Pancreatic carcinoma is a serious disease that develops in the pancreas, a small but vital organ tucked deep in the abdomen. This cancer often goes unnoticed in its early stages, making it one of the most challenging cancers to detect and treat. Understanding this disease, its risk factors, and how it affects the body can help patients and families navigate the difficult journey ahead.
Epidemiology
Pancreatic cancer represents a significant health challenge across the globe. It is responsible for approximately 3% of all cancers in the United States, ranking as 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 translates to more than 184 people receiving this diagnosis every single day.[8]
The disease is currently the fourth leading cause of cancer deaths in the United States.[1][5] Unfortunately, trends indicate that pancreatic cancer will become the second leading cause of cancer death in the United States by 2030, showing that cases are on the rise.[2][14] This upward trend makes understanding and addressing this disease even more urgent.
Looking at global patterns, pancreatic cancer kills more than 331,000 people per year worldwide and ranks as the seventh principal cause of cancer death in both men and women.[5] The estimated global 5-year survival rate for pancreatic cancer is about 5%, though in the United States this ranges from 5% to 15%, with an overall survival rate of only 6%.[5][2] These low survival rates reflect the difficulty in detecting the disease early and its resistance to many treatments.
Geographically, incidence rates for pancreatic cancer are highest in Northern America, Western Europe, Europe, and Australia/New Zealand. The lowest incidence rates are found in Middle Africa and South-Central Asia.[5] There are also some gender differences. For men, the greatest risk of developing pancreatic cancer is in Armenia, the Czech Republic, Slovakia, Hungary, Japan, and Lithuania, while the lowest risk is in Pakistan and Guinea. For women, the highest incidence rates are in Northern America, Western Europe, Northern Europe, and Australia/New Zealand, with the lowest rates in Middle Africa and Polynesia.[5] Around 10,500 people are diagnosed with pancreatic cancer in the UK each year, making it the 10th most common cancer in that country.[6]
Causes
The exact causes of pancreatic cancer are not fully understood. Changes in DNA cause cancer, and these changes can be inherited from parents or can develop over time.[8] Most pancreatic cancer happens randomly or is caused by factors such as smoking, obesity, and age. About 10% of pancreatic cancers are considered familial or hereditary, meaning they run in families.[8]
Pancreatic cancer is caused by certain changes to the way pancreatic cells function, especially how they grow and divide into new cells.[4] When cells in the pancreas mutate (change) and multiply out of control, they form a growth called a tumor. The pancreas is a gland in your abdomen, between your spine and stomach, that makes hormones to control blood-sugar levels and enzymes that aid in digestion.[2][14]
Most pancreatic cancers start in the ducts of the pancreas. Small changes in the cellular DNA result in uncontrolled multiplication and accumulation of cells in clusters called tumors. If untreated, these cancer cells can spread outside of the pancreas to other parts of the body.[1] Over 90% of all pancreatic tumors are exocrine tumors, which start in cells that produce digestive juices. The most common type of pancreatic cancer is adenocarcinoma, which begins in the cells that line your organs.[2][14] About 95% of pancreatic cancers begin in exocrine cells.[4]
Less than 10% of pancreatic tumors are neuroendocrine tumors (NETs), also known as islet cell carcinoma. These tumors often grow slower than exocrine tumors.[2][14] Around 8% of pancreatic tumors are neuroendocrine tumors.[8]
Risk Factors
A risk factor is anything that increases the chance of getting a disease. Some risk factors for pancreatic cancer can be changed, like smoking, while others cannot be changed, such as genetics and family history.[4] Having one or more risk factors does not mean you will definitely get pancreatic cancer. Many people with risk factors never develop the disease, while others with no known risk factors do.[4]
Smoking is recognized as a strong risk factor for pancreatic cancer. About 20% of pancreatic cancers are caused by smoking cigarettes, cigars, and using other forms of tobacco.[5][2] New research has found that the specific combination of smoking, diabetes, and poor diet increases the risk of pancreatic cancer the most beyond any one factor alone.[1]
Age is another important factor. Most pancreatic cancer is diagnosed after age 65, and being older than 55 years is considered a risk factor.[1][5] Having excess body weight, or obesity, also increases risk.[4][5] Carrying extra weight that is unhealthy for your body may be a contributing factor to developing this disease.[1]
Certain medical conditions raise the risk as well. Having a personal history of diabetes or chronic pancreatitis (long-term inflammation of the pancreas) increases the chance of developing pancreatic cancer.[4][5] Cirrhosis of the liver and Helicobacter pylori infection are also risk factors.[5] Additionally, work exposure to chemicals in the dry cleaning and metalworking industries has been linked to higher risk.[5]
Family history plays a role too. Having a family history of pancreatic cancer or pancreatitis can increase risk.[4] If you are a first-degree relative (such as a parent, sibling, or child) of someone diagnosed with pancreatic cancer, you may have an increased risk of developing the disease yourself.[8] Ten percent of pancreatic cancers have a genetic cause, such as genetic mutations or association with syndromes like Lynch syndrome, Peutz-Jeghers syndrome, Von Hippel-Lindau syndrome, and MEN1 (multiple endocrine neoplasia type 1).[5] Other hereditary conditions that increase risk include hereditary breast and ovarian cancer syndrome, familial atypical multiple mole melanoma (FAMMM) syndrome, and ataxia-telangiectasia.[4]
There are also some gender and racial differences in risk. Males are at slightly higher risk than females, and African Americans are at higher risk than whites.[5] Possible risk factors that are still being studied include heavy alcohol consumption, coffee consumption, physical inactivity, high red meat consumption, and drinking 2 or more soft drinks per day.[5]
Symptoms
One of the major challenges with pancreatic cancer is that there are no tell-tale early signs. Unfortunately, there aren’t any early signs of pancreatic cancer, and the disease doesn’t cause symptoms right away.[2][14] We don’t usually see the signs of pancreatic cancer until it’s in more advanced stages.[1] Symptoms typically emerge once the tumor starts impacting other organs in the digestive system.[2][14]
Some people develop vague symptoms up to one year before they receive a diagnosis.[2][14] 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 lying down.[2][14]
As the cancer grows, symptoms may include jaundice (yellowing of the skin and whites of the eyes), which is one of the more noticeable signs.[4][2] Along with jaundice, patients may notice light-colored stools and dark urine, which happen because of changes in how the body processes bile.[4][2]
Pain is a common symptom. This includes pain in the upper or middle abdomen and back, which can be persistent and troubling.[4][2] Digestive issues are also frequent. Patients may experience nausea and vomiting, gas or bloating, and a lack of appetite.[2][14] Weight loss is another significant symptom, often happening without trying to lose weight.[4][2]
Other symptoms can include fatigue, itchy skin, and blood clots.[2][14] A healthcare provider might suspect pancreatic cancer if a patient has recently developed diabetes or pancreatitis, especially if these conditions appear suddenly and without clear cause.[2][14]
It’s important to note that symptoms of pancreatic neuroendocrine cancer may be different from traditional pancreatic cancer symptoms. Instead of jaundice or weight loss, patients might experience diarrhea and anemia.[2][14]
Because symptoms are often vague and can be confused with other, less serious conditions, pancreatic cancer is difficult to diagnose early. This is why many patients are diagnosed only after the cancer has already spread.[4] If you experience any of these symptoms, especially if they persist or worsen, it’s important to see a healthcare provider for evaluation.
Prevention
While pancreatic cancer is not entirely preventable, there are steps people can take to reduce their risk. Technically, pancreatic cancer cannot be completely prevented because if you have a pancreas, there’s always a risk of developing pancreatic cancer.[10] However, there are some modifiable risk factors that, when addressed, can lower the likelihood of developing the disease.
Smoking is one of the most important modifiable risk factors. Since about 20% of pancreatic cancers are caused by smoking, quitting smoking or never starting in the first place is one of the most effective ways to reduce risk.[5] Those who smoke cigarettes, cigars, or use other forms of tobacco should seek help to quit.
Maintaining a healthy weight is another key prevention strategy. Obesity is associated with an increased risk of pancreatic cancer, so keeping body weight within a healthy range through balanced diet and regular physical activity can be protective.[1][4] New research suggests that the combination of smoking, diabetes, and poor diet increases risk significantly, so eating a nutritious diet with plenty of fruits, vegetables, lean proteins, and whole grains is beneficial.[1]
Managing chronic health conditions like diabetes and pancreatitis is also important. While these conditions themselves are risk factors, proper management and regular medical care can help reduce complications and possibly lower cancer risk.[4] Reducing alcohol consumption, staying physically active, and limiting intake of red meat and sugary drinks may also help, though these factors are still being studied.[5]
For individuals with a family history of pancreatic cancer or certain genetic syndromes, genetic testing and counseling may be recommended. Early screening and monitoring in high-risk individuals can sometimes help detect changes earlier, though routine screening for pancreatic cancer is not currently standard for the general population.[4] Talking with a doctor about personal and family medical history is important for understanding individual risk and what steps might be appropriate.
Overall, living a healthier lifestyle—not smoking, maintaining a healthy weight, eating well, and staying active—can reduce risk. While these measures don’t guarantee prevention, they support overall health and may lower the chances of developing pancreatic cancer.[10]
Pathophysiology
Understanding how pancreatic cancer changes the normal workings of the body can help patients and families grasp what is happening inside the body. The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side. It has three areas: the head, body, and tail. The pancreas is found in the abdomen near the stomach, intestines, and other organs.[4][11]
The pancreas has two main jobs in the body. First, it makes juices that help break down food into substances the body can use. These are digestive enzymes. Second, it makes hormones such as insulin and glucagon, which help control blood sugar levels and help the body use and store the energy it gets from food.[4][11] The pancreas produces enzymes that aid in digestion and hormones that regulate blood sugar.[8]
Pancreatic cancer occurs when cells in the pancreas mutate and multiply out of control, forming a tumor.[2][14] Most pancreatic cancers start in the ducts of the pancreas. The main pancreatic duct connects the pancreas to the common bile duct.[2][14] Pancreatic cancer can occur in exocrine pancreas cells, which produce digestive juices, or the endocrine pancreas cells, which produce hormones.[4][11]
When cancer develops in the exocrine cells, which is the case in over 90% of pancreatic cancers, the tumor disrupts the production and release of digestive enzymes.[2][14] This can lead to digestive problems, as the body struggles to break down food properly. Patients may experience bloating, gas, nausea, and changes in bowel movements as a result.
As the tumor grows, it can block the bile duct, which is a tube that carries bile from the liver to the small intestine. Bile is a fluid that helps digest fats. When the bile duct is blocked, bile backs up, causing jaundice. This is why the skin and whites of the eyes turn yellow, and urine becomes dark while stools become light-colored.[4][2]
Pancreatic cancer can also affect the production of hormones, especially insulin. When insulin production is disrupted, blood sugar levels can become difficult to control. This is why some patients develop new-onset diabetes as an early sign of pancreatic cancer.[2][14]
The tumor can press on nearby organs and nerves, causing pain in the abdomen and back. This pain can be persistent and may worsen over time as the cancer grows.[4][2] The tumor may also interfere with the stomach, making it difficult for food to pass through, leading to feelings of fullness, lack of appetite, and weight loss.[2][14]
Early-stage pancreatic tumors don’t show up on imaging tests, which makes the disease hard to detect early.[2][14] For this reason, many people don’t receive a diagnosis until the cancer has spread (metastasis) to other parts of the body. Pancreatic cancer often spreads to the liver, abdominal wall, lungs, bones, and lymph nodes.[8] Even when the cancer spreads to other areas of the body, it is still called pancreatic cancer if that is where it started.[8]
Unfortunately, there is a high frequency of subclinical metastases (cancer spread that cannot be detected) at initial presentation. There is also a high frequency of undetectable extrapancreatic disease (cancer outside the pancreas) at the time of surgical resection, which contributes to poor long-term outcomes.[13] Pancreatic cancer is also resistant to many common cancer drugs, making it notoriously difficult to treat.[2][14]
Because of these factors—late detection, aggressive spread, and resistance to treatment—pancreatic cancer has a very low survival rate. Ongoing research focuses on early detection through genetic testing and new imaging methods, but there is still much to learn.[2][14]
