What Is Pancreatic Cancer?
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Medically reviewed by Gagandeep Brar, MD
Pancreatic cancer develops when abnormal cells in the pancreas grow and divide uncontrollably, forming a tumor. The pancreas is a glandular organ nestled between the stomach and the spine that produces digestive enzymes that break down food and hormones (e.g., insulin) that help control your blood sugar level.
This type of cancer is rare, accounting for approximately 3% of all cancer diagnoses in the United States. Although the exact cause of pancreatic cancer is unknown, certain factors like smoking and obesity can increase your risk.
Early detection of pancreatic cancer is challenging, and symptoms like fatigue, weakness, abdominal pain, jaundice, and unintentional weight loss usually only develop once the tumor has grown significantly or the cancer has spread (metastasized) outside of the pancreas. However, treatments like surgery, radiation therapy, and chemotherapy can help shrink the tumor and improve symptoms.
Types of Pancreatic Cancer
There are two main types of pancreatic cancer, based on the type of cell that the tumor develops in. The two main types are exocrine and neuroendocrine.
Exocrine Pancreatic Cancer
About 93% of pancreatic cancer cases begin in the exocrine cells. Exocrine cells in the pancreas produce enzymes that help digest food. Adenocarcinoma is the most common type of pancreatic tumor, accounting for about 95% of all pancreatic exocrine tumors. Pancreatic adenocarcinoma begins in exocrine cells that produce digestive enzymes and line the pancreatic ducts.
Other types of exocrine tumors are less common but include:
Acinar cell carcinomas
Undifferentiated carcinomas
Adenosquamous carcinomas
Squamous cell carcinomas
Signet ring cell carcinomas
Undifferentiated carcinomas with giant cells
Neuroendocrine Pancreatic Cancer (PNETs)
Pancreatic neuroendocrine cancer develops when abnormal endocrine cells grow uncontrollably and form a tumor. Endocrine cells, also known as islet cells, produce hormones like insulin and glucagon, which help control blood sugar levels. Accounting for about 7% of all pancreatic tumors, the classification of pancreatic neuroendocrine tumors depends on the type of hormone the tumor cells produce. Common types of neuroendocrine pancreatic cancer include:
Insulinoma: Forms in cells that produce insulin
Gastrinoma: Forms in cells that produce gastrin
Glucagonoma: Forms in cells that produce glucagon
Somatostatinoma: Forms in cells that produce somatostatin
VIPoma: Forms in cells that produce vasoactive intestinal peptides (VIPs)
ACTH-secreting: Forms in cells that produce adrenocorticotropic hormone (ACTH)
Nonfunctional islet cell tumor: Forms in cells that do not produce hormones
Pancreatic Cancer Symptoms
In its early stages, pancreatic cancer usually causes no symptoms. As the cancer progresses and the tumor grows, symptoms can be vague and easily mistaken for other conditions that cause similar symptoms. When symptoms develop, the most common signs of pancreatic cancer include:
Jaundice (yellowing of the skin and eyes)
Light-colored, floating, or oily stools with a foul odor
Dark-colored urine
Burning sensation in the stomach
Pain in the back, upper abdomen, or arms
Weakness
Loss of appetite
Vomiting
Chills
Sweating
Causes
Pancreatic cancer develops when healthy pancreas cells develop mutations (changes) in their DNA that cause them to grow uncontrollably and form tumors. Researchers don't fully understand what triggers mutations in pancreas cells that cause them to become cancerous.
About 10% of all pancreatic cancer cases are familial, meaning they develop in people who inherit genes from their parents that increase the risk of pancreatic cancer. Most gene mutations associated with pancreatic cancer are acquired, meaning the mutations develop at some point in a person’s lifetime (as opposed to at birth).
Sometimes, acquired gene mutations occur due to exposure to cancer-causing chemicals (e.g., tobacco smoke) or lifestyle habits such as eating processed, high-fat foods and drinking alcohol. In other cases, what causes the acquired mutations is unknown.
Risk Factors
Certain risk factors can increase your likelihood of developing pancreatic cancer, including:
Age over 55
Being assigned male at birth
Smoking tobacco
Eating a high-fat diet
Excess alcohol intake
History of diabetes or pancreatitis (pancreas inflammation)
Family history of pancreatic cancer
Inherited genetic syndromes, such as Lynch syndrome, Peutz-Jeghers syndrome, and familial atypical multiple mole melanoma syndrome
Diagnosis
If you're experiencing symptoms of pancreatic cancer or may be at risk of the condition, it's important to seek medical care as soon as possible. Diagnosing pancreatic cancer involves a physical examination, medical history review, and diagnostic tests to confirm the presence, location, and stage of cancer.
During the physical examination, your healthcare provider will ask about your symptoms and look for signs of pancreatic cancer, such as a swollen abdomen and jaundice. If your healthcare provider suspects you have pancreatic cancer, they will order diagnostic tests to confirm a diagnosis, such as:
Blood tests: These check liver function, biological markers for tumors, and overall blood count levels.
Imaging scans: Scans like a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan visualize tumors inside your body and identify the location, stage, and extent of pancreatic cancer.
Endoscopic retrograde cholangiopancreatography (ERCP): The provider inserts a small tube with a light and video camera attached to your body to determine the presence of a tumor or blockage.
Percutaneous transhepatic cholangiography (PTC): The provider inserts a needle through your stomach and into a liver bile duct to take X-ray images of your pancreatic ducts to check for blockages or obtain a fluid or tissue sample for a biopsy.
Biopsy: Examining a tissue sample to check for the presence of cancer cells in your pancreas or pancreatic ducts.
Stages of Pancreatic Cancer
If you receive a diagnosis for cancer, your healthcare team will determine what stage you're in. A cancer stage tells you the location of the tumor, whether it has spread, and how far. Healthcare providers use the TNM system to stage most pancreatic cancers.
Tumor (T): What is the size of the tumor and has it grown outside of the pancreas?
Node (N): Has pancreatic cancer spread to nearby lymph nodes, and if so, how many are affected?
Metastasis (M): Has the cancer spread (metastasized) into distant lymph nodes or other body organs, such as the liver, bones, or lungs?
Depending on your condition and symptoms, your healthcare team may diagnose you in one of the following stages:
Stage 0: The cancer is in situ, meaning the cancerous cells are limited to the duct where they started.
Stage 1A: The tumor is 2 centimeters (cm) or smaller and confined to the pancreas.
Stage 1B: The tumor is larger than 2 cm and is confined to the pancreas.
Stage 2A: The tumor is larger than 2 cm and is confined to the pancreas.
Stage 2B: A tumor of any size has spread to 1-3 nearby lymph nodes.
Stage 3: A tumor of any size has spread to four or more nearby lymph nodes or has spread to nearby veins and arteries but not other body parts.
Stage 4: A tumor of any size that has spread to distant body areas, such as the liver, lungs, bones, or peritoneum (the lining of the abdominal cavity).
Treatment
There are several treatment options for pancreatic cancer. Your healthcare team will work with you to develop a treatment plan based on the cancer stage you're in and your overall health and preferences. Your treatment plan may include surgery, radiation therapy, chemotherapy, targeted therapy, or immunotherapy.
Surgery
Surgery offers the best chance for remission (complete removal of pancreatic cancer cells) in people with resectable (removable) pancreatic cancer. Resectable pancreatic cancer means the cancer is confined to the pancreas and doesn’t extend into nearby veins and arteries or elsewhere in the body. Surgeons use different types of surgical procedures based on the location of the tumor in the pancreas.
Pancreaticoduodenectomy: Also known as a Whipple procedure, this highly complex surgery involves removing all or part of the pancreas. Surgeons also remove nearby structures, including the gallbladder, lymph nodes, part of the bile duct, and sometimes part of the stomach. The surgeon attaches the remaining portion of the bile duct and pancreas to the small intestine, allowing digestive enzymes to enter the small intestine.
Distal pancreatectomy: Involves removing the pancreas tail, a part of the pancreas body, and sometimes the spleen.
Total pancreatectomy: Removes the entire pancreas, gallbladder, common bile duct, spleen, and part of the stomach and small intestine.
Radiation Therapy
Radiation therapy uses high-energy X-rays or particles to target and destroy cancer cells. Your healthcare provider may recommend radiation therapy before surgery (neoadjuvant therapy) to shrink the tumor and make it easier to remove or after surgery (adjuvant therapy) to kill any remaining cancer cells.
For pancreatic cancer specifically, radiation therapy uses a machine that directs beams of radiation precisely at the tumor from outside the body. Most radiation therapy protocols involve five radiation treatments a week for several weeks. The process is painless, though you may experience side effects like fatigue, skin irritation in the treatment area (e.g., redness, blistering), diarrhea, nausea and vomiting, and loss of appetite.
Chemotherapy
Chemotherapy (also known as chemo) involves using powerful drugs to kill cancer cells throughout the body. This is a systemic treatment, meaning it treats cancer cells located anywhere in the body. Your healthcare provider may recommend chemotherapy for pancreatic cancer before or after surgery or in combination with radiation therapy to improve treatment effectiveness.
Depending on the chemo drugs your healthcare provider recommends, you may receive chemotherapy intravenously (IV) through a vein or oral (by mouth) pills. There are several chemotherapy regimens for treating pancreatic cancer. Most people receive two or more of the following chemo drugs:
Abraxane (albumin-bound paclitaxel)
5-fluorouracil (5-FU)
Irinotecan
Cisplatin or oxaliplatin (platinum-based drugs)
Unfortunately, chemo doesn't come without side effects. Common chemotherapy side effects include nausea and vomiting, hair loss, fatigue, mouth sores, neuropathy (tingling and numbness in your fingers and toes), and an increased risk of infection.
Targeted Therapy
Targeted therapy is a newer approach to treating pancreatic cancer that targets specific proteins, genes, and tissue environments involved in cancer cell growth and survival. If your healthcare provider recommends targeted therapy, they may first run testing to determine which genes, proteins, and other factors play a role in the pancreatic tumor to find the most effective therapy for you.
Immunotherapy
Immunotherapy uses drugs to help your immune system recognize and destroy cancer cells. Immune checkpoint inhibitors are immunotherapy drugs that target proteins that usually prevent the immune system from attacking healthy cells. By blocking these checkpoints, immunotherapy drugs allow immune cells to attack cancer cells.
Keytruda (pembrolizumab) is an immune checkpoint inhibitor for a specific subgroup of pancreatic cancers associated with a gene mutation called mismatch repair (MMR) or tumors with a high level of microsatellite instability (MSI-H).
How To Prevent Pancreatic Cancer
Unfortunately, there is no guaranteed way to prevent pancreatic cancer, but certain lifestyle habits can help lower your risk:
Eat a balanced diet of fruits, vegetables, and whole grains
Limit your intake of processed, high-fat, or sugary foods
Avoid alcohol use
Get regular physical activity or exercise
Complications
Because of its impact on the production of your digestive enzymes and hormones, pancreatic cancer may cause one of the following complications:
Pancreatic exocrine insufficiency (PEI): Pancreatic cancer can affect your pancreas’ ability to secrete digestive enzymes for healthy digestion. PEI can cause malabsorption of vital nutrients (e.g., fat-soluble vitamins, amino or fatty acids), which may lead to weight loss and malnutrition.
Diabetes: Pancreatic cancer can damage insulin-producing cells in the pancreas, which may increase your risk of diabetes or worsen your condition if you already have diabetes. In some cases, adult-onset diabetes is an early sign of pancreatic cancer.
Metastasis: Because pancreatic cancer is difficult to detect in its early stages, many people do not receive a diagnosis until the cancer has spread (metastasized) to other surrounding tissues or distant body areas—such as the liver, lungs, and bones.
Pain: Severe abdominal and back pain is common in people with pancreatic cancer. As the tumor grows, it can press on nerves near the pancreas and cause significant pain.
Living With Pancreatic Cancer
Living with pancreatic cancer and dealing with treatment side effects can be difficult and overwhelming. Joining a support group with other people with pancreatic cancer can help you manage the emotional challenges that come with your diagnosis and connect with others facing similar challenges. It may also help to talk to your loved ones about what you're going through and ask them for support.
Pancreatic cancer is aggressive, but researchers are making significant advancements in treatment options, and research into new and more effective treatments is ongoing. While your cancer care team will work with you to develop a treatment plan, you may want to discuss participating in a clinical trial that offers promising new treatment options for some people with pancreatic cancer.
Frequently Asked Questions
What is the life expectancy with pancreatic cancer?
Survival rates for pancreatic cancer vary depending on the stage of the cancer, your age, and overall health. The 5-year survival rate of people who receive a diagnosis before the cancer spreads is 44%. When the diagnosis occurs after the cancer has spread to surrounding tissues (e.g., lymph nodes), the survival rate is 15%.
Unfortunately, more than half of people with pancreatic cancer receive a diagnosis after the cancer spreads to distant areas (e.g., lungs) when the 5-year survival rate is 3%.
Is cancer of the pancreas curable?
Pancreatic cancer is curable if detected at an early stage when the tumor is confined to the pancreas and removable with surgery. Due to the lack of symptoms in the early stages, pancreatic cancer is unfortunately often diagnosed at later stages when a cure is less likely.
Is chemo worth it for pancreatic cancer?
The decision of whether chemotherapy is worth it for pancreatic cancer is a personal decision. Chemotherapy can help control cancer growth and improve your quality of life, but it also causes side effects. Discussing the risks and benefits of chemotherapy with your healthcare provider can help guide your decision.
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