoscopy or minimally invasive surgery, keyhole surgery is sometimes used to look inside the abdomen to see if the cancer has spread to other parts of the body. It can also be done to take tissue samples before any further surgery.

Keyhole surgery is done under general anaesthetic, so you will be asked not to eat or drink (fast) for 6 hours beforehand. If you take blood-thinning medicines or have diabetes, let your doctor or nurse know before the surgery as they may need to adjust your medicines in the days leading up to the procedure.

The procedure uses an instrument called a laparoscope (a long tube with a light and camera on the end). The camera projects images onto a screen so the doctor can see inside your body. The doctor will guide the laparoscope through a small cut near your bellybutton. The doctor can then insert other instruments through other small cuts to take the biopsy.

You will have stitches where the cuts were made. You may feel sore while you heal, so you will be given pain medicine during and after the operation, and to take at home. There is a small risk of infection or damage to an organ with a laparoscopy. Your doctor will explain the risks before asking you to agree to the procedure.

During surgery to remove the tumour – If you are having a larger operation to remove the tumour, your surgeon may take the tissue sample at that time.

I went to the doctor because I was itchy and had constant diarrhoea. My GP initially thought it was gallstones and sent me for routine tests. After the CT scan I went into hospital for a laparoscopy and then had a biopsy, which confirmed I had cancer.

Jan

Genomic and genetic testing

Each cell in the human body has about 20,000 genes, which tell the cell what to do and when to grow and divide. Cancer starts because of changes to the genes (known as mutations).

Some people are born with a gene change that increases their risk of cancer (an inherited faulty gene), but most gene changes that cause cancer build up during a person’s lifetime (acquired gene changes).

In some circumstances, your doctors may recommend extra tests to look for acquired gene changes (genomic or molecular tests) or inherited gene changes (genetic tests).

Genomic testing

If you have pancreatic cancer, you may be offered extra tests on the biopsy sample known as genomic or molecular testing. This looks for gene changes and other features in the cancer cells that may help your doctors decide which treatments to recommend.

At the time of publication (March 2026), Medicare does not cover genomic testing for pancreatic cancer. These tests can be expensive, so check what costs are involved and how helpful it would be. If you are having genomic or molecular testing as part of a research project, the costs may be covered.

Genetic testing

Your doctor may suspect you have developed pancreatic cancer because you have inherited a faulty gene (e.g. because other members of your family have also had pancreatic cancer). In this case, they may refer you to a family cancer clinic for genetic counselling and extra tests.

These tests are known as genetic or germline tests. The results may help your doctor work out what treatment to recommend and can also provide important information for your blood relatives.

Genetic counselling can help you understand what tests are available to you and what the results mean for you and your family.

Medicare may cover the costs of genetic tests or you may need to pay for them – check this with your treatment team.