An Overview of Pancreatic Cancer

Pancreatic cancer is uncommon, but since the majority of these cancers are in the advanced stages at the time of diagnosis, it is the fourth leading cause of cancer-related deaths in the United States. Symptoms may include painless jaundice, abdominal pain, weight loss, and sometimes the unexpected onset of diabetes. Tests such as CT and endoscopic ultrasound are used to diagnosis the condition. Treatment options include surgery, chemotherapy, targeted therapies, radiation therapy, and clinical trials.

Understanding the Pancreas

The pancreas is an organ that is about six inches long, two inches wide and is shaped like a thin pear on its side. The wider end of the pancreas is called the head, while the middle section is called the body, and the narrow end the tail. Cancers are most common in the head.

The pancreas is cradled behind the stomach in front of the spine. It cannot be felt during a physical exam as it is surrounded by other organs, such as the stomach, liver, spleen, gallbladder, and small intestine, making diagnosis and surgery challenging.

The pancreas consists of two types of cells that can give rise to the types of cancers. Most cancers (adenocarcinomas) begin in cells known as exocrine cells that are responsible for producing pancreatic enzymes. These enzymes are secreted into the intestine to help digest proteins, carbohydrates, and fats.

Much less common are cancers (neuroendocrine tumors) that arise in endocrine cells. These cells produce hormones such as insulin, glucagon, and somatostatin that regulate processes ranging from blood sugar to the amount of acid in the stomach.

This overview focuses on primary pancreatic cancer.

Symptoms

The early symptoms of pancreatic cancer may be subtle and vague, and can easily be dismissed as being due to another, less serious condition. Some potential warning signs include:

  • Yellowing of the skin and whites of the eyes (jaundice) due to the build-up of bilirubin
  • Pale, clay-like stools, dark urine, and itching, also occur due to the accumulation of bilirubin in the blood
  • Upper abdominal pain that may radiate through to the back
  • Unintended weight loss
  • Nausea, vomiting, or diarrhea
  • Loss of appetite
  • The unexpected onset of diabetes in a person who does not have risk factors

Symptoms of rare pancreatic tumors (neuroendocrine tumors) are often related to the hormones they produce and may include symptoms such as those found with low or elevated blood sugar or elevated blood sugar.

All of these symptoms warrant a thorough medical evaluation—and a second opinion, if you're not getting answers that make sense to you.

Causes and Risk Factors

Although researchers are unsure as to what exactly causes the disease, there are risk factors for pancreatic cancer that have been identified:

  • Age: The majority of pancreatic cancers occur in people over the age of 55 (though they can occur in young people as well).
  • Race: Blacks have higher rates of pancreatic cancer than other ethnic groups. The risk is also higher in people of Ashkenazi Jewish heritage, though this is thought to be related to a high rate of BRCA2 gene mutations.
  • Sex: Incidence and mortality rates are slightly higher in men than in women.
  • Cigarette smoking: This is a significant risk factor (smoking increases the risk of many cancers) and is thought to be responsible for up to a third of pancreatic cancers.
  • Advanced gum disease (periodontitis) and total tooth loss (edentulousness)
  • A family history of pancreatic cancer or certain genetic syndromes: These are thought to be the cause of 5 percent to 10 percent of these cancers.
  • A personal history of diabetes
  • Chronic inflammation of the pancreas (pancreatitis)
  • Long-term, heavy alcohol use, especially when combined with smoking
  • Obesity: Being overweight or obese is thought to be responsible for around one in eight of these cancers.

    Diagnosis

    The diagnosis of diagnosis of pancreatic cancer begins with a careful history looking for risk factors, and a physical exam looking for any evidence of jaundice, an abdominal mass, or weight loss.

    Imaging studies are the mainstay of diagnosis, especially CT scans designed to look for pancreatic cancer (pancreatic protocol CT). Regular abdominal ultrasounds may be helpful for ruling out other abdominal problems but are limited in diagnosing pancreatic cancer due to gas in the intestines.

    Instead, endoscopic ultrasound—in which a tube with an ultrasound tip is placed through the mouth and threaded down into the lower part of the stomach or the upper part of the small intestine—can be a helpful tool. Other imaging tests that are sometimes used include ERCP (endoscopic retrograde cholangiopancreatography) and MRI. 

    A biopsy is not always needed to make the diagnosis, but when it is (such as if surgery is being considered) there are two main options: fine needle aspiration and laparoscopic biopsy.

    Blood tests are nonspecific with pancreatic cancer but may be helpful when combined with other findings. If jaundice is present, tests to determine the different types of bilirubin are helpful.

    Based on the results of imaging tests and other findings, these cancers are given a stage between 0 (precancerous) and stage 4 (spread to other organs, such as the liver or lungs).

    Treatment

    Treatment options for pancreatic cancer depend on the stage of the disease and the location of the cancer in the pancreas.

    For early-stage cancers, especially those in the head of the pancreas, surgery offers a chance to cure the disease. Unfortunately, only 15 to 20 percent of people are candidates for surgery (for the remainder, the cancer has spread too far for surgery to improve survival).

    The most common procedure performed is known as the Whipple procedure and involves removing the head of the pancreas, the common bile duct, part of the stomach, part of the small intestine, the spleen, and nearby lymph nodes. There are variations on the procedure, including surgery that removes the entire pancreas, but this is performed less often. These are very major surgeries, and making sure that surgery is feasible (such as with a laparoscopic biopsy and other tests) is imperative.

    Chemotherapy using a combination of drugs provides only modest improvement in short-term survival but may be more effective when combined with treatments such as targeted therapy and/or radiation therapy.

    Targeted therapies are newer treatments that "target" specific abnormalities in the growth of cancers. One medication, Tarceva (erlotinib), is helpful for some people, most often in combination with chemotherapy.

    Clinical trials are looking at combinations of the above treatments as well as newer approaches, such as immunotherapy.

    Coping

    If you or your loved one are diagnosed with pancreatic cancer, take some time to learn about your disease and take an active part in your care as your own advocate. Doing so not only helps reduce anxiety but might make a difference in outcomes for some people as well.

    Some suggestions that can help:

    • Take a moment to learn about how to research your cancer online.
    • Consider getting a second opinion, preferably at one of the larger National Cancer Institute-designated cancer centers.
    • Talk to your oncologist about any clinical trials that may be a fit for you, or consider checking out one of the free clinical trial matching services that provide nurse navigators who can match your particular situation to clinical trials happening anywhere in the world. 

    Some people also find it helpful to become involved in a support group. If such a group isn't available in your area, which may be the case as pancreatic cancer is relatively uncommon, online support communities may be a good way to find others who are facing the same challenges you are.

    Reach out to family and friends and allow them to help you cope. Many cancer centers also offer options for emotional support, ranging from cancer counseling to palliative care teams who address the whole person, body, mind, and soul. Take advantage of any of these options you believe would help. Sometimes the bravest thing people can do is admit that they need extra help and support.

    A Word From Verywell

    If you or a loved one has been diagnosed with pancreatic cancer, or you think that you may have the symptoms, there's no doubt that you may be very concerned. Pancreatic cancer has a reputation that most are aware of. Yet just as treatments are improving for other cancers, progress is being made for this disease, too. Some large medical centers are now doing surgery for cancers that were previously considered inoperable. And even with advanced disease, newer treatments such as targeted therapy and immunotherapy may be changing the face of pancreatic cancer, as they have with some other cancers.

    Even though treatments aren't what we wish for them to be today, oncology has come a very long way in managing the symptoms and concerns related to cancer so that people can get the most from their time with family and friends no matter how much time is left.

    What Are the Signs and Symptoms of Pancreatic Cancer?
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