What is pancreatic cancer?
Cancer in the pancreas occurs when the cells in the pancreas 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 is the pancreas?
The pancreas is a gland that is found behind the stomach. The main jobs of the pancreas are to aid in breaking down food and to 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. The pancreas is an exocrine gland because of its job making the enzymes for digestion and an endocrine gland because it makes hormones like insulin and glucagon.
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 cancer of the pancreas, or pancreatic cancer. The most common type begins in the ducts of the pancreas and is called ductal adenocarcinoma.
There are rarer forms of exocrine tumors, including one that is becoming more common—intraductal mucinous neoplasm (IPMN). This one starts out as benign but can grow and become cancerous over time.
The rest of the pancreatic tumors, about 7% of the total, are neuroendocrine tumors (NETs), called pancreatic NETs (PNETs). This type of tumor is also called an islet cell tumor or islet cell carcinoma. If you have an islet cell tumor, you might also hear them called a name based on the type of hormone the cell makes—for instance, insulinoma would be a tumor in a cell that makes insulin.
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 continue to overproduce hormones.
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. The expectation for 2019 was that some 56,770 U.S. adults would be diagnosed with pancreatic cancer.
Symptoms and Causes
What causes pancreatic cancer?
There is no clear answer. We do not know what causes pancreatic cancer. 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.
- Having diabetes, especially type 2 diabetes, which is linked to obesity. The new development of diabetes at an older age (for example, in someone in their 70s) and in someone with a normal weight or body mass index could be a sign of pancreatic cancer.
- Obesity is also a risk factor. Carrying weight around the waist is a risk factor even if you are not obese.
- Being exposed to chemicals used by dry cleaners and metal workers.
- Having chronic pancreatitis, an inflammation of the pancreas sometimes associated with smoking and drinking a lot of alcohol.
There are also risk factors that you can’t change. These include:
- Heredity, including some conditions that cause chronic pancreatitis and including a family history of cancer of the pancreas. It is also important to know any family history of breast cancer as the hereditary conditions associated with breast cancer, called BRCA syndromes, are associated with pancreatic cancer.
- Being older than 40.
- Being male.
- Being of African-American or Ashkenazi Jewish descent.
What are the signs and symptoms of pancreatic cancer?
Pancreatic cancer does not always show symptoms, especially in the earlier stages. However, pancreatic cancer may cause the following:
- Upper abdominal pain that may spread to the back.
- Yellowing of the skin and the whites of the eyes (jaundice), maybe with itchiness.
- Loss of appetite.
- Weight loss.
- Blood clots.
Your healthcare provider might suspect pancreatic cancer if you have some symptoms and you’ve recently developed diabetes or pancreatitis.
Diagnosis and Tests
How is pancreatic cancer diagnosed?
It is hard 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 end 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 something called CA 19-9 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).
Management and Treatment
How is pancreatic cancer treated?
Treatment of pancreatic cancer 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.
In the later stages, the treatment of pancreatic cancer is not likely to be effective. By the time a diagnosis is made, it is often too late for complete surgical removal of the pancreas. However, there are different ways to try to treat pancreatic cancer. These include:
- Surgical removal of the cancerous part of the pancreas (resection). 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.
- Radiation to kill the cancer cells.
- Chemotherapy. This method uses drugs that kill cancer cells.
- Immunotherapy. Immunotherapy helps your body to 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. Targeted therapy is 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, might include pain management. For pancreatic cancer, it might also include ways to improve your digestion and to control diabetes. 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 found early, tends to metastasize (spread) to nearby lymph nodes, then to the liver, peritoneum (the lining of the abdominal cavity) and lungs.
How can you prevent pancreatic cancer?
We don’t know what actually causes pancreatic cancer, so it is 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 outlook for people 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 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 done 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 10-25%.
When should I talk to 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.
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.
What resources are available for people with pancreatic cancer?
You might find the following organizations to be helpful.
- Pancreatic Cancer Action Network
- Hirshberg Foundation for Pancreatic Cancer Research
- Lustgarten Foundation Pancreatic Cancer Research
- American Cancer Society
- Visit our Butts & Guts Podcasts page to learn more about digestive conditions and treatment options from Cleveland Clinic experts.