Fiducial Markers

Before radiation therapy for pancreatic cancer, your doctor may recommend placing fiducial markers around your tumor. These metal markers show up on images (such as X-rays) to pinpoint the tumor.

Why it is Done

You may need fiducial markers placed if you have a tumor in your pancreas and need radiation treatment. Doctors want to make sure radiation is as exact as possible so that only the “bad” area is treated and healthy “good” tissue doesn’t get radiated.

When you move, the organs in your body shift around. Fiducial markers permanently mark the tumor and help make sure radiation is aimed right at the tumor, even if the organ moves around a bit. Using imaging to help guide radiation is called image-guided radiation therapy (IGRT).

What to Expect

Fiducial markers – three to six – may be placed with a thin needle inserted into the tumor through an endoscope (flexible tube) during endoscopic ultrasound (EUS). This is an outpatient procedure.

Your doctor places a thin tube (endoscope) through your mouth, down your esophagus, past your stomach and into your pancreas. A thin needle is inserted through the tube into your pancreatic tumor to place the fiducial markers. The endoscope contains a tiny camera, which transmits pictures to a monitor so your doctor can see inside as the markers are placed.

Sometimes, the markers – the size of a grain of rice – can be placed by a thin needle inserted through your skin. In this case, your doctor uses CT (computed tomography) scanning to help guide the needle and markers to the right spots.

You must wait a week or so after having markers placed before beginning radiation therapy.

What the Risks Are

Risks of having fiducial markers placed include:

  • Pancreatitis
  • Cholangitis (bile duct infection)
  • Bleeding
  • Abdominal pain
  • Fever
  • Elevated liver enzymes
  • Fiducial markers moving from the original site

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