Pancreatic cancer occurs when malignant (cancerous) cells form in the pancreas, an organ located between the stomach and the spine, deep within the abdomen.
Though relatively rare, pancreatic cancer is the third leading cause of cancer death in the United States, behind lung and colorectal cancers and ahead of breast cancer.
Because pancreatic cancer has few detectable symptoms in earlier stages, it is often not diagnosed until it has spread (metastasized) beyond the pancreas to the lymph nodes or other organs, or has become advanced with local invasion. Pancreatic cancer can be treated, but it is rarely curable and often fatal.
Pancreatic tumors are either exocrine or neuroendocrine (endocrine) tumors. Knowing the type of tumor is important because each type behaves differently and responds to different treatments.
Exocrine Pancreatic Tumors
The vast majority (more than 90 percent) of pancreatic cancers are exocrine tumors. These occur in the exocrine component of the pancreas, which is made up of ducts and small sacs at the ends of the ducts. These produce enzymes that help the body break down and digest food — especially fats — in the small intestine.
The most common type of exocrine pancreatic cancer is adenocarcinoma, a type of cancer that forms in mucus-secreting gland cells.
Other less common exocrine cancers include adenosquamous carcinomas, squamous cell carcinomas, signet ring cell carcinomas, acinar cell carcinomas, undifferentiated carcinomas, and undifferentiated carcinomas with giant cells.
Neuroendocrine Pancreatic Tumors
Less than 10 percent of pancreatic cancers are neuroendocrine tumors (pancreatic NETs or PNETs), also called islet cell tumors. These often grow more slowly than exocrine tumors.
The endocrine component of the pancreas is made up of clumps of cells located throughout the organ. These secrete hormones that play various roles in regulating the body’s metabolism. One of the most critical of these hormones is insulin, which helps control glucose levels in the blood.
Pancreatic cancer is often called a silent killer because symptoms may not develop right away or be obvious when they do emerge — and because there’s no reliable test to detect pancreatic cancer in asymptomatic people. As pancreatic tumors grow, many of the symptoms that develop can mimic symptoms of other medical conditions. These can include:
Bloating and gas
Gastrointestinal discomfort or burning sensation in the stomach
Foul-smelling diarrhea or greasy, floating stools
Nausea or vomiting
Weakness or fatigue
Loss of appetite
Unintended weight loss
Upper back or upper abdomen pain
Swelling in an arm or leg
Signs of jaundice, like yellowing skin and eyes and dark urine
Chills and sweats
Fever
While the exact cause of pancreatic cancer isn’t clear, several factors can increase the risk. Some risk factors for pancreatic cancer are related to lifestyle choices and environmental factors and may be modifiable. Other risk factors for pancreatic cancer — such as age and race — can’t be changed. Modifiable risk factors for pancreatic cancer include:
Smoking About 25 percent of cases are thought to be caused by cigarette smoking.
Being Overweight or Having Obesity People with obesity are about 20 percent more likely to develop pancreatic cancer.
Type 2 Diabetes People who have had type 2 diabetes for five years or more have an increased risk of pancreatic cancer.
Heavy Alcohol Use Heavy drinking can lead to pancreatitis, or inflammation of the pancreas, which is a risk factor for pancreatic cancer.
High-Fat Diet Diets heavy in saturated fats and processed meats (such as bacon and salami) may increase the risk of pancreatic cancer.
Chronic Pancreatitis Pancreatitis is often tied to heavy drinking and smoking.
Workplace Exposure to Certain Chemicals Chemicals commonly used in dry cleaning and metal working may increase the risk for pancreatic cancer.
Unmodifiable risk factors for pancreatic cancer include:
Age Nearly all people with pancreatic cancer are over age 45, and about two-thirds are over age 65.
Gender Men have a slightly higher risk than women.
Race or Ethnicity Black Americans have a slightly higher risk than white Americans.
Family History People with a family history of pancreatic cancer have a higher risk of developing the disease. The reason for this is not always known, though it may be due to specific inherited genes.
Inherited Genetic Syndromes These include certain hereditary forms of breast and ovarian cancer, melanoma, and pancreatitis, as well as two rare disorders — Lynch syndrome and Peutz-Jeghers syndrome.
Pancreatic cancer is diagnosed using various tests, including:
Endoscopic Ultrasound This test involves inserting a thin, flexible tube into the mouth, through the digestive tract, and into the small intestine, which is close to the pancreas. A probe at the end of the endoscope uses sound waves to create an image of the pancreas that may reveal cancer.
Biopsy Your doctor may remove a small sample of tissue and examine it under a microscope to see if it contains cancerous cells. This is typically done during an endoscopic ultrasound but can also be performed by inserting a needle through the skin and into the pancreas.
Blood Tests Blood tests can identify certain proteins — tumor markers shed by cancer cells that can help determine what type of pancreatic cancer you have and what treatment approach is likely to work best.
As with most cancers, the degree to which pancreatic cancer has advanced is defined by stages. There are several staging systems doctors may use for pancreatic cancer.
Resectable Staging
One system that doctors use for pancreatic cancer staging focuses on whether it’s possible to remove the entire tumor surgically. With this staging system, a tumor is described as:
Resectable The tumor is contained within the pancreas and is small enough to remove.
Borderline Resectable It’s possible surgery won’t get the entire tumor.
Nonresectable The tumor within the pancreas is too large, or it has metastasized and spread to other organs and tissue.
TNM Staging
TNM stands for tumor, node, and metastasis.
Tumor When doctors see at least some evidence of a tumor, they will assign a T category. Staging ranges from Tis, for carcinoma in situ (meaning the tumor is limited to the outer layers of pancreatic duct cells and is the easiest to treat), to T4, for cancer that has spread beyond the pancreas to surrounding organs, tissues, nerves, or large blood vessels.
Node When doctors assess lymph nodes, they assign an N category. N0 is when they don’t see cancer in the nodes, and N1 is when cancer has spread to surrounding lymph nodes.
Metastasis The cancer will be staged as M0 for cases when it has not reached surrounding tissues, organs, or lymph nodes, and M1 when it has.
Numerical Staging
After doctors do TNM staging, they may combine these categories in a numerical staging system from 0 to 4, with lower stages indicating easier to treat tumors with a better prognosis.
Stage 0 Abnormal cells are found in the lining of the pancreas and can potentially spread into nearby normal tissue.
Stage 1 The tumor is confined to the pancreas If the tumor is less than 2 centimeters across, it is designated stage 1A, and stage 1B if the tumor is more than 2 centimeters across.
Stage 2 The tumor may have grown outside of the pancreas and spread to nearby tissue and lymph nodes. If the cancer is confined to the pancreas and has not been found in nearby tissues or lymph nodes, it’s designated stage 2A. If the cancer has spread to nearby lymph nodes but has not spread to distant organs, it’s stage 2B.
Stage 3 The tumor has grown into nearby large blood vessels or major nerves.
Stage 4 The cancer has spread into parts of the body far from the pancreas. This can include the liver, lungs, or peritoneum (inner lining of the abdomen).
Treatment options for pancreatic cancer vary based on the cancer stage and are also influenced by a patient’s age, overall health, and personal preferences. Pancreatic cancer may be treated by one or a combination of interventions, including surgery, radiation, chemotherapy, targeted therapy, or immunotherapy.
Surgery
Fewer than 1 in 5 cases of pancreatic cancer are caught when the cancer is confined to the pancreas, and of those, not all can be treated with surgery alone.
The main types of surgery are a Whipple procedure or a pancreatectomy. In a Whipple procedure, the surgeon removes the head of the pancreas, a part of the small intestine called the duodenum, and the gallbladder and bile duct. The surgeon then reconnects the digestive tract and biliary system. A pancreatectomy is the removal of part or all of the pancreas.
Surgery may be followed or preceded by chemotherapy and radiation to reduce the risk of recurrence or preceded by these interventions to shrink the tumor before attempting to remove it. Risks of surgery can include bleeding, digestive problems, and an increased risk of type 2 diabetes resulting from the loss of insulin production in the pancreas.
Chemotherapy
Chemotherapy is a systemic treatment (meaning it affects the entire body) in which drugs designed to kill cancer cells are delivered into the bloodstream intravenously. Chemotherapy is the first-line treatment for pancreatic cancer and may be used in conjunction with radiation, surgery, and other treatments.
Chemotherapy drugs approved to treat pancreatic cancer include:
Folfirinox (combination of leucovorin calcium (folinic acid), fluorouracil, irinotecan hydrochloride, and oxaliplatin).
gemcitabine and capecitabine (if Folfirinox is not tolerated)
gemcitabine alone (in frail patients)
gemcitabine and nab-paclitaxel (used to shrink tumors prior to surgery, when feasible)
Side effects of chemotherapy may include nausea and vomiting, hair loss, mouth sores, nerve pain, and infections, among others.
Radiation
With radiation therapy, a machine delivers high-energy rays to areas of the body where cancer has been found. These rays can help stop cancer cells from continuing to grow and spread.
External beam radiation therapy — the type most frequently used in pancreatic cancer — is usually given five days a week for two to five weeks. Each treatment lasts only a few minutes and may be used in conjunction with other therapies for pancreatic cancer.
External beam radiation is the most common type of radiation used to treat pancreatic cancer. Radiation side effects can include fatigue, nausea, and diarrhea.
Targeted Therapy
Targeted therapies for pancreatic cancer target specific genes or proteins in certain tumors with little to no damage to healthy cells. They can be given via injection, orally, or intravenously.
Targeted therapies approved for exocrine pancreatic tumors include:
dabrafenib and trametinib (Tafinlar and Mekinist)
entrectinib (Rozyltrek)
erlotinib (Tarceva)
fam-trastuzumab deruxtecan-nxki (Enhertu)
larotrectinib (Vitrakvi)
olaparib (Lynparza)
Targeted therapies approved for neuroendocrine pancreatic tumors include:
everolimus (Afinitor)
sunitinib (Sutent )
Because targeted therapies are more specific for cancer cells, they often cause fewer side effects than other treatments. When side effects do occur, they may include nausea, vomiting, rashes, and lowered blood cell counts. Side effects differ depending on the patient and the specific drug.
Immunotherapy
Immunotherapy, delivered intravenously or as an oral medication, enhances the immune system’s ability to attack cancer.
Most immunotherapy drugs are being studied in clinical trials and are not widely available for pancreatic cancer. One immune checkpoint inhibitor, pembrolizumab (Keytruda), has been approved by the U.S. Food and Drug Administration (FDA) to treat pancreatic cancer patients with certain genetic alterations.
Medication side effects can include swelling and numbness of hands and feet, hair loss, nausea, weight loss, fatigue, and autoimmune symptoms.
While there isn’t a specific way to avoid pancreatic cancer altogether, there are some things that can lower your risk. These include:
Quitting Smoking Smoking is considered the most significant risk factor for pancreatic cancer.
Maintaining a Healthy Weight Losing weight if you are overweight or have obesity can help lower your risk of pancreatic cancer.
Avoiding Drinking Heavy alcohol use is associated with pancreatic cancer; it’s also tied to a condition known as chronic pancreatitis, a known risk factor for the disease.
Avoiding Workplace Chemicals Exposure to asbestos, some pesticides, and chemicals used in dry cleaning are associated with an increased risk of pancreatic cancer and other cancers.
The length of time a person lives after being diagnosed with pancreatic cancer depends on the stage of the cancer; whether the tumor is resectable, borderline, or nonresectable; treatment options; and other factors. While overall survival rates are low compared with other cancers, they are gradually increasing.
When pancreatic cancer is caught early, the five-year survival rate for localized tumors (those that haven’t spread to surrounding tissue and organs) is about 44 percent, according to the most recent figures from the American Cancer Society.
For regional tumors (those that have spread to tissue near the pancreas), the five-year survival rate is about 16 percent.
Once pancreatic cancer spreads to distant organs, tissue, nerves, and blood vessels, the five-year survival rate drops to about 3 percent.
Overall, the five-year survival rate is 13 percent.
Pancreatic cancer represents about 3 percent of cancer cases diagnosed in the United States each year and about 8 percent of deaths.
More than 67,000 people in the United States are expected to be diagnosed with pancreatic cancer in 2025, and about 52,000 people will die of the disease.
Pancreatic cancer predominantly affects older adults: Almost all patients are older than age 45, with the disease most frequently diagnosed among people between ages 65 and 74.
Black Americans are more likely to get pancreatic cancer than people from any other racial or ethnic group in the United States. Out of every 100,000 people, 16 Black people develop pancreatic cancer, compared with 13 white people.
Some research suggests that environmental and socioeconomic factors may be responsible for the discrepancy. Cigarette smoking, a major risk factor, is more common in Black people, as are diabetes, pancreatitis, and being overweight.
Black people also have a worse prognosis because they are more likely to be diagnosed when tumors are more advanced and difficult to treat. They are also less likely to be evaluated by a surgeon or to receive surgery.
People of Ashkenazi Jewish descent have a higher risk of pancreatic cancer, due in large part to inherited mutations of the BRCA1 and BRCA2 genes, which are linked to pancreatic, breast, and ovarian cancers.
Conditions that are associated with pancreatic cancer include pancreatitis and type 2 diabetes.
Pancreatitis is an inflammation of the pancreas that can be caused by multiple conditions, including (most commonly) excessive alcohol use or the presence of gallstones. Chronic pancreatitis is a risk factor for pancreatic cancer.
Research suggests that type 2 diabetes may be either a risk factor for pancreatic cancer or a symptom of it. Pancreatic cancer is more likely to develop in people who’ve had diabetes for more than five years.
While having type 2 diabetes isn’t necessarily a cause for alarm, a sudden worsening of blood sugar levels in people who previously had their condition under control may be an early sign of pancreatic cancer, as can being diagnosed with the disease after age 50.
Some of the organizations that offer online or in-person support groups for pancreatic cancer patients, survivors, and families include:
The Pancreatic Cancer Action Network (PanCan) is a nationwide organization dedicated to patient education and advocacy. PanCan offers an up-to-date list of in-person pancreatic cancer support groups across the country, as well as online support services.
The American Cancer Society offers in-person support groups across the country, as well as online communities like the Cancer Survivors Network, which provides discussion boards and live chats for patients, survivors, and caregivers.
CancerCare is a national organization offering free emotional and practical support for cancer patients and their families. Online and in-person support groups, run by an oncology social worker, are available to people with pancreatic cancer and their loved ones.
Pancreatic cancer occurs when cancerous cells form in the pancreas. Most of the time, by the time it is diagnosed, it has spread outside of the pancreas to other areas of the body.
People who smoke, are heavy drinkers, have diabetes, or have chronic pancreatitis are at higher risk of developing pancreatic cancer. Genetics and race also affect risk.
Pancreatic cancer can be treated with chemotherapy, radiation, surgery, and immunotherapy.
Because it is an aggressive cancer, pancreatic cancer is often fatal, with an overall five-year survival rate of 13 percent.
