Adenocarcinoma of the Pancreas
Adenocarcinoma of the pancreas is the most common type of pancreatic cancer, accounting for about 90% of cases. This disease often develops without early warning signs, making it difficult to detect until it has advanced. Understanding this cancer, its symptoms, and available treatments can help patients and their families navigate this challenging diagnosis.
Table of contents
- What is Pancreatic Adenocarcinoma?
- The Pancreas and Its Function
- Symptoms and Warning Signs
- Risk Factors
- How is it Diagnosed?
- Outlook and Survival
- Treatment Options
- Managing Quality of Life
What is Pancreatic Adenocarcinoma?
Pancreatic adenocarcinoma is a type of cancer that begins in the cells lining the small tubes inside the pancreas, called ducts. These ducts normally carry digestive juices that contain enzymes to help break down food.[1][2]
About 95 out of 100 pancreatic cancers are exocrine cancers, which means they start in the exocrine cells that make digestive enzymes. Most of these exocrine cancers are adenocarcinomas. In fact, about 9 out of 10 people with pancreatic cancer have this specific type of tumor.[4][5]
Pancreatic adenocarcinoma can grow anywhere in the pancreas, though it is most often found in the head of the pancreas, which is the widest part of the organ.[5] When people or doctors refer to “pancreatic cancer” without specifying the type, they are usually talking about adenocarcinoma.[6]
The Pancreas and Its Function
The pancreas is a gland located in your abdomen, between your spine and stomach. It sits behind the stomach and is shaped like a thin pear lying on its side. The organ is about 6 inches long and has three main parts: the widest end is called the head, the middle section is the body, and the narrow end is the tail.[1][7]
- Pancreas
- Stomach
- Small intestine
- Bile duct
Your pancreas has two main jobs in your body. First, it makes digestive juices that help break down food into substances the body can use. Second, it makes hormones like insulin and glucagon that help control blood sugar levels and help the body use and store energy from food.[1][7]
Symptoms and Warning Signs
Unfortunately, pancreatic adenocarcinoma does not cause noticeable symptoms in its early stages. Most patients are without symptoms during the early course of disease, which often leads to delays in diagnosis.[1][2] This is one reason why the disease is often not discovered until it has already spread to other parts of the body.[3]
As the cancer grows and begins to affect other organs in the digestive system, symptoms typically emerge. The signs of pancreatic cancer, when present, are similar to the signs of many other illnesses, such as pancreatitis (inflammation of the pancreas) or an ulcer.[7]
Common symptoms include:[1][3][7]
- Jaundice (yellowing of the skin and whites of the eyes)
- Light-colored stools or dark urine
- Pain in the upper or middle abdomen
- Back pain
- Unexplained weight loss
- Loss of appetite
- Fatigue
- Nausea and vomiting
- Gas or bloating
- Blood clots
- New-onset diabetes
Some people develop vague symptoms up to one year before receiving a diagnosis. Many people report that their first symptoms were back pain or stomach pain. These symptoms can come and go at first but may worsen after meals or when lying down.[3]
Risk Factors
While the exact cause of pancreatic adenocarcinoma is not fully understood, experts have identified several factors that increase a person’s chances of developing the disease. Having one or more risk factors does not mean you will definitely get pancreatic cancer, and many people with no known risk factors do develop the disease.[7]
The most common risk factors include:[1][2][3]
- Cigarette smoking: This appears to be one of the strongest risk factors and is likely associated with as many as one quarter of all pancreatic tumors. About 25% of cases are linked to smoking.[2][6]
- Age: Most pancreatic cancer is diagnosed after age 65, and it rarely occurs before age 40.[1][6]
- Diabetes mellitus: Type 2 diabetes may play a role in development of pancreatic cancer. Patients with type 2 diabetes often have years of insulin resistance with high insulin levels, and insulin’s ability to promote cell growth may explain the association.[2]
- Chronic pancreatitis: Long-term inflammation of the pancreas increases risk.[1]
- Family history: Having family members with pancreatic cancer raises your risk.[1]
- Certain genetic syndromes: Including hereditary nonpolyposis colon cancer (Lynch syndrome), hereditary breast and ovarian cancer syndrome, and others.[7]
- Obesity: Carrying extra weight increases risk.[1]
- Alcohol use: Heavy drinking is associated with increased risk.[2]
Research has found that the specific combination of smoking, diabetes, and poor diet increases the risk of pancreatic cancer more than any single factor alone.[1] Additionally, the disease is more common in African-Americans and slightly more common in men.[2]
How is it Diagnosed?
Pancreatic cancer is difficult to detect and diagnose early because there are no noticeable signs or symptoms in the early stages, and the pancreas is hidden behind other organs in the abdomen, making it difficult to see clearly on imaging tests.[7]
To diagnose pancreatic adenocarcinoma and determine its extent, doctors use several tests:[7][8]
- Imaging tests: These include computed tomography (CT) scans, magnetic resonance imaging (MRI), and endoscopic ultrasonography to look at the pancreas and surrounding areas.
- Blood tests: These can measure tumor markers like CA 19-9, though this marker has low specificity. Most patients with pancreatic cancer have an elevated CA 19-9 level at diagnosis.[12]
- Tissue biopsy: A small sample of tissue is removed and examined under a microscope to confirm cancer and determine its type.[3]
- Endoscopic procedures: Tools inserted through the mouth or other openings can help visualize and sample tissue from the pancreas.
Doctors may also use PET scans and genetic testing to stage the cancer accurately and assess its behavior. These newer tests help determine if treatment is working effectively.[20]
Outlook and Survival
The outlook for pancreatic adenocarcinoma is generally poor. The overall one- and five-year survival rates are 24% and 6%, respectively, making it the only cancer with an overall 5-year survival rate in the single digits.[2][15]
Approximately 80% of patients have disease that has spread to nearby areas or other parts of the body at the time of diagnosis.[2] Pancreatic cancer is the fourth leading cause of cancer death in men and women in the United States, and it is expected to become the second leading cause of cancer death by 2030.[2][3]
The primary factors that influence prognosis include:[12]
- Whether the tumor can be completely removed by surgery
- Whether the tumor has spread to lymph nodes or other parts of the body
- The patient’s overall health and ability to tolerate treatment
However, there is reason for hope. People with pancreatic cancer are living longer thanks to improved treatment approaches. New methods of treatment and better ways to detect and manage the disease are helping improve outcomes for patients.[20]
Treatment Options
Treatment for pancreatic adenocarcinoma depends on several factors, including where the tumor is located, whether it can be removed by surgery, and whether it has spread. The main treatment approaches include surgery, chemotherapy, radiation therapy, and supportive care.[2]
Surgery
Surgery is the primary treatment that offers any chance of curing the disease. However, fewer than 20% of patients are eligible for surgery because the cancer has often already spread by the time of diagnosis.[15] The most common surgical procedure is the Whipple procedure (also called pancreaticoduodenectomy), which removes the head of the pancreas, part of the small intestine, the gallbladder, and part of the bile duct.[8][21]
Other surgical options include distal pancreatectomy, which removes the tail and sometimes the body of the pancreas, and total pancreatectomy, which removes the entire pancreas.[14]
Chemotherapy
Chemotherapy uses drugs to kill cancer cells. It may be given before surgery (neoadjuvant therapy) to shrink the tumor, after surgery (adjuvant therapy) to kill any remaining cancer cells, or as the main treatment when surgery is not possible.[9][21]
Common chemotherapy combinations include FOLFIRINOX and gemcitabine-based regimens. The choice depends on the patient’s overall health and the specific characteristics of the cancer.[10]
Radiation Therapy
Radiation therapy uses high-energy beams to kill cancer cells. It is often combined with chemotherapy (called chemoradiotherapy) and may be used before or after surgery, or as the main treatment for tumors that cannot be removed.[9]
Targeted Therapy and Immunotherapy
For some patients, newer treatments like targeted therapy and immunotherapy may be options. Immunotherapy drugs like pembrolizumab (Keytruda) and dostarlimab (Jemperli) are approved for small subsets of patients whose tumors have specific characteristics, such as high microsatellite instability or DNA mismatch repair deficiency.[15]
Palliative Care
Palliative care focuses on relieving symptoms and improving quality of life rather than curing the disease. This type of care is important for all patients with pancreatic cancer, regardless of whether they are receiving other treatments. Palliative care can help manage pain, digestive problems, and other symptoms.[10]
Managing Quality of Life
A pancreatic cancer diagnosis brings many life changes, both physical and emotional. While the disease and its treatment can be stressful, there are several ways patients can better cope and maintain their quality of life.[17]
Nutrition and Diet
Maintaining proper nutrition is essential but can be challenging. Patients often experience loss of appetite, feeling full quickly, and digestive difficulties. Eating multiple small meals throughout the day rather than three large meals can help. Some patients benefit from taking pancreatic enzyme supplements prescribed by their doctor to help digest food better.[19]
Staying hydrated is crucial, especially if experiencing diarrhea or vomiting. Water, herbal teas, and clear broths are good choices. It may help to avoid fatty foods, very spicy foods, and foods high in sugar, as these can be harder to digest.[18]
Physical Activity
Staying physically active can help improve mood, increase energy levels, and support overall health. Even light exercise like walking, gentle stretching, or yoga can be beneficial. The key is to start slowly and listen to your body, resting when needed.[18][19]
Managing Symptoms
Common symptoms like pain, fatigue, and depression can be managed with proper medical care. Pain can be controlled with medications, and it’s important to work with a pain specialist if needed. Anti-depressant medications and counseling can help with depression and anxiety. Don’t hesitate to ask your medical team for help managing these symptoms.[19]
Support Systems
Developing a strong support system is vital. This includes family, friends, clergy, and your medical team. Talking openly about your feelings and concerns can help everyone cope better. Many patients find comfort in support groups where they can connect with others facing similar challenges.[17][16]
Remember that you are not alone. Organizations like the Pancreatic Cancer Action Network offer one-on-one support, counseling connections, and resources to help you throughout your journey.[16]
Finding Your “New Normal”
Life changes after a pancreatic cancer diagnosis, but living each day as normally as you can is important. Being open to new meaning in life and embracing a “new normal” can help. This might mean adapting activities you enjoy or discovering new hobbies. Taking time for self-care, relaxation, and activities that bring joy can make a significant difference in your well-being.[16]
