Learn about symptoms, risk factors, prevention, diagnosis, surgery, chemotherapy and other treatments for this serious condition affecting the pancreas.
Pancreatic cancer is a type of cancer that begins as a growth of cells in the pancreas. The pancreas lies behind the lower part of the stomach. It makes enzymes that help digest food and hormones that help manage blood sugar.
The most common type of pancreatic cancer is pancreatic ductal adenocarcinoma. This type begins in the cells that line the ducts that carry digestive enzymes out of the pancreas.
Pancreatic cancer rarely is found at its early stages when the chance of curing it is greatest. This is because it often doesn't cause symptoms until after it has spread to other organs.
Your health care team considers the extent of your pancreatic cancer when creating your treatment plan. Treatment options may include surgery, chemotherapy, radiation therapy or a mix of these.
The pancreas is a long, flat gland that lies horizontally behind your stomach. It has a role in digestion and in regulating the level of sugar in your blood.
Pancreatic cancer often doesn't cause symptoms until the disease is advanced. When they happen, signs and symptoms of pancreatic cancer may include:
Make an appointment with a health care professional if you have symptoms that worry you.
It's not clear what causes pancreatic cancer. Doctors have found some factors that might raise the risk of this type of cancer. These include smoking and having a family history of pancreatic cancer.
The pancreas is about 6 inches (15 centimeters) long and looks something like a pear lying on its side. It releases hormones, including insulin. These hormones help the body process the sugar in the foods you eat. The pancreas also makes digestive juices to help the body digest food and take in nutrients.
Pancreatic cancer happens when cells in the pancreas develop changes in their DNA. A cell's DNA holds the instructions that tell a cell what to do. In healthy cells, the instructions tell the cells to grow and multiply at a set rate. The cells die at a set time. In cancer cells, the changes give different instructions. The changes tell the cancer cells to make many more cells quickly. Cancer cells can keep living when healthy cells would die. This causes there to be too many cells.
The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body.
Most pancreatic cancer begins in the cells that line the ducts of the pancreas. This type of cancer is called pancreatic ductal adenocarcinoma or pancreatic exocrine cancer. Less often, cancer can form in the hormone-producing cells or the neuroendocrine cells of the pancreas. These types of cancer are called pancreatic neuroendocrine tumors or pancreatic endocrine cancer.
Factors that might raise the risk of pancreatic cancer include:
As pancreatic cancer progresses, it can cause complications such as:
Jaundice. Pancreatic cancer that blocks the liver's bile duct can cause jaundice. Signs include yellowing of the skin and the whites of the eyes. Jaundice can cause dark-colored urine and pale-colored stools. Jaundice often occurs without belly pain.
If the bile duct is blocked, a plastic or metal tube called a stent can be put inside it. The stent helps hold the bile duct open. This is done using a procedure called endoscopic retrograde cholangiopancreatography, also called ERCP.
During ERCP, a health care professional puts a long tube with a tiny camera, called an endoscope, down the throat. The tube goes through the stomach and into the upper part of the small intestine. The health professional puts a dye into the pancreatic ducts and bile ducts through a small tube that fits through the endoscope. The dye helps the ducts show up on imaging tests. The health professional uses those images to place a stent at the right spot in the duct to help hold it open.
Pain. A growing tumor may press on nerves in your abdomen, causing pain that can become severe. Pain medications can help you feel more comfortable. Treatments, such as radiation and chemotherapy, might help slow tumor growth and provide some pain relief.
When medicines aren't helping, a health care professional might suggest a celiac plexus block. This procedure uses a needle to put alcohol into the nerves that control pain in the belly. The alcohol stops the nerves from sending pain signals to the brain.
Bowel blockage. Pancreatic cancer can grow into or press on the first part of the small intestine, called the duodenum. This can block the flow of digested food from the stomach into the intestines.
A health care professional might suggest putting a tube called a stent in the small intestine to hold it open. Sometimes, it might help to have surgery to place a feeding tube. Or surgery can attach the stomach to a lower part of the intestines where the cancer isn't causing a blockage.
Endoscopic retrograde cholangiopancreatography (ERCP) uses a dye to highlight the bile ducts and pancreatic duct on X-ray images. A thin, flexible tube with a camera on the end, called an endoscope, is passed down your throat and into your small intestine. The dye enters the ducts through a small hollow tube, called a catheter, passed through the endoscope. Tiny tools passed through the catheter also can be used to remove gallstones.
Screening uses tests to look for signs of pancreatic cancer in people who don't have symptoms. It might be an option if you have a very high risk of pancreatic cancer. Your risk might be high if you have a strong family history of pancreatic cancer or if you have an inherited DNA change that increases the risk of cancer.
Pancreatic cancer screening might involve imaging tests, such as MRI and ultrasound. These tests are generally repeated every year.
The goal of screening is to find pancreatic cancer when it's small and most likely to be cured. Research is ongoing, so it's not yet clear whether screening can lower the risk of dying of pancreatic cancer. There are risks to screening. This includes the chance of finding something that requires surgery but later turns out to not be cancer.
Talk about the benefits and risks of pancreatic cancer screening with your health care team. Together you can decide whether screening is right for you.
If you have a family history of pancreatic cancer, discuss it with a health care professional. The health professional can review your family history and help you understand whether genetic testing might be right for you.
Genetic testing can find DNA changes that run in families and increase the risk of cancer. If you're interested in genetic testing, you might be referred to a genetic counselor or other health care professional trained in genetics.
You might reduce your risk of pancreatic cancer if you:
Tests used to diagnose pancreatic cancer include:
Removing a tissue sample for testing. A biopsy is a procedure to remove a small sample of tissue for testing in a lab. Most often, a health professional gets the sample during EUS. During EUS, special tools are passed through the endoscope to take some tissue from the pancreas. Less often, a sample of tissue is collected from the pancreas by inserting a needle through the skin and into the pancreas. This is called fine-needle aspiration.
The sample goes to the lab for testing to see if its cancer. Other specialized tests can show what DNA changes are present in the cancer cells. The results help your health care team create your treatment plan.
After confirming a diagnosis of pancreatic cancer, your health care team works to find the extent of the cancer. This is called the stage of the cancer. Your health care team uses your cancer's stage to understand your prognosis and create a treatment plan.
The stages of pancreatic cancer use the numbers 0 to 4. In the lowest stages, the cancer is only in the pancreas. As the cancer grows, the stage increases. By stage 4, the cancer has spread to other parts of the body.
During an endoscopic ultrasound of the pancreas, your doctor inserts a thin, flexible tube (endoscope) down your throat and into your stomach. An ultrasound device at the end of the tube emits sound waves that generate images of your digestive tract and nearby organs and tissues.
Treatment for pancreatic cancer depends on the stage of the cancer and the location. Your health care team also considers your overall health and your preferences. For most people, the first goal of pancreatic cancer treatment is to get rid of the cancer, when possible. When that isn't possible, the focus may be on improving quality of life and keeping the cancer from growing or causing more harm.
Pancreatic cancer treatments may include surgery, radiation, chemotherapy or a combination of these. When the cancer is advanced, these treatments aren't likely to help. So treatment focuses on relieving symptoms to keep you as comfortable as possible for as long as possible.
Surgery can cure pancreatic cancer, but it's not an option for everyone. It might be used to treat cancer that hasn't spread to other organs. Surgery might not be possible if the cancer grows large or extends into nearby blood vessels. In these situations, treatment might start with other options, such as chemotherapy. Sometimes surgery might be done after these other treatments.
Operations used to treat pancreatic cancer include:
Surgery for cancers in the pancreatic head. The Whipple procedure, also called pancreaticoduodenectomy, is an operation to remove the head of the pancreas. It also involves removing the first part of the small intestine and the bile duct. Sometimes the surgeon removes part of the stomach and nearby lymph nodes. The remaining organs are rejoined to allow food to move through the digestive system.
Each of these operations carries the risk of bleeding and infection. After surgery some people have nausea and vomiting if the stomach has trouble emptying, called delayed gastric emptying. Expect a long recovery after any of these procedures. You'll spend several days in the hospital and then recover for several weeks at home.
Research shows that pancreatic cancer surgery tends to cause fewer complications when done by highly experienced surgeons at centers that do many of these operations. Ask about your surgeon's and hospital's experience with pancreatic cancer surgery. If you have any doubts, get a second opinion.
Chemotherapy uses strong medicines to kill cancer cells. Treatment might involve one chemotherapy medicine or a mix of them. Most chemotherapy medicines are given through a vein, but some are taken in pill form.
Chemotherapy might be the first treatment used when the first treatment can't be surgery. Chemotherapy also might be given at the same time as radiation therapy. Sometimes this combination of treatments shrinks the cancer enough to make surgery possible. This approach to treatment is offered at specialized medical centers that have experience caring for many people with pancreatic cancer.
Chemotherapy is often used after surgery to kill any cancer cells that might remain.
When the cancer is advanced and spreads to other parts of the body, chemotherapy can help control it. Chemotherapy might help relieve symptoms, such as pain.
Radiation therapy uses powerful energy beams to kill cancer cells. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.
Radiation can be used either before or after surgery. It's often done after chemotherapy. Radiation also can be combined with chemotherapy.
When surgery isn't an option, radiation therapy and chemotherapy might be the first treatment. This combination of treatments might shrink the cancer and make surgery possible.
When the cancer spreads to other parts of the body, radiation therapy can help relieve symptoms, such as pain.
Immunotherapy is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. Immunotherapy might be an option if your pancreatic cancer has specific DNA changes that would make the cancer likely to respond to these treatments.
Clinical trials are studies of new treatments. These studies provide a chance to try the latest treatments. The risk of side effects might not be known. Ask your health care professional if you might be able to be in a clinical trial.
Palliative care is a special type of health care that helps people with serious illness feel better. If you have cancer, palliative care can help relieve pain and other symptoms. A team of health care professionals does palliative care. The team can include doctors, nurses and other specially trained professionals. The team's goal is to improve quality of life for you and your family.
Palliative care specialists work with you, your family and your care team to help you feel better. They provide an extra layer of support while you have cancer treatment. You can have palliative care at the same time as strong cancer treatments, such as surgery, chemotherapy or radiation therapy.
When palliative care is used with all the other appropriate treatments, people with cancer may feel better and live longer.
The Whipple procedure, also called pancreaticoduodenectomy, is an operation to remove the head of the pancreas. The operation also involves removing the first part of the small intestine, called the duodenum, the gallbladder and the bile duct. The remaining organs are rejoined to allow food to move through the digestive system after surgery.
Some integrative medicine and alternative therapies may help with symptoms caused by cancer or cancer treatments.
People with cancer often have distress. Distress might feel like worry, fear, anger and sadness. If have these feelings, you may find it hard to sleep. You might think about your cancer all the time.
Discuss your feelings with a member of your health care team. Specialists can help you sort through your feelings. They can help you find ways to cope. In some cases, medicines may help.
Integrative medicine and alternative therapies also may help you cope with your feelings. Examples include:
Talk with a member of your health care team if you'd like to try some of these treatment options.
Learning you have a life-threatening illness can feel stressful. Some of the following suggestions may help:
Learn about your cancer. Learn enough about your cancer to help you make decisions about your care. Ask a member of your health care team about the details of your cancer and your treatment options. Ask about trusted sources of more information.
If you're doing your own research, good places to start are the National Cancer Institute and the Pancreatic Cancer Action Network.
Start by making an appointment with a doctor or other health care professional if you have symptoms that worry you. You might then be referred to:
When you call to make the appointment, ask about anything you need to do for the appointment, such as restricting your diet. Ask a relative or friend to go with you to help you remember all the information.
Make a list of:
Be prepared to answer some questions about your symptoms and your health, such as: