Pancreatic Biopsy

The only certain way to diagnose a cancer is by getting a cell sample (biopsy) and looking at the cells under a microscope. The easiest way to do this is by putting a needle into the area of suspected cancer, and sucking out some cells. But specialists don’t usually take biopsies this way if they think the cancer is removable with surgery. There is too much of a risk that the biopsy could spread pancreatic cancer.

If it is likely that your cancer can be removed, then your diagnosis will be made entirely by the doctor examining you and considering the results of your scans and tests. A confirmed diagnosis can be made when you have your surgery. If you have a cancer that is not removable with surgery, your specialist may want to biopsy it.

How to take a biopsy

There are several different ways your doctor can take a biopsy. Which one your doctor uses will depend on where the tumour is in the pancreas. You may have a biopsy guided by ultrasound or CT scan to see exactly where the tumour is. You may also have a biopsy during an ERCP, a laparoscopy or a laparotomy.

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Why you need a biopsy

The only absolutely certain way to diagnose a cancer is by getting a cell sample (biopsy) and looking at the cells under a microscope.

The easiest way to do this is by putting a needle into the area of suspected cancer, and sucking out some cells. This can be a problem with cancer of the pancreas. Specialist surgeons do not usually take biopsies by putting a needle in if they think the cancer is removable with surgery (resectable). There is too much of a risk that taking the biopsy could spread pancreatic cancer. If it is likely that your cancer can be removed, then your diagnosis will be made entirely by the doctor examining you and considering the results of your scans and tests. A confirmed diagnosis can be made when you have your surgery.

If you have a cancer that is not removable with surgery, your specialist may want to biopsy it so that you can go on to have cancer treatment to try to slow down its growth. If all your other test results point to cancer and your consultant thinks there is no doubt that this is what you have, you may not need a biopsy before you have treatment.

Different ways of taking a biopsy

There are several different ways your doctor can take a biopsy. Which is used will depend on where in the pancreas the tumour is. You may have a biopsy

• Biopsy with endoluminal ultrasound (EUS)
• Biopsy during an ERCP
• Ultrasound or CT guided biopsy
• During a laparoscopy
• During a laparotomy

Biopsy with endoluminal ultrasound (EUS)

If you have an EUS a thin ultrasound tube is put down the endoscope. The ultrasound picture helps the doctor to see where the cancer is and to take a biopsy more accurately.

Biopsy during an ERCP

If your doctor can see the cancer during an ERCP, you'll have a sample of tissue taken then. Your doctor may take samples of pancreatic juice during the ERCP. These will go to the lab because they may contain cancerous cells.

Ultrasound or CT guided biopsy

Your cancer may form a mass that can be reached with a needle through the skin of your abdomen. If so, your doctor will take a biopsy this way. You have a local anaesthetic injection so that the area goes numb. Then using ultrasound or CT to see exactly where the tumour is, your doctor will put a fine needle through the skin and into the tumour. Then a small piece of tissue can be taken out with the needle. This should not be painful because of the local anaesthetic. But you will feel pressure when the needle goes in.

During a laparoscopy

A laparoscope is a bit like a flexible telescope. It is a tube with a light and camera attached. Your doctor can use it to look directly inside the abdomen.

You are most likely to have this all done under a short general anaesthetic. Once you are under, you have several small cuts (incisions) in the skin of your abdomen. Sometimes gas is pumped into the abdomen to make it swell and give more room for your doctor to look around. This gas will not do any harm and will gradually disperse and disappear after the test. Your doctor may use an ultrasound through the laparoscope. This will help to show exactly where the cancer is, so that your doctor can take a biopsy more accurately. After this test is over, you will have stitches or steristrips holding the incisions closed. They will heal within a week or so.

During a laparotomy

If your disease cannot be diagnosed any other way, you will have an operation called a laparotomy. This is an operation to open the abdomen and take a tissue sample from the pancreas. This is not often done these days. Laparoscopy is usually done instead because it is a much smaller operation. You have to come into hospital for a laparotomy and stay in for a few days afterwards. Some surgeons will send the biopsy to the laboratory while you are still under anaesthetic. If they get a positive diagnosis, they may continue to do the surgery you need for your cancer.

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