Skip to main contentLast updated: 09-Nov-2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Pancreas Cancer Surgeon
Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad · 18 years of experience
In short
A biopsy report names the type of tumour. A gene test looks for changes that may allow a targeted drug. They are two different reports.
Almost every pancreatic cancer carries a KRAS change, so that finding is expected. The results that can change treatment are BRCA, PALB2, MSI-high and a few rare fusions.
Ask for both a tumour test and a germline test, which reads the genes you were born with. The second one can protect your family.
This post explains the laboratory side. For the whole treatment pathway, from stent to operation, see our pancreatic cancer treatment page.
The biopsy tells us the type of cancer and how abnormal the cells look. Most reports say ductal adenocarcinoma, which is the usual pancreatic cancer.
The pathologist looks at a thin slice of tissue under the microscope. Three things matter to you: the tumour type, the grade, and whether the sample was good enough to answer the question.
A biopsy report does not give the stage. The stage, meaning how far the cancer has spread, comes from your scans.
A biopsy says what the tumour is. A gene test says what is driving it. The gene test often uses the same tissue, but it is a separate order.
Many patients leave the hospital with a diagnosis but no gene report. That is not an error, because the gene test is usually requested on purpose, after the cancer type is confirmed. Ask your surgeon or oncologist whether it has been sent.
Two kinds of gene tests are used, and they answer different questions.
| Question | Tumour test (somatic) | Germline test |
|---|---|---|
| What is tested? | The cancer tissue, or tumour DNA in the blood | Blood or saliva, which carries the genes you were born with |
| What does it find? | Changes that grew inside the cancer | Changes passed down in the family |
| Why do it? | To look for a targeted or immunotherapy drug | To guide drug choice and to protect relatives |
| Who should have it? | Most patients, by present guidelines | All patients, by present guidelines |
Doing both gives the fullest picture. A germline change is also found in the tumour, so the two reports are read together.
KRAS is a growth switch that is stuck on in almost every pancreatic cancer. Seeing it on your report is expected and does not mean your cancer is worse.
KRAS was long thought to be a target that could not be hit by a drug. That is now changing, but slowly.
So a KRAS result is useful mainly as a map. It rarely changes the chemotherapy today, but it shapes which trials may suit you later.
A few results matter most: BRCA and PALB2 for DNA repair, MSI-high for immunotherapy, and rare fusions that have their own drugs. Each one is uncommon.
| Result on the report | What it means | What it can change |
|---|---|---|
| BRCA1, BRCA2 or PALB2 | The cell cannot repair its DNA well | Platinum chemotherapy may work better; a PARP inhibitor may be used to hold the response |
| MSI-high or dMMR | The cell cannot fix copying errors | Immunotherapy may be an option |
| KRAS G12C | A rare type of KRAS change | A targeted drug may be an option |
| NTRK, RET or NRG1 fusion | Two genes are joined together by mistake | A matching targeted drug may be an option |
| BRAF or HER2 change | Rare growth signals | A targeted drug may be tried, often in a trial |
| TP53, CDKN2A or SMAD4 | Common brakes lost in the cancer | Mostly explains behaviour; no drug yet |
Most patients will not have a result that opens a targeted drug. That is common, and it does not mean you are getting a lesser plan. The usual chemotherapy remains the base of treatment for most people.
A germline change was born with you, so your children, brothers and sisters may carry it too. Knowing it lets them be checked early.
Not every patient with a change in BRCA, PALB2, ATM or a Lynch syndrome gene has a family history. Many have none, which is why we test everyone rather than only those with a story.
You may feel worried about telling the family. A genetic counsellor can help you plan that talk and explain what the result does and does not mean.
Ask for the gene test soon after the diagnosis, ideally before chemotherapy begins. It uses the biopsy tissue you already have, or a blood sample.
Pancreatic biopsies are small, so tissue is precious. Before the first stain is cut, ask the pathologist to keep spare slices for gene testing. If the tissue runs out, a blood test that reads tumour DNA can still help, although it may miss some changes.
Results usually take a few weeks. We do not wait for them if treatment needs to begin, because the first chemotherapy is the same for most patients.
A gene test cannot tell you how long you will live, or whether the cancer can be removed. Scans and a surgeon’s review decide those.
Be careful with reports that claim a drug is promising for your gene change. Many of these drugs are new, tested in few patients, and not easy to obtain. We tell you plainly what is approved, what is only in trials, and what is practical for you.
If you have a report and wish to understand where you stand, read about the tests that come with the diagnosis, then bring all your papers to a consultation.
It names the type of tumour, how abnormal the cells look, which is called the grade, and whether the sample was enough. Most reports say ductal adenocarcinoma. The report does not give the stage; scans do that.
No. A biopsy tells us what the tumour is. A gene test looks inside the tumour, or in your blood, for changes that may open a targeted drug. Both can use the same tissue sample.
Most guidelines advise testing for everyone. The result may change the choice of drug, and an inherited result matters for your children, brothers and sisters.
A tumour test reads the changes that grew inside the cancer. A blood or saliva test reads the genes you were born with. They answer different questions, and many patients need both.
KRAS is a switch that is stuck on in almost every pancreatic cancer, so finding it is expected. It does not mean the cancer is worse. Only a rare KRAS type has a targeted drug, and trials of others are going on.
These genes repair damaged DNA. A change may make the cancer respond well to platinum chemotherapy, and a drug group called PARP inhibitors may be used later. Your close family should be offered genetic counselling.
It means the cancer cells cannot fix copying errors in their DNA. It is uncommon in pancreatic cancer, but those patients may respond well to immunotherapy, so we always check for it.
Often yes. Pancreatic samples are small, so ask the pathologist to save tissue before the first test is run. If tissue runs out, a blood test of tumour DNA is another option.
For the whole treatment pathway, start at the pancreatic cancer treatment page. For questions before you travel, call +91-63555-64601.
Dr Harsh Shah — Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Dr. Jivraj Mehta Hospital, Dr Jivraj Mehta Marg, Vasna, Ahmedabad 380007.
Consultations, review of reports and scans, operations and follow-up. OPD Monday to Saturday, 9 am to 5 pm.
Appointments: +91-63555-64601 · +91-63590-11009 · Hospital 079-2663 6363
Directions to the hospital · WhatsApp +91-63555-64601
Holding a pancreas biopsy or gene test report and not sure what it means? Dr Harsh Shah can go through it with you in plain words and tell you what each line changes in your treatment. Bring the report and any scans. You can also call, or message us on WhatsApp. Call For Appointment Book on WhatsApp Tapping Book on WhatsApp will likely open the WhatsApp app on your phone.
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