Pancreatic Cancer Concerns: What tests are done for diagnosis?

I hope they don't mind having you give some blood; a few other tests might be helpful.

CA19-9 and CEA are the two primary blood markers related to pancreatic cancer, and they're pretty cheap. Neither one is a conclusive diagnostic for PC, but elevation on either one, especially in conjunction with anything else, should be cause for more investigation.

Several DNA-based blood tests can also be informative. The test from Invitae can detect "germline"
gene mutations you inherited from your parents that indicate you might be more susceptible than average to certain types of cancer. https://www.invitae.com/en/cancer Family history of pancreatic cancer is not the only red flag; breast and other digestive cancers often spring from the same mutations as PC. (My ancestors had both -- the mutations and the other cancers -- that predisposed me to PC.)

Various tests from Guardant (e.g., https://guardanthealth.com/products/tests-for-patients-with-advanced-cancer/ ) can identify DNA shed by tumors, and also identify "somatic" mutations they possess (which can help fine-tune your treatment).

There's a test called Galleri from Grail ( https://www.galleri.com/ ) that claims to be able to detect 50 different types of cancer early from a simple blood draw. It would most likely be a self-pay of about $1000, and no guarantee it works. If it gives you a false positive, at least you have something to investigate. If it gives you a false negative (like it did me), it's a false sense of confidence that might delay treatment.

Consider all the above as worthy of exploration (but none in isolation), and any positives as a reason to dig deeper. Those are the non-invasive options. They're reasonably east and affordable, and if you push for them, you might get them sooner rather than later.

Invasive surgical options like endoscopic ultrasound + ERCP + biopsy might not be advisable unless the non-invasive tests suggest they are warranted.

@wellandwhole , Yes, I got a false negative from Galleri. My PC in particular seemed to play hide and seek.

Summary:

Whipple w/ all clean margins and lymph nodes on 6/15/2022
Clean MRI and perfect CA19-9 on 7/15/2022
Negative Signatera on 7/27/2022
Negative Galleri on 10/3/2022
Negative Signatera on 10/26/2022
Tumor spotted on MRI at Whipple site (1.3 cm) and lymph node on 10/26/2022
EUS Biopsy negative on 11/1/2022
Positive Guardant 360 on 11/14/2022
Positive Signatera on 12/1/2022
Tumors confirmed growing (2.1 cm) by MRI and rapidly increasing CA19-9 on 12/17/2022

So... it managed to hide from 3 DNA-based tests (two Signateras and one Galleri) before being detected on MRI, and even managed to hide from the EUS biopsy despite the rapid growth from zero in mid-July to 1.3 cm at the end of October. Rising CA19-9 on tests in that span was my biggest hint of recurrence. I was surprised and disappointed the DNA tests didn't pick up on the tumor within 3 weeks of the MRI detection (and especially the biopsy that same week!). Those let to about 7 weeks of delay in my starting treatment for the recurrence.

Anyway, I'm really interested to hear how your Galleri report turns out and exactly when it was done in your overall time line. Of course, I'm hoping you get a good, true negative out of yours!!!