Pancreatic cancer is a malignant tumor arising from cells of the pancreas. Exocrine pancreatic cancers, especially pancreatic ductal adenocarcinoma, are the most common form. Early disease may cause few or no symptoms, while later disease may cause jaundice, abdominal or back pain, unexplained weight loss and appetite loss.
Pancreatic cancer develops in the pancreas, an organ located behind the stomach that has digestive and hormone-producing functions. Pancreatic cancers include exocrine cancers and less common pancreatic neuroendocrine tumors. Exocrine pancreatic ductal adenocarcinoma is the most common type. Early pancreatic cancer can be difficult to detect because noticeable symptoms may be absent or nonspecific.
The pancreas is a gland located behind the stomach and near the duodenum, liver, gallbladder, spleen and major abdominal blood vessels. It has a head, neck, body and tail. It produces digestive enzymes and hormones including insulin and glucagon.
Pancreatic cancer begins when pancreatic cells develop genetic changes that disrupt normal control of cell growth and survival. Over time, abnormal cells can form a malignant tumor and invade surrounding tissue or spread through lymphatic and blood vessels.
Abnormal pancreatic cells acquire changes that allow uncontrolled growth and survival. The tumor may obstruct the bile duct, invade nearby tissues or blood vessels, spread to regional lymph nodes, and eventually metastasize to distant organs.
Pancreatic malignancies include exocrine cancers and pancreatic neuroendocrine tumors. Pancreatic ductal adenocarcinoma is the dominant exocrine cancer. Other less common exocrine malignancies include acinar cell carcinoma and adenosquamous carcinoma. Neuroendocrine tumors arise from hormone-producing pancreatic cells and have different biology and treatment approaches.
The major categories are exocrine pancreatic cancers and pancreatic neuroendocrine tumors. Pancreatic ductal adenocarcinoma is the most common exocrine malignancy. Other rare types include acinar cell carcinoma and adenosquamous carcinoma. Neuroendocrine tumors may be functional or nonfunctional and require different evaluation.
Jaundice or yellowing of the skin and eyes
Dark urine or pale/light-colored stools
Upper or middle abdominal pain
Back pain
Unexplained weight loss
Loss of appetite
Fatigue
Nausea or digestive discomfort
New or worsening diabetes
Early disease may have no obvious symptoms
There is no single cause of pancreatic cancer. Cancer develops through accumulated genetic and cellular changes. Risk is increased by cigarette smoking, excess body weight, chronic pancreatitis, diabetes, family history and certain inherited genetic conditions.
Cigarette smoking
Obesity or excess body weight
Chronic pancreatitis
Diabetes mellitus
Family history of pancreatic cancer
Inherited cancer susceptibility syndromes
Increasing age
Previous pancreatic disease
Certain inherited genetic variants
Evaluation may include medical history and examination, blood chemistry tests, liver tests, bilirubin measurement, CA 19-9 and sometimes CEA, pancreatic-protocol CT, MRI/MRCP, endoscopic ultrasound and tissue sampling when indicated. Imaging is particularly important for determining tumor location, local involvement and resectability.
Jaundice
Unexplained weight loss
Persistent upper abdominal or back pain
Loss of appetite
Abdominal tenderness
Dark urine or pale stools
Unexplained fatigue
New or worsening diabetes
Complete blood count when clinically indicated
Liver function tests
Serum bilirubin
Blood chemistry tests
CA 19-9 tumor marker
Carcinoembryonic antigen (CEA) in selected situations
Blood glucose and diabetes assessment
Nutritional and metabolic assessment when indicated
Genetic or molecular testing in selected patients
Pancreatic-protocol contrast CT
MRI/MRCP
Endoscopic ultrasound
Selected PET/CT or other imaging when clinically indicated
Chest and abdominal imaging for staging when appropriate
Endoscopic ultrasound-guided tissue sampling
Biopsy or fine-needle sampling when indicated
CA 19-9 assessment
Molecular or biomarker testing for selected advanced cancers
Genetic counseling and germline testing when indicated
Acute pancreatitis
Chronic pancreatitis
Peptic ulcer disease
Gallstones or biliary obstruction
Cholangiocarcinoma
Hepatitis or other causes of jaundice
Other gastrointestinal cancers
Pancreatic exocrine cancer is commonly staged using TNM principles and grouped into stages 0 through IV. Treatment planning also uses clinically important categories such as resectable, borderline resectable, locally advanced, metastatic and recurrent disease.
Staging or grading systems differ between diseases. The information here is educational and should be interpreted by a qualified healthcare professional in the context of the individual case.
Treatment depends on stage, tumor biology, resectability and overall health. Options may include surgery, chemotherapy, radiation therapy, chemoradiation, targeted therapy for selected tumors or molecular findings, clinical trials and palliative/supportive care. Biliary stents or other procedures may be used to relieve obstruction.
Chemotherapy medicines selected by the oncology team
Targeted therapy for selected molecular findings
Analgesics for cancer-related pain
Antiemetic medicines for treatment-related nausea
Pancreatic enzyme replacement therapy when exocrine insufficiency occurs
Medicines for diabetes or glucose management when needed
Medicines listed here are for educational information only. Do not start, stop, or change a medicine without professional medical advice.
Possible complications include obstructive jaundice, biliary infection, pain, malnutrition, pancreatic exocrine insufficiency, diabetes, blood clots, gastrointestinal obstruction, bleeding and metastatic disease.
Fever with jaundice or suspected biliary infection
Severe or rapidly worsening abdominal pain
Persistent vomiting or inability to keep fluids down
Confusion, fainting or severe weakness
Vomiting blood or black/tarry stools
Sudden chest pain, shortness of breath or one-sided leg swelling
If symptoms are severe, rapidly worsening, or life-threatening, seek emergency medical care immediately.
The most important prognostic factors include whether the tumor is localized and completely removable, lymph-node involvement, distant metastases, tumor characteristics, general health and response to treatment. Early detection and complete surgical removal when feasible provide the greatest opportunity for long-term control.
Survival statistics describe outcomes in groups of people and cannot predict exactly what will happen to one individual. Prognosis depends on factors such as cancer stage, tumor biology, treatment response, overall health, and follow-up.
Pancreatic cancer is more common with increasing age. Major recognized risk factors include tobacco exposure, excess body weight, chronic pancreatitis, diabetes, family history and inherited susceptibility. The exocrine form is much more common than pancreatic neuroendocrine tumors.
Risk reduction includes avoiding tobacco, maintaining a healthy body weight, staying physically active, limiting alcohol and appropriately managing diabetes and chronic pancreatitis. People with strong hereditary or family risk should discuss genetic counseling and specialist surveillance.
What type and stage of pancreatic cancer do I have?
Is my tumor resectable, borderline resectable, locally advanced or metastatic?
What imaging tests are needed before treatment?
Do I need a biopsy or endoscopic ultrasound?
Should my tumor be tested for genetic or molecular changes?
Would surgery be appropriate for me?
Would I benefit from chemotherapy before or after surgery?
How will treatment affect digestion, nutrition and blood sugar?
Do I need pancreatic enzyme replacement?
What symptoms should make me seek urgent medical care?
BimariDur provides educational health information to help people understand diseases, symptoms, tests, and treatment concepts. It does not replace examination, diagnosis, or treatment by a qualified healthcare professional.
Do not delay professional medical care because of information read on BimariDur.