Pancreatic Cancer

What Is Pancreatic Cancer? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Pamela Kaufman
By Medically Reviewed by 
Reviewed:
Medically Reviewed
Though relatively rare, pancreatic cancer is the third leading cause of cancer death in the United States, behind lung and colorectal cancers and ahead of breast cancer, according to the Centers for Disease Control and Prevention (CDC).


Pancreatic cancer forms in the pancreas, an organ located between the stomach and the spine, deep within the abdomen. It is about 6 inches long and 2 inches wide and is shaped like a fish with a wide head, tapering body, and narrow tail, notes the American Cancer Society (ACS).

The pancreas has two important components:

  • The exocrine component is made up of ducts and small sacs at the ends of the ducts. These produce enzymes that help the body break down and digest food — especially fats — in the small intestine.
  • The endocrine component is made up of clumps of cells located throughout the pancreas. These secrete hormones that play various roles in regulating the body's metabolism. One of the most critical of these hormones is insulin, which helps control glucose levels in the blood.
The vast majority of pancreatic cancers are exocrine cancers. Endocrine cancers make up less than 5 percent of all pancreatic cancers, according to Cancer.net.

Common Questions & Answers

What causes pancreatic cancer?
There are a variety of contributors to pancreatic cancer, including obesity, smoking, and inheriting genetic mutations, such as BRCA mutations, that increase risk.
What is pancreatic cancer?
Pancreatic cancer is cancer that forms in the organ known as the pancreas. The pancreas is a gland that produces digestive juices and hormones that aid digestion and help regulate blood sugar.
Can pancreatic cancer be cured?
Cancer of the pancreas can be cured if found early. Unfortunately, because early symptoms like back pain, weight loss, and loss of appetite are common, it is often not detected until it is more advanced.
What are the signs of pancreatic cancer?
Back pain, weight loss, loss of appetite, and jaundice (a yellowing of the whites of the eyes) are all symptoms of pancreatic cancer. Pancreatic cancer may also be marked by nausea and vomiting.
Why is pancreatic cancer so deadly?
Among the reasons that pancreatic cancer tends to be deadly are that it’s often diagnosed at a late stage, there is no easy screening test for it, and it tends to spread easily.

Signs and Symptoms of Pancreatic Cancer

Pancreatic cancer is often called a silent killer because symptoms may not develop right away or be obvious when they do emerge — and because there's no reliable test to detect pancreatic cancer in asymptomatic people. As pancreatic tumors grow, many symptoms that do develop can seem like symptoms of other medical conditions. Per Cancer.net, symptoms can include:

  • Chills and sweats
  • Fever
  • Bloating and gas
  • Gastrointestinal discomfort or burning sensation in stomach
  • Diarrhea or watery, loose, bad-smelling stools
  • Nausea or vomiting
  • Weakness or fatigue
  • Fever
  • Loss of appetite
  • Unexplained weight loss
  • Upper back or upper abdomen pain
  • Swelling in an arm or leg
  • Signs of jaundice, like yellowing skin and eyes and dark urine

Learn More About Signs and Symptoms of Pancreatic Cancer

Causes and Risk Factors of Pancreatic Cancer

While the exact cause of pancreatic cancer isn't clear, there are several factors that can increase the risk. Some risk factors for pancreatic cancer are related to lifestyle choices and environmental factors and may be modifiable. Other risk factors for pancreatic cancer — such as age and race — can't be changed, according to the ACS.

Modifiable risk factors for pancreatic cancer include:

  • Smoking About 25 percent of cases are thought to be caused by cigarette smoking.
  • Overweight or Obesity People with obesity are about 20 percent more likely to develop pancreatic cancer.
  • Heavy Alcohol Use
  • High-Fat Diet
  • Type 2 Diabetes
  • Chronic Pancreatitis Pancreatitis is often tied to heavy drinking and smoking.
  • Workplace Exposure to Certain Chemicals Chemicals commonly used in dry cleaning and metal working may increase the risk.

Unmodifiable risk factors for pancreatic cancer include:

  • Age Nearly all patients are over 45 and about two-thirds are over 65.
  • Gender Men have a slightly higher risk than women.
  • Race or Ethnicity Black Americans have a slightly higher risk than white Americans.
  • Family History
  • Inherited Genetic Syndromes This includes certain hereditary forms of breast and ovarian cancer, melanoma, and pancreatitis as well as two rare disorders — Lynch syndrome and Peutz-Jeghers syndrome.

Learn More About Causes of Pancreatic Cancer: Common Risk Factors, Genetics, and More

How Is Pancreatic Cancer Diagnosed?

Pancreatic cancer is generally diagnosed using several types of examinations, notes the Mayo Clinic.

These can include:

Noninvasive Imaging Tests To get a better look at the pancreas, your doctor may order tests such as an ultrasound, computerized tomography (CT) scans, magnetic resonance imaging (MRI), or positron emission tomography (PET) scans.

Endoscopic Ultrasound To see images of the pancreas taken from inside the abdomen, you may get an endoscopic ultrasound (EUS). This test involves inserting a thin, flexible tube into the mouth and through the digestive track all the way into the small intestine, close to the pancreas. A probe at the end of the endoscope uses sound waves to create an image of the pancreas that may reveal cancer.

Biopsy Your doctor may remove a small tissue sample to examine under a microscope. This is typically done during an endoscopic ultrasound, but can also be performed by inserting a needle through the skin and into the pancreas.

Blood Tests You may get blood tests to look for certain proteins — tumor markers that are shed by cancer cells — that can help determine what type of pancreatic cancer you have, whether it might respond to targeted therapy, and what treatment approach works best.

Learn More About Diagnosing Pancreatic Cancer

Stages and Prognosis of Pancreatic Cancer

Like most cancers, the degree to which pancreatic cancer has advanced is defined by stages. Because pancreatic cancer has few detectable symptoms in earlier stages, it's often caught when it's more advanced and harder to treat. Per Johns Hopkins, there are several staging systems doctors may use for pancreatic cancer:

Resectable Staging One system that doctors use for pancreatic cancer staging focuses on whether it's possible to surgically remove the entire tumor. With this staging system, a tumor is described as "resectable" when it's contained within the pancreas and small enough to remove, "borderline resectable" when it's possible surgery won't get the entire tumor, or "nonresectable" when the tumor within the pancreas is too large or because it has metastasized and spread to other organs and tissue.

TNM Staging This stands for tumor, node, and metastasis staging.

  • Tumor When doctors see at least some evidence of a tumor, T category staging ranges from "Tis," for carcinoma in situ that is limited to the outer layers of pancreatic duct cells and easiest to treat, to "T4" for cancer that has spread beyond the pancreas to surrounding organs and tissue as well as nerves or large blood vessels.
  • Node When doctors can assess lymph nodes, they will assign N categories: N0 is the stage when they don't see cancer in the nodes and N1 is when cancer has spread to surrounding lymph nodes.
  • Metastasis When doctors can assess whether the cancer has spread beyond the pancreas, the staging is M0 for cases when it has not reached surrounding tissue, organs or lymph nodes, and M1 when it has.

Numerical Staging After doctors do TNM staging, they may combine these categories in a numerical staging system from 0 to 4, with lower stages indicating easier to treat tumors with a better prognosis.

The prognosis for pancreatic cancer varies by stage, with an overall five-year survival rate of 10 percent, according to the National Cancer Institute.

When pancreatic cancer is caught early, the five-year survival rate for "localized" tumors that haven't spread to surrounding tissue and organs is about 39 percent. For so-called "regional" tumors that have spread only to tissue near the pancreas, the five-year survival rate is about 13 percent. Once pancreatic cancer spreads to distant organs, tissue, nerves, and blood vessels, the five-year survival rate drops to slightly below 3 percent.

Duration of Pancreatic Cancer

The length of time a patient lives with pancreatic cancer depends on the stage of the cancer, whether the tumor is resectable, borderline, or nonresectable, treatment options, and other factors — every patient is different. While overall survival rates are low compared with other cancers, they are gradually increasing, notes Johns Hopkins.

Treatment for Pancreatic Cancer

Treatment options for pancreatic cancer will vary based on the staging, and also be influenced by a patient's age, overall health, and personal preferences. Pancreatic cancer may be treated by one or a combination of interventions, including surgery, radiation, chemotherapy, targeted therapy, or immunotherapy.

Surgery About 1 in 5 cases of pancreatic cancer are caught when cancer is confined to the pancreas, making surgery an effective treatment option with the potential for a cure.

The main types of surgery are a Whipple procedure or a pancreatectomy. In a Whipple procedure, the surgeon removes the head of the pancreas, a part of the small intestine called the duodenum, as well as the gall bladder and bile duct. The surgeon then reconnects the digestive tract and biliary system. It's a complex and challenging operation, notes the Mayo Clinic.

A pancreatectomy is removal of part or all of the pancreas.
Surgery may be followed by chemotherapy and radiation to reduce the risk of recurrence, or preceded by these interventions to shrink the tumor before attempting removal, according to Cancer.net.

Radiation External beam radiation is the most common approach for pancreatic cancer.

Chemotherapy Doctors may use one drug at a time or a combination of chemotherapies to attack cancer. There are more than a half-dozen chemotherapy drugs approved to treat pancreatic cancer.

Targeted Therapy These therapies for pancreatic cancer target specific genes or proteins in certain tumors, with little to no damage to healthy cells. Tarceva (erlotinib) is approved for advanced pancreatic cancer and targets the EGFR receptor. Lynparza (olaparib) is approved for metastatic pancreatic cancer associated with a hereditary BRCA mutation. Vitrakvi (larotrectinib) can be used for a variety of cancer types, including pancreatic cancer with a rare genetic change called NTRK fusion, according to the Pancreatic Cancer Action Network (PanCAN).

Immunotherapy Biologics, also called immunotherapy, are designed to enhance the body's ability to attack cancer. Immune checkpoint inhibitors such as Keytruda (pembrolizumab) are a type of immunotherapy that may be used to treat pancreatic cancer patients with certain rare genetic mutations.

Treatment Risks Side effects from surgery can include digestive problems — due to loss of normal digestive enzymes — as well as an increased risk of type 2 diabetes resulting from the loss of insulin production in the pancreas. Radiation side effects can include fatigue, nausea, and loose bowel movements. With chemotherapy and other medications to treat pancreatic cancer, side effects vary widely based on the exact drugs used as well as the dose and duration of treatment. Medication side effects can include swelling and numbness of hands and feet, hair loss, nausea, weight loss, and fatigue.


Prevention of Pancreatic Cancer

While there isn't a specific way to avoid pancreatic cancer altogether, there are some things that can lower your risk. Per the ACS, these include:

Quitting Smoking This is the most crucial pancreatic risk factor that can be avoided.

Maintaining a Healthy Weight Losing weight if you are overweight or have obesity can help lower your risk of pancreatic cancer, and so can getting plenty of exercise and eating healthy meals.

Not Drinking Heavy alcohol use is associated with pancreatic cancer, and it's also tied to a condition known as chronic pancreatitis that can raise the risk of pancreatic cancer.

Avoiding Workplace Chemicals There are some chemicals in the workplace that are associated with an increased risk of pancreatic cancer and other cancers.

Research and Statistics: Who Has Pancreatic Cancer?

Pancreatic cancer represents about 3 percent of cancer cases diagnosed in the United States each year and about 7 percent of deaths, according to the ACS.

An estimated 57,600 people get diagnosed with pancreatic cancer in the United States each year, and about 47,050 people die of these tumors.

Pancreatic cancer predominately affects older adults: almost all patients are older than 45, and it is most frequently diagnosed among people who are between 65 and 74 years old. The median diagnosis age is 70.

Black and Jewish Communities and Pancreatic Cancer

Racial and ethnic disparities persist in the timeliness of diagnosis, access to treatment, and outcomes for many type of cancer, and pancreatic cancer is no exception. Unlike some other malignancies such as breast or colon cancer that can be caught earlier with screening, there's no screening for pancreatic cancer. So disparities in outcomes for pancreatic cancer do not result from screening.

Black people are more likely to develop pancreatic cancer than Asian, Hispanic, or white people. Ashkenazi Jews also have an increased risk of developing pancreatic cancer, notes Cancer.net.

In the United States, Black people are more likely to get pancreatic cancer than people from any other racial or ethnic group. Out of every 100,000 people, 15.9 Black people develop pancreatic cancer, compared with 13.5 white people. Black people also have a worse prognosis because they are more likely to be diagnosed when tumors are more advanced and difficult to treat, according to Johns Hopkins.

Ashkenazi Jewish people have a higher risk of pancreatic cancer due in large part to inherited mutations of the BRCA1 and BRCA2 genes, which are tied to pancreatic cancer as well as to breast and ovarian tumors.

Some research also suggests that Black and Hispanic patients may be less likely to receive optimal treatment for pancreatic cancer than white people, although the magnitude of these disparities varies by study.

Related Conditions of Pancreatic Cancer

Pancreatitis is inflammation of the pancreas which can be caused by multiple conditions, most commonly related to excessive alcohol use or the presence of gallstones. Chronic pancreatitis is a risk factor for pancreatic cancer, per Mayo Clinic.

Research suggests that type 2 diabetes may be either a risk factor for pancreatic cancer or a symptom of it. Pancreatic cancer is more likely to occur in people who've had diabetes for over five years than in people without diabetes, according to PanCAN.

While having type 2 diabetes isn't necessarily a cause for alarm when it comes to pancreatic cancer, a sudden worsening of type 2 diabetes in people who previously had their condition under control, may be an early sign of pancreatic cancer, notes Memorial Sloan Kettering Cancer Center.

Resources We Love

Pancreatic Cancer Action Network

PanCAN is a nonprofit dedicated to advancing pancreatic cancer research, advocating for patients, and building community. They've got resources for those facing a pancreatic cancer diagnosis, as well as their loved ones and caregivers, an overview of treatment options and clinical trials, and links for support groups.

The Sol Goldman Pancreatic Cancer Research Center at Johns Hopkins

This research center at Johns Hopkins Medicine provides a comprehensive overview of pancreatic cancer, including symptoms, diagnosis, treatment, and managing quality of life. Their website also features a discussion board and info on support groups.

National Cancer Institute (NCI)

As part of the National Institutes of Health, the NCI is a trusted source for information on pancreatic cancer — from dealing with a diagnosis to treatment options. On their website you can find updates on the latest research into prevention, detection, and treatment of pancreatic cancer.

There are many more resources available, from information to support, to help you understand and cope with pancreatic cancer.

 

Additional reporting by Lisa Rapaport.

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