Pancreatic Cancer

Pancreatic cancer is an aggressive tumor that forms in your pancreas, a gland that aids in digestion. This disease is the 11th most common cancer in the U.S. It’s on track to be the second most common cause of cancer-related deaths by the year 2030.

It often doesn’t cause symptoms in the early stages, so many people don’t learn they have it until it’s already spread. It’s also resistant to many common cancer drugs, making it notoriously difficult to treat. Even when it’s caught early, more than half of people will not survive beyond five years because it’s so aggressive and difficult to treat.

Still, no two diagnoses are the same. Your healthcare provider will let you know what to expect based on your situation.

Types of this condition

There are two main types:

• Adenocarcinoma (exocrine tumors): Over 9 out of 10 of all tumors that form in the pancreas are this type. When people talk about pancreatic cancer, they usually mean this kind.
• Neuroendocrine tumors: These rare tumors are also called PNETs. They can be either cancerous or noncancerous (benign). The cancerous form is also called Islet cell carcinoma.

The differences are important because treatments and outlook vary by type. PNETs are usually less aggressive than adenocarcinoma.

Symptoms of pancreatic cancer

Unfortunately, there aren’t any early signs of pancreatic cancer. Symptoms often start once the tumor impacts other organs in your digestive system. At this point, the disease is often advanced.

Symptoms include:

• Pain in your upper abdomen, mid-back or side
• Signs of jaundice
• Upset stomach and nausea
• Weight loss and loss of appetite
• Constipation and/or diarrhea
• Dark pee and/or pale poop (stools)
• Itchy skin
• Fatigue

Your healthcare provider might suspect pancreatic cancer if you’ve recently developed pancreatitis — inflammation in your pancreas — or diabetes. This is because your pancreas helps manage your blood sugar levels.

​Pancreatic cancer causes and risk factors

It happens when gene changes (mutations) cause cells to grow out of control. Over time, they can form a tumor. Experts don’t know why it happens. But they’ve found mutations common in pancreatic cancer. For instance, more than 9 out of 10 cases involve errors in the KRAS gene. 

About 1 out of 10 people with this condition inherit genes from a biological parent that raise their risk. But most people develop mutations linked to cancer that are not hereditary in their lifetimes. 

Most people diagnosed are over 60 years old. The risk is greater among males and people who are Black or of Ashkenazi Jewish descent. 

Other risk factors include:

• Smoking cigarettes, cigars and using other forms of tobacco
• Obesity, particularly if you carry extra weight around your waist
• Diabetes, especially Type 2 diabetes
• Exposure to pesticides and chemicals refined from oil to make products
• Pancreatitis, including forms that run in families
• Hereditary syndromes that involve gene mutations, like BRCA1 or BRCA2
• Family history of pancreatic cancer

You can’t change most of these things. But you can reduce your risk by choosing not to smoke (or quitting if you do) and losing weight if you have obesity.

How doctors diagnose this condition

It’s difficult to detect pancreatic cancer early. Diagnosis is often delayed because symptoms don’t start until the cancer is advanced. Also, healthcare providers can’t feel lumps in your pancreas during routine exams. It’s too deep inside your abdomen.

Instead, you’ll need several tests, including:

• Imaging tests: Most providers use CT scans to check for tumors. They may also use an MRI, PET scan or endoscopic ultrasound (EUS). 
• Blood tests: Providers check for enzymes or proteins that may suggest the presence of a tumor. They’ll check for high levels of (CA) 19-9. This is a substance released by cancer cells in the pancreas.
• Biopsy: They’ll use a thin needle to remove a sample of the tumor and test it for cancer cells. This may happen during an EUS. 
• Genetic tests: Your provider will test cancer cells for gene mutations. This can help them find treatments that target weaknesses in those cells. Hereditary genetic testing is recommended for every person diagnosed with pancreatic cancer, regardless of age or family history.

Staging

Healthcare providers mainly use imaging scans, like CT, MRI or PET scans, to determine the stage of pancreatic cancer.

They’ll label the tumor as:

• Resectable: The tumor is only in your pancreas and doesn’t involve nearby blood vessels or other organs. It’s the same as early-stage cancer. A surgeon can remove it with surgery.
• Borderline resectable: The tumor is in your pancreas and affects nearby blood vessels. But a surgeon may still be able to remove it.
• Locally advanced: The tumor is in your pancreas and involves major blood vessels to the point that surgery isn’t possible.
• Metastatic: The cancer has spread to places like your liver, lungs or abdomen. More than half of pancreatic cancers are diagnosed at this advanced stage.

Sometimes, providers use laparoscopy to see how much the cancer has spread. They’ll make a few small cuts in your abdomen and insert a scope with a camera on the end. This allows them to see inside your abdomen and look for signs of cancer.

Your provider may also rank the cancer from stages 1 to 4. Stage 1 means early-stage disease, while stage 4 is metastatic.

They’ll explain how the cancer stage impacts your treatment options.

How is it treated?

Pancreatic cancer is one of the hardest cancers to treat. In addition to often being advanced at diagnosis, your pancreas is hard to access. First, it’s behind your stomach and close to key blood vessels. This makes surgery challenging. It’s enclosed by dense tissue called the stroma. Drugs trying to reach the tumor can’t always cross this tissue barrier.

This is why one of the best options may be to take part in a clinical trial to access new treatments that are trying to overcome these challenges.

Surgery

Surgery on your pancreas is the only way to cure pancreatic cancer. But surgeons only recommend it when they think they can remove all of the cancer. Otherwise, there’s little to no benefit.

For surgery to be successful, the cancer must be in only your pancreas. There are different techniques, depending on the location and size of the tumor:

• Whipple procedure: Removes the widest part of your pancreas, the first part of your small intestine, your gallbladder, part of your bile duct and nearby lymph nodes.
• Distal pancreatectomy: Removes the thinnest part of your pancreas and some of the middle part. Often, surgeons remove your spleen.
• Total pancreatectomy: Removes your pancreas, gallbladder, spleen, and part of your stomach and small intestine.

You can live without a pancreas, but it can cause major side effects. Your pancreas makes insulin and other hormones that keep blood sugar at a safe level. Without a pancreas, you’ll develop diabetes and need insulin shots to survive. You’ll also need to take pancreatic enzyme pills to help with digestion.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells throughout your body. Healthcare providers give these drugs in pill form or through an IV in your arm. It’s the most common treatment for people diagnosed with pancreatic cancer.

Providers may use chemotherapy alone, especially if the cancer is advanced. They may recommend chemotherapy before surgery to shrink the tumor or after surgery to kill any remaining cancer cells.

Radiation therapy

Radiation therapy uses high-energy X-rays to kill cancer cells. Most often, providers combine radiation therapy with chemotherapy. They may recommend it before surgery, after surgery or as part of your main cancer treatment.

Targeted therapy

This treatment uses drugs that “target” certain proteins. These proteins help cancer cells grow and spread. You may benefit from a targeted therapy if the cancer cells contain the gene changes that the drug targets.

Providers may combine targeted therapy with other treatments. Researchers are testing promising new forms of this treatment in clinical trials.

When should I see my healthcare provider?

It may be a good idea to speak with a genetic counselor if you’re concerned about inherited gene mutations linked to pancreatic cancer. There aren’t standard screening guidelines for this disease. But we know that in some cases, there’s a biological family link.

If your diagnosis involves an inherited mutation, a genetic counselor can help you understand how to communicate potential risks to family members.

If you have a family history of pancreatic cancer, a genetic counselor can help you decide whether you'd benefit from hereditary gene testing.

​What can I expect if I have this condition?

A pancreatic cancer diagnosis can feel overwhelming. Most people learn they have it once they’re already at stage 4, where it’s most challenging to treat.

Still, no two cases are the same. Your care team will help you decide the best treatment plan for your situation. This may involve treatments to send cancer into remission for early-stage pancreatic cancer. It may involve managing symptoms and helping you feel better. This is called palliative care.

Unlike hospice treatments, palliative care isn’t end-of-life care. It can help no matter your prognosis. It can:

• Help you manage pain: This is important, as tumors in your pancreas can press on nerves and cause pain.
• Ensure you get enough nutrition: Cancers that affect your digestive system can cause you to lose weight and strength. Keeping your body nourished is very important.
• Connect you with resources: This includes providing emotional support to make living with this disease feel more manageable.

How long do people live with pancreatic cancer?

Most people who are diagnosed with pancreatic cancer die within the year. The five-year survival rate is 13%. This means that about 13 out of 100 people with this diagnosis survive beyond five years.

Remember, though, that survival rates are estimates. They can’t tell you how long you will live or how you’ll respond to treatment. Also, the numbers are about the past. They don’t account for the impact new treatments can have on your outlook.

This is why your healthcare provider is your best resource to explain your prognosis.

Has anyone ever survived pancreatic cancer?

Yes. Cancer survivors include people with pancreatic cancer. The best chance for survival involves having a successful surgery for early-stage cancer. The National Comprehensive Cancer Network recommends treatment in a center that does at least 15 to 20 pancreatic cancer surgeries each year.