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Diagnosis

As a visitor to this site you may be referred to the outpatient clinic for gastroenterological and hepatic tumours of the UMC Utrecht, or in Dutch “Poli for MDL tumoren”. This clinic is part of the UMC Utrecht Cancer Centre. This clinic is a collaboration of the Departments of Gastroenterology and Hepatology and Surgery. The name “Gastroenterology and Hepatology” can be confusing since diseases of the esophagus, bile ducts and pancreas are also included. You may be referred because the diagnosis of pancreatic cancer is established in your referring hospital. Or the diagnosis has not yet been established. But you may have signs that may indicate pancreatic cancer. Further examination should be carried out.

The outpatient clinic for gastroenterological and hepatic tumours of the UMC Utrecht Cancer Centre is a clinic that specializes in diagnosing cancer. The outpatient clinic for gastroenterological and hepatic tumours will be held on Wednesday. You can make an appointment by telephone, the number of the clinic is 088-75 562 76.

In the clinic all the necessary examinations will be performed as soon as possible. This will show whether you have cancer. And if so: what kind of tumour is it exactly, the exact localisation, how far the tumour has grown, and whether it has spread.

These are the items you need to take with you to the outpatient clinic

• Your appointment confirmation or referral
• Your health insurance card
• An identity document (passport, ID card)
• If you recently underwent examination of the pancreas, please take the results with you. Or ask your doctor to directly send these to UMC Utrecht Poli for MDL tumoren, PO Box 85500, 3500 GA Utrecht.
• If your appointment is a second opinion, please take all the relevant information from your medical record.
• If you are on medication, please note the name, dose and indication for the medication. You can also ask this at your pharmacy. It’s free.
• And above all, consider whether you can and want to take someone with you to your appointment. For most people, this works well. It’s nice to have someone nearby during the examinations. Moreover, you can both hear the information and ask questions.

Please note that the UMC Utrecht is a large building on large grounds. If you arrive by car, parking and walking to the clinic takes about 10 minutes. On the day of the appointment we ask you to arrive 10 minutes before your appointment at the outpatient clinic from the department of surgery. This is located on the same floor as the entrance to the hospital. You can register at reception 23b, at the counter of the Cancer Centre.

Examinations
A number of examinations can reveal whether you have pancreatic cancer. Often a combination of these studies is performed. They serve not only to find out whether you have cancer. But also to determine how far the cancer has developed and whether it has spread. The following tests may be done as standard examinations:

• General physical examination of the abdomen
• Blood tests
• Imaging studies such as:
o Echo
o CT-scan

Standard investigations
The following studies can determine whether you have pancreatic cancer. If so, further research is usually done.

Blood tests

Blood tests may reveal the function of several abdominal organs. In addition, so-called “tumour markers” can be assessed. These are special substances that are produced by the tumour. Thus can be established whether there is cancer, and any metastases. By repeating the blood tests from time to time, the physician can determine how quickly the cancer grows.

Imaging techniques can be used to visualise the pancreas. These images can assess whether there is a tumour in the pancreas. Sometimes it can remain unclear whether the tumour is benign or malignant (cancer). In that case, further investigations are necessary. There are several imaging techniques to visualise pancreas and other organs. If cancer has been established, it is always investigated whether there are metastases in the body at other locations.

Ultrasound

Ultrasound is a test using sound waves. These waves are not audible, but the reverberation (echo) makes organs and / or tissues visible on a screen. The tumour and / or any metastases can be visualised. During the examination you lie on an examination table. A gel is applied on your skin, and a small device that emits sound waves is moved over your abdomen. The images on the screen can be captured in pictures. Ultrasound is a simple, non-burdensome examination. However, it is sometimes necessary that you do not eat or drink a few hours before the examination.

CT scan

A CT scan is made with X-rays. It provides a series of very precise pictures. The device has a circular opening through which a movable table is guided. While the table moves, the device makes a series of photographs showing ‘slices’ of the organ or tissue. This ‘slices’ give an impression of the location, size and extent of the tumour and / or any metastases. Often contrast enhancement is required. Usually this liquid is injected into a vein of your arm during the examination. In addition, it is usually required that you drink a contrast medium. This improves the visualisation of the pancreas.

Additional examinations

If there is pancreatic cancer, additional examinations are performed to determine exactly how far the tumour has grown and whether it has spread. The following examinations may be done:
• ERCP examination
• Endo-ultrasound

ERCP examination

ERCP is short for endoscopic retrograde cholangio pancreaticography. This examination visualises the bile ducts and the drainage of the pancreas. An ERCP is carried out with an X-ray device, and a viewing tube (an endoscope). At the end of the endoscope is a small camera. The physician moves the endoscope via the mouth, oesophagus, stomach, and duodenum to the pancreas. A special channel in the endoscope allows the physician to insert tools. ERCP is sometimes performed to obtain (tumourous) tissue, this is called a biopsy. The biopsies are examined in the laboratory.

ERCP can also be used if you have complaints due to jaundice. Jaundice may mean that the flow of bile is blocked by the tumour. During an ERCP a plastic tube (stent or endoprosthesis) can be inserted. The bile can flow freely and the jaundice disappears. ERCP is not painful, but many patients experience it as unpleasant. Usually you are administered some relaxing medication before and sometimes during the procedure.

Endo-ultrasound

Endo-ultrasound is an investigation through which the location, size, and by the degree of tumour invasion in the surrounding organs of the pancreas, can be determined. The physician can thus also assess the lymph nodes in the immediate vicinity of the tumour.

During this examination, the physician slides a tube with a tiny camera (endoscope) through the mouth, oesophagus, stomach and duodenum to the pancreas. This tube is also linked to an echo device. This device sends sound waves. The reverberation (echo) of the sound waves visualise the pancreas and surrounding organs from the inside out.

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