Pancreatic Cancer

Pancreatic Cancer Lab Tests and health information

The pancreatic cancer tests include liver function, CA 19-9, Carcinoembryonic antigen (CEA), and Complete blood count (CBC),  with confidential online results. Ulta Lab Tests provides reliable blood work, results in 1 to 2 days, and secure testing, so order today!

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A large percentage of patients with gastrointestinal tumors (such as pancreatic, liver, gastric, colorectal tumors) and some other malignancies have been shown to have elevated serum CA 19-9 levels. Serum CA 19-9 levels may be useful for monitoring disease activity or predicting relapse following treatment. CA 19-9 should not be used as a screening test.

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Increased serum CEA levels have been detected in persons with primary colorectal cancer and in patients with other malignancies involving the gastrointestinal tract, breast, lung, ovarian, prostatic, liver and pancreatic cancers. Elevated serum CEA levels have also been detected in patients with nonmalignant disease, especially patients who are older or who are smokers. CEA levels are not useful in screening the general population for undetected cancers. However, CEA levels provide important information about patient prognosis, recurrence of tumors after surgical removal, and effectiveness of therapy.

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The major sources of amylase are the pancreas and the salivary glands. The most common cause of elevation of serum amylase is inflammation of the pancreas (pancreatitis). In acute pancreatitis, serum amylase begins to rise within 6-24 hours, remains elevated for a few days and returns to normal in 3-7 days. Other causes of elevated serum amylase are inflammation of salivary glands (mumps), biliary tract disease and bowel obstruction. Elevated serum amylase can also be seen with drugs (e.g., morphine) which constrict the pancreatic duct sphincter preventing excretion of amylase into the intestine.

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Confirmatory evidence for diagnosis of pancreatitis

Comprehensive Metabolic Panel

A Complete Blood Count (CBC) Panel is used as a screening test for various disease states including anemia, leukemia, and inflammatory processes.

A CBC blood test includes the following biomarkers: WBC, RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, Platelet count, Neutrophils, Lymphs, Monocytes, Eos, Basos, Neutrophils (Absolute), Lymphs (Absolute), Monocytes(Absolute), Eos (Absolute), Basos (Absolute), Immature Granulocytes, Immature Grans (Abs)

NOTE: Only measurable biomarkers will be reported.

Reflex Parameters for Manual Slide Review
  Less than  Greater Than 
WBC  1.5 x 10^3  30.0 x 10^3 
Hemoglobin  7.0 g/dL  19.0 g/dL 
Hematocrit  None  75%
Platelet  100 x 10^3  800 x 10^3 
MCV  70 fL  115 fL 
MCH  22 pg  37 pg 
MCHC  29 g/dL  36.5 g/dL 
RBC  None  8.00 x 10^6 
RDW  None  21.5
Relative Neutrophil %  1% or ABNC <500  None 
Relative Lymphocyte %  1% 70%
Relative Monocyte %  None  25%
Eosinophil  None  35%
Basophil  None  3.50%
Platelet  <75 with no flags,
>100 and <130 with platelet clump flag present,
Instrument Flags Variant lymphs, blasts,
immature neutrophils,  nRBC’s, abnormal platelets,
giant platelets, potential interference
The automated differential averages 6000+ cells. If none of the above parameters are met, the results are released without manual review.
CBC Reflex Pathway

Step 1 - The slide review is performed by qualified Laboratory staff and includes:

  • Confirmation of differential percentages
  • WBC and platelet estimates, when needed
  • Full review of RBC morphology
  • Comments for toxic changes, RBC inclusions, abnormal lymphs, and other
  • significant findings
  • If the differential percentages agree with the automated counts and no abnormal cells are seen, the automated differential is reported with appropriate comments

Step 2 - The slide review is performed by qualified Laboratory staff and includes: If any of the following are seen on the slide review, Laboratory staff will perform a manual differential:

  • Immature, abnormal, or toxic cells
  • nRBC’s
  • Disagreement with automated differential
  • Atypical/abnormal RBC morphology
  • Any RBC inclusions

Step 3 If any of the following are seen on the manual differential, a Pathologist will review the slide:

  • WBC<1,500 with abnormal cells noted
  • Blasts/immature cells, hairy cell lymphs, or megakaryocytes
  • New abnormal lymphocytes or monocytes
  • Variant or atypical lymphs >15%
  • Blood parasites
  • RBC morphology with 3+ spherocytes, RBC inclusions, suspect Hgb-C,
  • crystals, Pappenheimer bodies or bizarre morphology
  • nRBC’s

Serum albumin measurements are used in the monitoring and treatment of numerous diseases involving those related to nutrition and pathology particularly in the liver and kidney. Serum albumin is valuable when following response to therapy where improvement in the serum albumin level is the best sign of successful medical treatment. There may be a loss of albumin in the gastrointestinal tract, in the urine secondary to renal damage or direct loss of albumin through the skin. More than 50% of patients with gluten enteropathy have depressed albumin. The only cause of increased albumin is dehydration; there is no naturally occurring hyperalbuminemia

Serum alkaline phosphatase levels are of interest in the diagnosis of hepatobiliary disorders and bone disease associated with increased osteoblastic activity. Moderate elevations of alkaline phosphatase may be seen in several conditions that do not involve the liver or bone. Among these are Hodgkin's disease, congestive heart failure, ulcerative colitis, regional enteritis, and intra-abdominal bacterial infections. Elevations are also observed during the third trimester of pregnancy.

AST is widely distributed throughout the tissues with significant amounts being in the heart and liver. Lesser amounts are found in skeletal muscles, kidneys, pancreas, spleen, lungs, and brain. Injury to these tissues results in the release of the AST enzyme to general circulation. In myocardial infarction, serum AST may begin to rise within 6-8 hours after onset, peak within two days and return to normal by the fourth or fifth day post infarction. An increase in serum AST is also found with hepatitis, liver necrosis, cirrhosis, and liver metastasis.

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Measurement of the levels of bilirubin is used in the diagnosis and treatment of liver, hemolytic, hematologic, and metabolic disorders, including hepatitis and gall bladder obstruction. The assessment of direct bilirubin is helpful in the differentiation of hepatic disorders. The increase in total bilirubin associated with obstructive jaundice is primarily due to the direct (conjugated) fraction. Both direct and indirect bilirubin are increased in the serum with hepatitis.

Measurement of the levels of bilirubin is used in the diagnosis and treatment of liver, hemolytic, hematologic, and metabolic disorders, including hepatitis and gall bladder obstructive disease

Chromogranin A, LC/MS/MS - Chromogranin-A (CgA) is an acidic glycoprotein expressed in the secretory granules of most normal and neoplastic neuroendocrine (NE) cell types, where it is released together with peptide hormones and biogenic amines. Neuroendocrine tumors (NETs) are a form of cancer that differ from other neoplasia in that they synthesize, store, and secrete peptides, e.g., CgA and amines. CgA is secreted from neuroendocrine-derived tumors including foregut, midgut and hindgut gastrointestinal NETs, pheochromocytomas, neuroblastomas, medullary thyroid carcinomas, some pituitary tumors, functioning and non-functioning pancreatic NETs.
Significantly elevated CgA levels have been found in patients with other diseases, such as impaired renal function, untreated benign essential hypertension, gastritis, prostatic carcinoma, and hyperparathyroidism. The best-characterized circulating biomarker that identifies NETs in general is CgA. Monitoring blood CgA levels may effectively provide information that is helpful in delineating tumor burden and rate of tumor growth, predicting tumor response to therapy and providing some indication as to prognosis.


Clinical Significance

A galectin-3 test may be ordered for the identification of individuals with chronic heart failure at elevated risk of disease progression.

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Clinical Significance

The glucagon assay is useful primarily when considering a glucagon-secreting tumor of the pancreas. Glucagonomas cause an unusual but characteristic syndrome consisting of a rash, mild diabetes, weight loss and hypoamninoacidemia. Measurement of plasma glucagon confirms the diagnosis; glucagon levels are very high in the setting of glucagonoma.

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Pancreatic polypeptide tests are used in the assessment of pancreatic tumor burden and to assist in the early diagnosis of pancreatic tumors. The measurement of its concentrations is also used to monitor pancreatic carcinoma therapy and to predict the recurrence of pancreatic tumors

Total protein is useful in evaluating patients for nutritional status, liver disease, protein-losing renal and gastrointestinal diseases, and many other medical conditions. Elevated concentrations may be observed in patients with monoclonal gammopathies, autoimmune hepatitis, infammation, and other medical conditions

The presence of reducing substances is useful in the diagnosis of abnormalities in carbohydrate metabolism, i.e., sucrose and lactase. The unabsorbed sugars in stool are measured as reducing substances.


Clinical Significance 

Matrix metalloproteinases (MMPs) are a family of Zinc-dependent endopeptidases that degrade extracellular matrix proteins. Human MMP-9 Matrix metalloproteinase-9 (Gelatinase-B), with a molecular weight of 82 Kd, is inhibited by TIMP-1 and alpha 2 macroglobulin. MMP-9 is secreted by tumor cells, endothelial cells, fibroblasts and leucocytes.MMP-9 is involved in inflammation, tissue modeling, wound healing and processing of cytokines. Expression of MMP-9 correlates with abnormal collagen deposition that accompanies pancreatic cancer, with the metastasis to lymph nodes by human breast cancer cells and invasion of regional vessels in giant cell tumors of bones. MMP-9 is elevated in saliva in patients with gingivitis and periodontal diseases.


Pancreatic Cancer refers to the development of abnormal cells within the pancreas. As the cancerous or abnormal cells continue to develop, they turn into malignant tumors and damage the pancreas leading to a long list of symptoms. These tumors also cause the pancreas to cease working as it should in a healthy human being before the cancer spreads to other organs and/or tissues.   

Generally described as a flat, narrow-sized gland, the pancreas is about 6 inches in length and resides within the abdominal cavity, situated under the liver and behind the stomach. The pancreas is noted for having three distinct sections (head, body, and tail). For the head section, it is connected into the duodenum or small intestine. 

There are small-sized ducts inside the pancreas designed to push bicarbonate and digestive enzymes into the pancreatic duct. The pancreatic duct itself stretches across the pancreas (head to tail) and straight into the small intestine.  

It’s also important to note that there is a common bile duct that is positioned through the head of the pancreas and is responsible for transporting bile from the gallbladder/liver into the small intestine. The two ducts (bile and pancreatic) end up joining at the entrance of the small intestine (duodenum) as they have access to the same opening. 

The pancreas is made of two types of tissues:

The exocrine pancreas is responsible for producing active enzymes to handle proteins, fats, and carbs within the small intestine. When the enzymes are produced, they are carried forward into the small intestine before being activated as required.  

The endocrine pancreas is responsible for producing and releasing hormones such as glucagon and insulin before pushing them into the blood. By doing this, the body can regulate its blood glucose level at the cellular level and use it as a form of energy.   

With pancreatic cancers, abnormal cell development begins within the exocrine tissues.  Due to this, it becomes challenging to diagnose early-stage pancreatic cancer in patients as the symptoms are limited/absent without visible tumors that would demand an immediate physical examination. Once the symptoms do arise, the patient starts having severe symptoms such as jaundice because cancer has spread throughout the body. 

Cancer is also able to start within the pancreatic cells that are responsible for hormone production (i.e., neuroendocrine cells). When this happens, they produce what are known as neuroendocrine tumors (or islet cell tumors), but this is far rarer than conventional exocrine tumors. 

With islet cell tumors, most of them are known for being benign/non-cancerous, which means they don’t spread throughout the body. However, malignant/cancerous cells are known to grow at a slower pace in comparison to exocrine tumors. 

To diagnose or detect islet cell tumors, it’s possible to do so at an earlier stage as they do appear with a long list of symptoms due to the excessive pancreatic hormone production such as glucagon and insulin. Certain tests can be used to determine whether or not these hormone levels are spiked in the blood. 

The rest of this guide will focus on exocrine tumors (i.e., pancreatic ductal adenocarcinoma) as they are far more common than islet cell tumors. 

Pancreatic cancer is renowned for being the fourth-leading reason for cancer-related death in the US across men and women. Research by the American Cancer Society states that approximately 57,000 Americans are diagnosed with this type of cancer each year, and 46,000 die each year. This particular type of cancer causes more deaths in men than in women.  

Risk Factors 

A common reason for pancreatic cancer is smoking. Studies have shown 25% of pancreatic cancers are caused by smoking cigarettes, cigars, and/or smokeless tobacco products. If a person stops smoking, their risk for pancreatic cancer begins dropping substantially. 

Additional risk factors include: 

  • Chronic Pancreatitis 
  • Excessive Weight 
  • Family History of Pancreatic Cancer/Pancreatitis 
  • History of Diabetes (Especially Type 2 Diabetes) 
  • Genetic Predisposition (i.e., Hereditary Ovarian Cancer Syndrome, Breast Cancer, Familial Atypical Multiple Mole Melanoma Syndrome) 

Signs and Symptoms 

There is a common set of symptoms associated with pancreatic cancer, but most of them are subtle. 

These can include: 

  • Itchy Skin 
  • Nausea 
  • Loss of Appetite 
  • Light-Colored Stools 
  • Dark Urine 
  • Abdominal Pain/Back Pain 
  • Jaundice 
  • Extreme Fatigue 
  • Unexplained Weight Loss 

It’s important to note that these symptoms are also present with other conditions aside from pancreatic cancer. This causes the diagnosis to be missed during the earlier stages of pancreatic cancer. Most of these cases are recognized when a person is vomiting or has chronic pain, irregular blood sugar control, and/or malabsorption. This is when cancer starts to spread onto other organs and/or tissues. 

Lab Testing 

As of right now, there are no specific lab tests to run for early-stage pancreatic cancer. Researchers continue to pour time into finding the right test to detect pancreatic cancer during the early stages of this condition, as that is when it’s most treatable. There have been certain breakthroughs when it comes to experimental tests, but nothing concrete is available in the form of a screening/diagnostic test. 

If you have been diagnosed with pancreatic cancer, additional blood tests are run to help determine the prognosis and appropriate treatment plan.  

These can include: 

CEA (or Carcinoembryonic Antigen) – This is not reserved just for pancreatic cancer, but it can spot elevated levels of the tumor and help with the prognosis 

CA 19-9 (or Cancer Antigen 19-9) – This is a test to find a tumor marker to measure the pancreatic cancer treatment and its effectiveness. It doesn’t assist with the diagnosis process as many non-cancerous conditions also come with elevated CA 19-9 levels. 

There are additional lab tests that can be run at the same time: 

Comprehensive Metabolic Panel (or CMP) – These are multiple tests run to assess the condition of a patient’s kidneys and liver after a jaundice diagnosis. 

Complete Blood Count (or CBC) – This helps assess the blood cells (platelets, red blood cells, white blood cells). 

Amylase/Lipase – This test assists with assessing the blood for a person’s pancreatic enzymes, which can be elevated due to pancreatic cancer but are far more common in non-cancerous pancreatic disease.