Pancreatic Mass - CA level 3.4

Hi,

My father is 70 years old and diagnosed to have pancreatic mass on the head of the pancreas.
It was not resectable and triple bypass was done.There are some weird results in his case.

1) His biopsy result shows it is not cancerous.(Needle Biopsy was taken)
2) Clinical opinion of the doctor points to pancreatic cancer.
3) CA19.9 level is 3.4 before/after surgey.
4) He had jaundice and after surgey it is under control.
5) There is no pain for the patient till now.

I would like to know if there is any way to confirm it is cancerous or not so that we can proceed with
the next level of treatment.

Thanks
Nambi

[Fernando Roque, MD]

Hi.  The only sure way to confirm if that pancreatic mass is cancerous or not is to do an excision biopsy or a core biopsy and examine the tissue under a microscope.  Fine needle biopsy findings are only conclusive if the results are positive for cancer.  A negative result may mean that the mass is really not cancerous, but it could also mean that an error in sampling occurred.  The needle used to harvest tissue samples is very thin, and sometimes, only the areas with dead cells and necrotic debris are sampled, and not the areas with viable cancer cells.  

With excision biopsy or core biopsy, a larger amount of tumor tissue can be harvested, and sampling errors can be avoided.  The limitation of these two procedures is that open surgery needs to be done to perform the biopsy because the pancreas lies deep within the abdomen and is not readily accessible.  My hope is that when the surgeons did the triple bypass surgery on your father, they also excised a small portion from the mass.  If this was not done, the only way to get more tissue to study is to perform another open surgery.  I don't know if this is still practical.

If the CA 19-9 level was greatly elevated, this could also serve to confirm the presence of pancreatic cancer.  Since it isn't increased, confirmation really has to come by way of a biopsy.