Pancreatic Cancer: A Comprehensive Guide

Overview

Pancreatic cancer begins in the tissues of your pancreas — an organ in your abdomen that lies horizontally behind the lower part of your stomach. The pancreas releases enzymes that aid digestion and hormones that help manage your blood sugar.

Pancreatic cancer is often aggressive and spreads quickly to nearby organs. It is seldom detected in its early stages, which is a major reason why it's a leading cause of cancer death. According to the American Cancer Society, about 62,210 people (32,970 men and 29,240 women) will be diagnosed with pancreatic cancer in the United States in 2022, and about 49,830 people (25,970 men and 23,860 women) will die from it.

Pancreatic cancer typically affects older adults, with the average age at diagnosis being 70. It is slightly more common in men than in women, and more common in African Americans than in whites.

Symptoms

Signs and symptoms of pancreatic cancer often don't occur until the disease is advanced. They may include:

• Abdominal pain that radiates to your back
• Loss of appetite or unintended weight loss
• Yellowing of your skin and the whites of your eyes (jaundice)
• Light-colored stools
• Dark-colored urine
• Itchy skin
• New diagnosis of diabetes or existing diabetes that's becoming more difficult to control
• Blood clots
• Fatigue

If you're experiencing any persistent signs and symptoms that worry you, make an appointment with your doctor. Ask your doctor about any signs or symptoms that concern you.

Causes and Risk Factors

It's not clear what causes pancreatic cancer. Doctors have identified some factors that may increase the risk of this type of cancer, including:

• Smoking: People who smoke cigarettes are about twice as likely to develop pancreatic cancer as those who don't.
• Diabetes: Pancreatic cancer is more common in people with diabetes.
• Chronic inflammation of the pancreas (pancreatitis): This condition is linked with an increased risk of pancreatic cancer.
• Family history of genetic syndromes: These can increase cancer risk, including a BRCA2 gene mutation, Lynch syndrome, and familial atypical mole-malignant melanoma (FAMMM) syndrome.
• Family history of pancreatic cancer: The risk increases if you have a parent, sibling, or child with pancreatic cancer.
• Obesity: People who are obese are more likely to develop pancreatic cancer.
• Older age: The risk increases as you age.

A majority of pancreatic cancer cases occur in people with no known risk factors, and some people with known risk factors never develop the disease.

Diagnosis

If your doctor suspects pancreatic cancer, they may recommend:

• Imaging tests that create pictures of your internal organs, such as ultrasound, CT scan, MRI, and PET scan.
• Using a scope to create ultrasound pictures of your pancreas (endoscopic ultrasound).
• Removing a sample of tissue for testing (biopsy).
• Blood tests to look for tumor markers, such as CA19-9, which may indicate pancreatic cancer.

Determining the extent (stage) of the cancer is crucial for planning treatment. Stages of pancreatic cancer are indicated by Roman numerals ranging from 0 to IV, with the lowest stages indicating cancer that is confined to the pancreas. By stage IV, the cancer has spread to other parts of the body.

Treatment Options

Treatment for pancreatic cancer depends on the stage and location of the cancer as well as your overall health and personal preferences. The first goal of treatment is to eliminate the cancer, when possible. When that isn't an option, the focus may be on improving your quality of life and limiting the cancer from growing or causing more harm.

Surgery

Operations used in people with pancreatic cancer include:

• Surgery for tumors in the pancreatic head: If your pancreatic cancer is located in the head of the pancreas, you may consider an operation called a Whipple procedure (pancreatoduodenectomy).
• Surgery for tumors in the pancreatic tail and body: Surgery to remove the tail of the pancreas or the tail and a small portion of the body is called distal pancreatectomy.
• Surgery to remove the entire pancreas: In some cases, the entire pancreas may need to be removed. This is called total pancreatectomy.
• Surgery for tumors affecting nearby blood vessels: Many people with advanced pancreatic cancer are not considered eligible for the Whipple procedure or other pancreatic surgeries if their cancer involves nearby blood vessels. At specialized medical centers, surgeons may offer blood vessel reconstruction with pancreatic surgery.

Radiation Therapy

Radiation therapy uses high-energy beams, such as X-rays and protons, to destroy cancer cells. You may receive radiation treatments before or after cancer surgery, often in combination with chemotherapy. Or, your doctor may recommend a combination of radiation and chemotherapy treatments when your cancer can't be treated surgically.

Chemotherapy

Chemotherapy uses drugs to help kill cancer cells. These drugs can be injected into a vein or taken orally. You may receive only one chemotherapy drug, or you may receive a combination of chemotherapy drugs.

Clinical Trials

Clinical trials are studies to test new treatments, such as new drugs or new approaches to surgery or radiation therapy. If the treatment being studied proves to be safer and more effective than current treatments, it can become the new standard of care.

Clinical trials for pancreatic cancer might give you a chance to try new targeted therapy, chemotherapy drugs, immunotherapy treatments, or vaccines.

Living with Pancreatic Cancer

Living with pancreatic cancer can be challenging. Here are some tips to help you manage:

• Learn about your cancer to make informed decisions about your care.
• Keep friends and family close for support.
• Find someone to talk with, such as a counselor or medical social worker.
• Connect with other pancreatic cancer survivors through support groups.
• Take care of yourself by eating a healthy diet, getting enough rest, and staying active when you can.

Palliative care is a specialty area of medicine that focuses on relieving pain and other symptoms of a serious illness. Palliative care specialists work with you, your family, and your other doctors to provide an extra layer of support that complements your ongoing care.

Prevention

While there's no sure way to prevent pancreatic cancer, you can take steps to reduce your risk:

• Stop smoking. If you smoke, try to stop. Talk to your doctor about strategies to help you stop, including support groups, medications, and nicotine replacement therapy.
• Maintain a healthy weight. If you are at a healthy weight, work to maintain it. If you need to lose weight, aim for a slow, steady weight loss — 1 to 2 pounds (0.5 to 1 kilogram) a week.
• Choose a healthy diet. A diet full of colorful fruits and vegetables and whole grains may help reduce your risk of cancer.
• Exercise most days of the week. Aim for at least 30 minutes of moderate exercise on most days.

Complications

As pancreatic cancer progresses, it can cause complications such as:

• Weight loss: A number of factors may cause weight loss in people with pancreatic cancer. The cancer itself may cause weight loss. Nausea and vomiting caused by cancer treatments or a tumor pressing on your stomach may make it difficult to eat. Or your body may have difficulty processing nutrients from food because your pancreas isn't making enough digestive juices.
• Jaundice: Pancreatic cancer that blocks the liver's bile duct can cause jaundice. Signs include yellow skin and eyes, dark-colored urine, and pale-colored stools. Jaundice usually occurs without abdominal pain.
• Pain: A growing tumor may press on nerves in your abdomen, causing pain that can become severe. Pain medications can help you feel more comfortable.
• Bowel obstruction: Pancreatic cancer that grows into or presses on the first part of the small intestine (duodenum) can block the flow of digested food from your stomach into your intestines.

When to Seek Emergency Care

Sources and Further Reading

• Mayo Clinic
• American Cancer Society
• National Cancer Institute
• World Health Organization
• Cleveland Clinic