Overview

Pancreatic cancer begins in the tissues of your pancreas — an organ in your abdomen that lies horizontally behind the lower part of your stomach. Your pancreas secretes enzymes that aid digestion and hormones that help regulate the metabolism of sugars.

Pancreatic cancer often has a poor prognosis, even when diagnosed early. Pancreatic cancer typically spreads rapidly and is seldom detected in its early stages, which is a major reason why it's a leading cause of cancer death. Signs and symptoms may not appear until pancreatic cancer is quite advanced and complete surgical removal isn't possible.

Symptoms

Signs and symptoms of pancreatic cancer often don't occur until the disease is advanced. When signs and symptoms do appear, they may include:

  • Upper abdominal pain that may radiate to your back
  • Yellowing of your skin and the whites of your eyes (jaundice)
  • Loss of appetite
  • Weight loss
  • Depression
  • Blood clots

Diagnosis

If your doctor suspects pancreatic cancer, you may have one or more of the following tests to diagnose the cancer:

  • Imaging tests to create pictures of your internal organs. Imaging tests help your doctor visualize your internal organs, including your pancreas. Imaging tests used to diagnose pancreatic cancer include ultrasound, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and, sometimes, positron emission tomography (PET) scans.
  • Using a scope to create ultrasound pictures of your pancreas. An endoscopic ultrasound (EUS) uses an ultrasound device to make images of your pancreas from inside your abdomen. The ultrasound device is passed through a thin, flexible tube (endoscope) down your esophagus and into your stomach in order to obtain the images. Your doctor may also collect a sample of cells (biopsy) during EUS.
  • Removing a tissue sample for testing (biopsy). A biopsy is a procedure to remove a small sample of tissue from the pancreas for examination under a microscope.
  • Blood test. Your doctor may test your blood for specific proteins (tumor markers) shed by pancreatic cancer cells.
  • Using a scope to inject dye into the pancreatic ducts. In certain cases, your doctor may recommend endoscopic retrograde cholangiopancreatography (ERCP), which uses a dye to highlight the bile ducts in your pancreas.

Treatment

Treatment for pancreatic cancer depends on the stage and location of the cancer as well as on your overall health and personal preferences.

The first goal of pancreatic cancer treatment is to eliminate the cancer, when possible. When that isn't an option, the focus may be on preventing the pancreatic cancer from growing or causing more harm.

When pancreatic cancer is advanced and treatments aren't likely to offer a benefit, your doctor will help to relieve symptoms and make you as comfortable as possible.

Surgery

Surgery may be an option if your pancreatic cancer is confined to the pancreas. Operations used in people with pancreatic cancer include:

  • Surgery for tumors in the pancreatic head. If your pancreatic cancer is located in the head of the pancreas, you may consider an operation called a Whipple procedure (pancreatoduodenectomy).
  • Surgery for tumors in the pancreatic tail and body. Surgery to remove the tail of the pancreas or the tail and a small portion of the body is called distal pancreatectomy. Your surgeon may also remove your spleen. Surgery carries a risk of bleeding and infection.

Research shows pancreatic cancer surgery tends to cause fewer complications when done by experienced surgeons. Don't hesitate to ask about your surgeon's experience with pancreatic cancer surgery. If you have any doubts, get a second opinion.

Radiation Therapy

Radiation therapy uses high-energy beams, such as those made from X-rays and protons, to destroy cancer cells. You may receive radiation treatments before or after cancer surgery, often in combination with chemotherapy. Or, your doctor may recommend a combination of radiation and chemotherapy treatments when your cancer can't be treated surgically.

Radiation therapy usually comes from a machine that moves around you, directing radiation to specific points on your body (external beam radiation). In specialized medical centers, radiation therapy may be delivered during surgery (intraoperative radiation).

Radiation therapy traditionally uses X-rays to treat cancer. Some medical centers may offer radiation therapy that uses protons, which may be a treatment option for some people with advanced pancreatic cancer.

Chemotherapy

Chemotherapy uses drugs to help kill cancer cells. Chemotherapy can be injected into a vein or taken orally. You may receive only one chemotherapy drug, or you may receive a combination of chemotherapy drugs.

Chemotherapy can also be combined with radiation therapy (chemoradiation). Chemoradiation is typically used to treat cancer that has spread beyond the pancreas, but only to nearby organs and not to distant regions of the body. This combination may also be used after surgery to reduce the risk that pancreatic cancer may recur.

In people with advanced pancreatic cancer, chemotherapy may be used alone or it may be combined with targeted drug therapy.

Clinical trials are studies to test new forms of treatment, such as new drugs, new approaches to surgery or radiation treatments, and novel methods such as gene therapy. If the treatment being studied proves to be safer or more effective than are current treatments, it can become the new standard of care.

Clinical trials for pancreatic cancer may give you a chance to try new targeted therapy drugs, immunotherapy treatments or vaccines.

Clinical trials can't guarantee a cure, and they may have serious or unexpected side effects. On the other hand, cancer clinical trials are closely monitored to ensure they're conducted as safely as possible. And they offer access to treatments that wouldn't otherwise be available to you.

Talk to your doctor about what clinical trials might be appropriate for you.

Supportive (Palliative) Care

Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation therapy.

When palliative care is used along with all of the other appropriate treatments — even soon after your diagnosis — people with cancer may feel better and live longer.

Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving. Palliative care is not the same as hospice care or end-of-life care.

No complementary or alternative treatments have been found to effectively treat pancreatic cancer.

But complementary and alternative medicine treatments may help with signs and symptoms you experience due to your cancer or cancer treatments. Talk to your doctor about your options.

Alternative Treatments For Coping With Distress

People with cancer frequently experience distress. Some research suggests distress is more common in people with pancreatic cancer than it is in people with other types of cancer.

If you're distressed, you may have difficulty sleeping and find yourself constantly thinking about your cancer. You may feel angry or sad.

Discuss your feelings with your doctor. Specialists can help you sort through your feelings and help you devise strategies for coping. In some cases, medications may help.

Discuss your feelings with your doctor. Specialists can help you sort through your feelings and help you devise strategies for coping. In some cases, medications may help.

Complementary and alternative therapies may also help you cope with distress. Examples include:

  • Art Therapy
  • Exercise
  • Meditation
  • Music Therapy
  • Relaxation Exercises
  • Spirituality

Talk to your doctor if you're interested in complementary and alternative treatments.

Prevention / Risk Factors

It's not clear what causes pancreatic cancer in most cases. Doctors have identified risk factors, such as smoking, that increase your risk of developing pancreatic cancer.

Pancreatic cancer occurs when cells in your pancreas develop mutations in their DNA. These mutations cause cells to grow uncontrollably and to continue living after normal cells would die. These accumulating cells can form a tumor.

Most pancreatic cancer begins in the cells that line the ducts of the pancreas. This type of cancer is called pancreatic adenocarcinoma or pancreatic exocrine cancer. It accounts for the vast majority of pancreatic cancers.

Rarely, cancer can form in the hormone-producing cells or the neuroendocrine cells of the pancreas. These types of cancer are called islet cell cancer, pancreatic endocrine cancer or pancreatic neuroendocrine tumors.

Factors that may increase your risk of pancreatic cancer include:

  • Excess body weight
  • Chronic inflammation of the pancreas (pancreatitis)
  • Diabetes
  • Family history of genetic syndromes that can increase cancer risk, including a BRCA2 gene mutation, Lynch syndrome and familial atypical mole-malignant melanoma (FAMMM) syndrome
  • Personal or family history of pancreatic cancer
  • Smoking

 
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