Diagnostic and X-ray
Diagnostic imaging techniques
Various imaging techniques are used to screen organs in the body.
Ultrasound (US): Ultrasound utilises ultrasonic sound waves and the computer creates an image of the organs examined from the reflected ultrasound waves. This test is good at assessing the gallbladder or bile ducts for stones and can detect initial evidence of a liver or pancreas tumour.
Computer Tomography (CT): For this test, X-rays are used and a computer-generated cross-sectional image of the body is formed. In case of underlying cancer the CT helps to assess how far the cancer has advanced, how many tumours there are, how large the tumours are and whether they can be surgically removed.
Magnetic Resonance Imaging (MRI): MRI uses magnetic rays. This test, similar to CT, can provide very detailed images of liver and pancreas tumours.
PET (Positron Emission Tomography): This technology utilises the fact that most cancer cells are more active than other cells. This causes the cancer to absorb sugar more rapidly than normal cells. A small dose of radioactive sugar is injected into a vein and areas of tumour cells are highlighted on the PET scan. PET can be used in combination with CT scans.
Upper Gastrointestinal endoscopy/Colonoscopy: A specialist (gastroenterologist or surgeon) examines the lining of the oesophagus, stomach and duodenum (Upper GI endoscopy) or large bowel (colonoscopy) using a flexible tube with a camera at its tip. Tissue biopsies can be taken during the procedure via the endoscope. For upper gastrointestinal endoscopy or colonoscopy the patient is under sedation. In case of suspicious liver lesions, this test is often used to screen for the primary cancer location.
Endoscopic Ultrasound (EUS): A specialist (gastroeneterologist) puts a flexible tube through the oesophagus, stomach and the top part of the small intestine. On the tip of the tube is a small ultrasound probe which creates imaging of the intestine and specifically the pancreas. If necessary tissue samples can be taken from lesions in the stomach or pancreas. For this procedure the patient is under sedation.
Endoscopic retrograde cholangiopancreaticography (ERCP): A small flexible tube is advanced into the top end of the small intestine (duodenum) to view the bile ducts, gallbladder and sometimes the pancreatic duct. X-rays are used during the ERCP to help visualising the structures. Minor surgery can be carried out during an ERCP. For this procedure the patient is under sedation.
Laparoscopy (key-hole surgery): Laparoscopy can be used to avoid unnecessary more invasive surgery in selected patients. A camera (laparoscope) is passed via a small incision into the abdomen to view the liver and surrounding organs. Instruments can be inserted to take tissue biopsies. Laparoscopy is done under general anaesthetics.
Biopsy/ cell samples: This is a small sample of tissue or fluid from the tumour site, which is sent to a pathologist to examine under a microscope. In general a biopsy is not performed as a first test in liver lesions as we can usually determine the diagnosis by using several different imaging techniques. In pancreatic or bile duct tumours biopsies are more likely to be used.