Pancreatic Carcinoma

Pancreatic cancer begins when cells in the pancreas grow out of control, forming a tumor. This disease is difficult to detect early and often spreads before symptoms appear, making it one of the most challenging cancers to treat.

Table of contents

• What Is Pancreatic Cancer?
• The Pancreas and Its Function
• Types of Pancreatic Cancer
• Risk Factors
• Signs and Symptoms
• Diagnosis
• Stages of Pancreatic Cancer
• Treatment Options
• Prognosis and Survival
• Living with Pancreatic Cancer

What Is Pancreatic Cancer?

Pancreatic cancer occurs when cells in your pancreas change and multiply out of control, forming a tumor^[1][2]. Normally, cells divide to form new cells as the body needs them. When cells get old, they die, and new cells take their place. Sometimes this process breaks down. New cells form when the body does not need them, or old cells do not die^[8].

The extra cells may form a mass of tissue called a tumor. Some tumors are benign (not cancerous), meaning they are abnormal but cannot invade other parts of the body. A malignant tumor is called cancer. The cells grow out of control and can spread to other tissues and organs^[8].

Pancreatic cancer is responsible for approximately 3% of all cancers in the United States. It is the 10th most common cancer in men and the 8th most common cancer in women^[2]. More than 67,000 Americans are expected to be diagnosed with pancreatic cancer in 2025, which is more than 184 people diagnosed every day^[8].

Even when the cancer spreads to other areas of the body, it is still called pancreatic cancer if that is where it started. Pancreatic cancer often spreads to the liver, abdominal wall, lungs, bones and lymph nodes^[8].

The Pancreas and Its Function

• Pancreas
• Stomach
• Intestines
• Liver
• Spleen

Your pancreas is a gland in your abdomen, located between your spine and stomach^[2]. The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side^[4]. The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail^[4].

The pancreas has two main jobs in the body. First, it makes juices that help break down food into substances the body can use. Second, it makes hormones, such as insulin (a hormone that helps control blood sugar) and glucagon, that help control blood sugar levels and help the body use and store the energy it gets from food^[4].

The pancreas produces digestive juices and hormones. It makes enzymes that aid in digestion and hormones that control blood-sugar levels^[2][6].

Types of Pancreatic Cancer

Pancreatic cancer can occur in exocrine pancreas cells, which produce digestive juices, or the endocrine pancreas cells, which produce hormones. About 95% of pancreatic cancers begin in exocrine cells^[4].

There are two main types of pancreatic tumors^[2]:

Exocrine tumors: Over 90% of all pancreatic tumors are exocrine tumors. The most common type of pancreatic cancer is adenocarcinoma, which begins in the cells that line your organs. Most pancreatic cancers start in the ducts of your pancreas^[2]. Around 92% of pancreatic cancers are classified as exocrine tumors^[8].

Neuroendocrine tumors: Less than 10% of pancreatic tumors are neuroendocrine tumors (NETs), also called islet cell tumors or pancreatic NETs (PNETs). They often grow slower than exocrine tumors^[2][8].

Risk Factors

A risk factor is anything that increases the chance of getting a disease. Some risk factors for pancreatic cancer, like smoking, can be changed. However, risk factors also include things people cannot change, like their genetics and their family history^[4].

Having one or more of these risk factors does not mean that you will get pancreatic cancer. Many people with risk factors never develop pancreatic cancer, while others with no known risk factors do^[4].

Risk factors for pancreatic cancer include^[4][5]:

• Smoking: Smoking cigarettes, cigars and using other forms of tobacco. About 20% of pancreatic cancers are caused by smoking^[5].
• Age: Most pancreatic cancer is diagnosed after age 65^[1].
• Excess body weight: Having excess body weight or obesity^[4].
• Diabetes: Having a personal history of diabetes^[4].
• Chronic pancreatitis: Having a personal history of chronic pancreatitis or inflammation of the pancreas^[4].
• Family history: Having a family history of pancreatic cancer or pancreatitis^[4].
• Gender and ethnicity: Males more than females, and African Americans more than whites^[5].
• Cirrhosis of the liver^[5]
• Helicobacter pylori infection^[5]
• Work exposure to chemicals in the dry cleaning and metalworking industry^[5]

Having certain hereditary conditions also increases risk, such as^[4]:

• Hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome)
• Peutz-Jeghers syndrome
• Hereditary breast and ovarian cancer syndrome
• Familial atypical multiple mole melanoma (FAMMM) syndrome
• Ataxia-telangiectasia

About 10% of pancreatic cancers are considered familial or hereditary. Most pancreatic cancer happens randomly or is caused by things such as smoking, obesity and age^[8].

Possible risk factors include heavy alcohol consumption, coffee consumption, physical inactivity, high red meat consumption, and 2 or more soft drinks per day^[5].

Signs and Symptoms

Unfortunately, there are not any early signs of pancreatic cancer^[2]. Pancreatic cancer often does not cause any signs or symptoms in its early stages, making it hard to detect^[4]. Early-stage pancreatic tumors do not show up on imaging tests. For this reason, many people do not receive a diagnosis until the cancer has spread^[2].

Symptoms typically emerge once the tumor starts impacting other organs in your digestive system^[2]. Some people develop vague symptoms up to one year before they receive a diagnosis^[2].

Pancreatic cancer symptoms may include^[2][4]:

• Jaundice (yellowing of the skin and whites of the eyes)
• Light-colored stool
• Dark urine
• Pain in the upper or middle abdomen and back
• Weight loss
• Fatigue
• Itchy skin
• Nausea and vomiting
• Gas or bloating
• Lack of appetite
• Blood clots
• New-onset diabetes

Many people report that their first pancreatic cancer symptoms were back pain or stomach pain. These symptoms can come and go at first, but may get worse after meals or when you lie down^[2].

Your healthcare provider might suspect pancreatic cancer if you have recently developed diabetes or pancreatitis, which is a painful condition due to inflammation in your pancreas^[2].

Symptoms of pancreatic neuroendocrine cancer may be different from traditional pancreatic cancer symptoms, such as jaundice or weight loss. Symptoms can vary, but may include diarrhea and anemia^[2].

Diagnosis

Pancreatic cancer is difficult to diagnose early^[4]. Because the pancreas is hidden behind other organs, health care providers cannot see or feel the tumors during routine exams^[9].

Doctors use a physical exam, blood tests, imaging tests, and a biopsy to diagnose it^[9]. Tests that examine the pancreas are used to diagnose and stage pancreatic cancer^[4].

Most people are diagnosed with pancreatic cancer after they become unwell and go to the emergency department. Others start by seeing their primary care doctor^[6].

Some people decide to get a second opinion. You have a right to seek a second opinion, and pancreatic cancer organizations strongly recommend seeking a second opinion, as needed, at any point in your diagnosis^[4].

Stages of Pancreatic Cancer

Stage means the size of the cancer and whether it has spread. Staging describes the size of the cancer, and how advanced the cancer is (whether it has spread)^[6].

Knowing the stage information helps doctors decide about treatment^[6]. Certain factors affect prognosis (chance of recovery) and treatment options^[4].

Typically, extrapancreatic disease precludes curative resection, and surgical treatment may be palliative at best^[15]. Only 20% of pancreatic cancer is surgically resectable at the time of diagnosis^[5].

Treatment Options

Your treatment depends on the position of the cancer in the pancreas, how big it is, the type of pancreatic cancer it is, whether it has spread, if they can remove it with surgery and your general health^[6].

There is consensus that surgery is the primary mode of treatment for pancreatic cancer^[15]. Surgical resection is the only current option for a cure^[5]. However, an important role exists for chemotherapy and radiation therapy in an adjuvant or neoadjuvant setting, and in the treatment of patients with unresectable disease^[15].

Because it is often found late and it spreads quickly, pancreatic cancer can be hard to treat. Possible treatments include surgery, radiation, chemotherapy, and targeted therapy (treatment that uses drugs or other substances that attack specific cancer cells with less harm to normal cells)^[9].

Curative resection options include pancreaticoduodenectomy (also known as the Whipple procedure), with or without sparing of the pylorus; total pancreatectomy; and distal pancreatectomy^[15]. The Whipple procedure is one of the most common procedures done for pancreatic cancer, specifically when located in the head or uncinate process of the pancreas^[10].

In qualified high-volume centers, pancreatic surgery (especially distal pancreatectomy, but including pancreaticoduodenectomy) can often be performed laparoscopically^[15].

Pancreatic cancer patients who participate in clinical research have better outcomes. Every treatment available today was approved through a clinical trial^[21].

Prognosis and Survival

Pancreatic cancer survival rates are low because the disease is difficult to detect in the early stages^[2]. The 5-year survival rate in the United States ranges from 5% to 15%. The overall survival rate is only 6%^[5].

Cases of pancreatic cancer are on the rise. Trends indicate that pancreatic cancer will be the second leading cause of cancer death in the United States by 2030^[2].

Close cooperation among various specialties, including surgeons, oncologists, radiation oncologists, pathologists, and radiologists, is extremely important for the chance of survival in patients with resectable disease and borderline resectable disease^[5].

For patients who have undergone surgical resection of the involved pancreas, published series from high-volume referral centers examining long-term survivors indicate that only 10% to 27% of patients with early-stage disease who underwent resection survived at least 5 years^[13].

There is a high frequency of subclinical metastases at initial presentation as well as a high frequency of undetectable extrapancreatic disease at the time of surgical resection, which also contributes to the poor long-term outcomes^[13].

Living with Pancreatic Cancer

Living with pancreatic cancer means different things to different people. Whether or not you have been diagnosed with pancreatic cancer, or care for someone who has the disease, it will have a large impact on your life^[18].

Managing the symptoms associated with pancreatic cancer, side effects of treatments and conditions that can occur because of the disease, can feel complicated and daunting^[18].

Get practical and emotional support to help you cope with a diagnosis of pancreatic cancer, and life during and after treatment^[6]. Support is critical to improve quality of life and overall well-being^[21].

A diagnosis of pancreatic cancer requires a patient to adapt to many life changes. The disease is accompanied by a wide range of new, and sometimes difficult, emotions, various physical symptoms, and numerous decisions regarding care^[19].

A strong support system, including family, friends, clergy, and a good medical team, will help a patient deal with these different aspects of pancreatic cancer^[19]. Patients may find comfort in writing in a journal, joining a formal support group, or seeking individual counseling^[19].

Getting organized can help patients and their loved ones take control and better understand their options. This includes keeping copies of your medical records and lab results, tracking your symptoms, side effects and questions, and finding out what support resources are available through your hospital^[21].

Maintaining health and staying active are crucial for improving quality of life and managing symptoms. Engaging in healthy habits can help boost energy levels, enhance mood, and support the body during treatment^[20].