Pancreatic Cancer

Overview

What is the pancreas?

The pancreas is a small, hockey stick-shaped gland located behind the stomach. The main jobs of the pancreas are to aid in food digestion and regulate blood sugar levels in the body. The pancreas is involved in maintaining blood sugar levels because it makes insulin and glucagon, two hormones that control blood sugar levels.

What is pancreatic cancer?

Pancreatic cancer occurs when changes (mutations) in the pancreas cells lead them to multiply out of control. A mass of tissue can result. Sometimes, this mass is benign (not cancerous). In pancreatic cancer, however, the mass is malignant (cancerous).

What are the types of pancreatic cancer?

There are two types of tumors that grow in the pancreas: exocrine or neuroendocrine tumors. About 93% of all pancreatic tumors are exocrine tumors, and the most common kind of pancreatic cancer is called adenocarcinoma. Pancreatic adenocarcinoma is what people usually mean when they say they have pancreatic cancer. The most common type begins in the ducts of the pancreas and is called ductal adenocarcinoma.

The rest of the pancreatic tumors — about 7% of the total — are neuroendocrine tumors (NETs), also called pancreatic NETs (PNETs), an islet cell tumor or islet cell carcinoma. Some NETs produce excessive hormones. They may be called names based on the type of hormone the cell makes — for instance, insulinoma would be a tumor in a cell that makes insulin.

Who gets pancreatic cancer?

According to the American Cancer Society, pancreatic cancer represents approximately 3% of all cancers and 7% of all cancer deaths in the United States. It occurs slightly more often in men than in women.

Symptoms and Causes

What are the symptoms of pancreatic cancer?

Most people don’t experience early signs of pancreatic cancer. As the disease progresses, however, people may notice:

  • Upper abdominal pain that may spread to the back.
  • Yellowing of the skin and the whites of the eyes (jaundice).
  • Tiredness.
  • Loss of appetite.
  • Light-colored poop.
  • Dark-colored pee.
  • Weight loss.
  • Blood clots in the body.
  • Itchy skin.
  • New or worsening diabetes.
  • Nausea and vomiting

Your healthcare provider might suspect pancreatic cancer if you have some symptoms and you’ve recently developed diabetes or pancreatitis — a painful condition due to the inflammation of pancreas.

Symptoms of pancreatic neuroendocrine cancer may be different than the traditional pancreatic cancer symptoms, such as jaundice or weight loss. This is because some PNETs overproduce hormones.

What causes pancreatic cancer?

There is no clear answer. We don’t know exactly what causes pancreatic cancer. However, research has identified some risk factors.

What are the risk factors for pancreatic cancer?

The average lifetime risk of developing pancreatic cancer is about 1 in 64. A risk factor is something that raises the chance that you will get a disease. There are risk factors that are a result of behavior and that can be changed. For pancreatic cancer, these types of risk factors include:

  • Smoking cigarettes, cigars and using other forms of tobacco.
  • Obesity is also a risk factor. Carrying weight around the waist is a risk factor even if you do not have obesity.
  • Having diabetes, especially type 2 diabetes, which is linked to obesity. The new development of diabetes at an older age and in someone with a normal weight or body mass index could be a sign of pancreatic cancer.
  • Being exposed to chemicals used by dry cleaners and metal workers.
  • Having chronic pancreatitis, a permanent inflammation of the pancreas usually associated with smoking and drinking a lot of alcohol.

There are also risk factors that you can’t change. These include:

  • Hereditary chronic pancreatitis due to gene changes (mutations) passed from parent to child.
  • Hereditary syndromes with gene changes (mutations) in genes — such as BRCA genes passed from parent to child.
  • Being older than 45.
  • Being male.
  • Being Black.
  • Being of Ashkenazi Jewish descent.

Your healthcare provider might suspect pancreatic cancer if you have certain symptoms or if you’ve recently developed diabetes or pancreatitis.

Do pancreatic cancer symptoms in females differ from pancreatic cancer symptoms in males?

No. Even though slightly more men develop pancreatic cancer than women, the potential symptoms are the same.

Diagnosis and Tests

How is pancreatic cancer diagnosed?

It’s difficult to detect pancreatic cancer in the early stages. This is because healthcare providers cannot feel the pancreas in a routine exam. If your provider suspects that you may have pancreatic cancer, they may order imaging tests to take pictures of the internal organs. An endoscopic ultrasound can also be done.

An endoscopic ultrasound (EUS) is a thin tube with a camera at the tip that is passed through the mouth and into the stomach. The ultrasound probe at the end of the endoscope allows imaging of the pancreas through the stomach wall. If necessary, an ultrasound-guided biopsy (tissue sample) from the pancreas can be obtained during the procedure.

A blood test can find a substance called a tumor marker. For pancreatic cancer, high levels of carbohydrate antigen (CA) 19-9 — a type of protein released by pancreatic cancer cells — might indicate a tumor.

Everyone who is newly diagnosed with pancreatic cancer should talk to their doctor about doing genetic counseling and testing to see if there is a hereditary reason they developed pancreatic cancer. This is based on recommendations from two of the largest cancer organizations, the National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO).

What are the stages of pancreatic cancer?

Pancreatic cancer is categorized into five different stages. Your diagnosis depends on the size and location of the tumor and whether or not the cancer has spread:

  • Stage 0: Also known as carcinoma in situ, Stage 0 is characterized by abnormal cells in the lining of the pancreas. The cells could become cancerous and spread to nearby tissue.
  • Stage 1: The tumor is in the pancreas.
  • Stage 2: The tumor is in the pancreas and has either spread to nearby tissues, organs or lymph nodes.
  • Stage 3: The cancer has spread to major blood vessels near the pancreas. It may have also spread to nearby lymph nodes.
  • Stage 4: In stage 4 pancreatic cancer, the cancer has spread to distant areas in the body, such as the liver, lungs or abdominal cavity. It has possibly spread to organs, tissues or lymph nodes near the pancreas.

Be sure to talk with your provider about your situation. Understanding your pancreatic cancer prognosis can help you make an informed decision about your treatment.

Management and Treatment

How is pancreatic cancer treated?

Pancreatic cancer treatment depends on certain things, including where the tumor is located, what stage it is in, how healthy you are and whether or not the cancer has spread beyond the pancreas. Treatment options include:

  • Surgical removal: The cancerous part of the pancreas (resection) is removed. Lymph nodes near to the pancreas may also be removed. The surgery to remove the pancreas or part of the pancreas is called a pancreatectomy. If your tumor is located in the head (the widest part of pancreas near small intestine) of the pancreas, your provider may recommend the Whipple procedure. This surgical method removes the head of the pancreas, the duodenum (the first portion of the small intestine), the gallbladder, a portion of the bile duct and nearby lymph nodes.
  • Radiation therapy: High-speed energy used to kill the cancer cells.
  • Chemotherapy: This method uses drugs that kill cancer cells.
  • Immunotherapy: Treatment to help your body fight the cancer. Immunotherapy has largely been ineffective against pancreatic cancer, but about 1% of people with pancreatic cancer and a specific genetic change may benefit from it.
  • Targeted therapy: Directed at certain genes or proteins that help cancer grow. Genetic testing is generally how we determine if a targeted therapy is right for you.
  • Clinical trials: Talk to your healthcare provider about whether participating in a clinical trial might be an option.

Other things to know about treatment:

Chemotherapy and/or radiation might be used instead of surgery, before surgery to make the tumor smaller, or after surgery to make sure all cancer cells are killed. You should be comfortable working with your healthcare team in making decisions about treatment.

Also, you and your provider should discuss ways to prevent or reduce the side effects related to your treatment. This type of care, called supportive or palliative care, may include:

  • Pain management: If pain medication fails to provide relief, an endoscopic procedure called celiac plexus block or neurolysis can be performed under direct guidance from endoscopic ultrasound.
  • Jaundice treatment: Your healthcare provider can insert a stent (tube) inside your bile duct to manage your jaundice symptoms.
  • Reducing intestinal blockage: Your provider can insert a stent to open up the blockage in your small intestine.
  • Diabetes control: Your medical team can help monitor your blood sugar levels and manage your diabetes medicine.
  • Emotional support: Supportive care can also help you understand and process your own emotions and those of your family and friends.

Where does pancreatic cancer most often spread?

Pancreatic cancer, which is not often detected early, tends to metastasize (spread) to nearby lymph nodes, then to the liver, peritoneum (the lining of the abdominal cavity) and lungs.

Can pancreatic cancer be cured?

Yes, it’s possible. Even though pancreatic cancer has a poor survival rate, it can potentially be cured if detected and treated very early.

Prevention

How can I prevent pancreatic cancer?

We don’t know what actually causes pancreatic cancer, so it’s difficult to know how to prevent it. However, you can change your day-to-day behaviors to become healthier. These tips may help reduce the risk of getting pancreatic cancer:

  • Don’t smoke. If you do smoke or use tobacco in any form, try to quit.
  • Try to reach and maintain a normal weight by eating healthy and exercising.
  • Drink alcohol in moderation, or quit drinking altogether.
  • Try to avoid getting diabetes. If you have it, control your blood sugar levels.
  • Use safety equipment if your work exposes you to toxins.

Outlook / Prognosis

What is the life expectancy of someone with pancreatic cancer?

Pancreatic cancer is usually not found until it has become advanced. Therefore, it is one of the leading causes of cancer deaths. After one year, the pancreatic cancer survival rate is about 20%. After five years, that number drops to about 6%. Every year, about 3,000 more people die of pancreatic cancer than die of breast cancer in the United States.

If surgery can be performed and you have a section of your pancreas removed, the average survival rate is 18 to 20 months. The five-year survival rate in such cases rises to 10 to 25%.

What is the Stage 4 pancreatic cancer survival rate?

Stage 4 pancreatic cancer has a five-year survival rate of 1%. On average, a person diagnosed with Stage 4 pancreatic cancer will live for about one year after their diagnosis.

Living With

When should I see my healthcare provider about pancreatic cancer?

If you have not been diagnosed with cancer of the pancreas, but you have any symptom that is worrying you (like pain or jaundice), call your provider for an appointment and tell them about your concerns. If you have pancreatic cancer, and you have any type of worsening or new symptoms, call your provider.

What questions should I ask my healthcare provider?

Develop an open and cooperative relationship with your healthcare provider. Take a list of questions with you so you remember to get the answers you need to live your best life. These questions might include:

  • What stage is the cancer? What does this mean for me?
  • What are my treatment options? Which do you recommend and why?
  • What side effects might I develop as a result of treatment?
  • Is genetic testing right for me?
  • Am I able to be a part of a clinical trial?
  • Will I be able to keep working and doing the things that I need or want to do every day?
  • Are there situations in which I need to call you immediately or get emergency care?
  • Can you tell me where to find financial support?
  • Can you tell me where to find emotional support?
  • What should I do to stay as healthy as I can?

Make sure to follow the plan that you and your provider agree on. Keep to the schedule of follow-up appointments and testing.

Frequently Asked Questions

What resources are available for people with pancreatic cancer?

You might find the following organizations to be helpful:

A note from Cleveland Clinic

A pancreatic cancer diagnosis can be shocking and life-changing. You might consider joining a support group for people with pancreatic cancer. Spending time with others who are going through the same things can be empowering and beneficial for your mental and emotional health. You can also talk with a counselor, therapist or social worker about how you’re feeling. Knowledge is power, and there are several helpful resources available for you and your family.

Last reviewed by a Cleveland Clinic medical professional on 09/07/2021.

References

  • American Cancer Society. Pancreatic Cancer. (http://www.cancer.org/cancer/pancreaticcancer/) Accessed 9/28/2021.
  • American Society of Clinical Oncology (ASCO). Cancer.Net. Pancreatic Cancer. (https://www.cancer.net/cancer-types/pancreatic-cancer) Accessed 9/28/2021.
  • Hirshberg Foundation for Pancreatic Cancer Research. Frequently Asked Questions About Pancreatic Cancer. (http://pancreatic.org/pancreatic-cancer/faqs/) Accessed 9/28/2021.
  • Ilic M, Ilic I. Epidemiology of pancreatic cancer. (https://pubmed.ncbi.nlm.nih.gov/27956793/) World Journal of Gastroenterology. 2016 Nov 28;22(44):9694-9705. doi: 10.3748/wjg.v22.i44.9694. PMID: 27956793; PMCID: PMC5124974. Accessed 9/28/2021.
  • Kamisawa T, Wood LD, Itoi T, Takaori K. The Lancet, 388 (2016), pp. 73-85. Pancreatic cancer. (https://www.sciencedirect.com/science/article/abs/pii/S0140673616001410) Accessed 9/28/2021.
  • Koop AH, Palmer WC, Stancampiano FF. Gastric outlet obstruction: a red flag, potentially manageable. (https://www.ccjm.org/content/86/5/345) Cleveland Clinic Journal of Medicine 2019; 86(5):345-353. Accessed 9/28/2021.
  • National Cancer Institute. Pancreatic Cancer-Patient Version. (https://www.cancer.gov/types/pancreatic) Accessed 9/28/2021.
  • Neuroendocrine Tumor Research Foundation. Pancreatic Neuroendocrine Cancer vs. Pancreatic Cancer. (https://netrf.org/2018/11/07/pancreatic-neuroendocrine-cancer-vs-pancreatic-cancer/) Accessed 9/28/2021.
  • Pancreatic Cancer Action Network. What Is Pancreatic Cancer? (https://www.pancan.org/facing-pancreatic-cancer/about-pancreatic-cancer/what-is-pancreatic-cancer/%29) Accessed 9/28/2021.
  • Pancreatic Cancer UK. Information about pancreatic cancer. (https://www.pancreaticcancer.org.uk/information/) Accessed 9/28/2021.

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