What is pancreatic cancer?
Pancreatic cancer occurs within the tissues of the pancreas, which is a vital endocrine organ located behind the stomach. The pancreas plays an essential role in digestion by producing enzymes that the body needs to digest fats, carbohydrates, and proteins.
The pancreas also produces two important hormones: glucagon and insulin. These hormones are responsible for controlling glucose (sugar) metabolism. Insulin helps cells metabolize glucose to make energy and glucagon helps raise glucose levels when they are too low.
Due to the location of the pancreas, pancreatic cancer may be difficult to detect and is often diagnosed in more advanced stages of the disease.
According to the American Cancer Society, pancreatic cancer makes up about 3 percent of cancer diagnoses in the United States and 7 percent of cancer deaths.
Pancreatic cancer often doesn’t show symptoms until it reaches the advanced stages of the disease. For this reason, there typically aren’t any early signs of pancreatic cancer.
Even once the cancer has grown, some of the most common symptoms can be subtle. They include:
- loss of appetite
- unintentional weight loss
- abdominal (stomach) or lower back pain
- blood clots
- jaundice (yellow skin and eyes)
Pancreatic cancer that spreads may worsen preexisting symptoms. If the cancer spreads, you may experience additional signs and symptoms of advanced pancreatic cancer.
The cause of pancreatic cancer is unknown. This type of cancer occurs when abnormal cells begin to grow within the pancreas and form tumors.
Normally, healthy cells grow and die in moderate numbers. In the case of cancer, there is an increased amount of abnormal cell production, and these cells eventually take over the healthy cells.
While doctors and researchers don’t know what causes the changes in the cells, they do know some common factors that may increase a person’s risk for developing this type of cancer.
The two most significant risk factors are inherited gene mutations and acquired gene mutations. Genes control the way cells acts, so changes to those genes may lead to cancer.
A survival rate is a percentage of how many people with the same type and stage of a cancer are still alive after a specific amount of time. This number doesn’t indicate how long people may live. Instead, it helps gauge how successful treatment for a cancer might be.
Many survival rates are given as a five-year percentage. It’s important to keep in mind that survival rates are not definitive. If you have questions about these numbers, talk with your doctor.
The five-year survival rate for localized pancreatic cancer is 34 percent. Localized pancreatic cancer is stages 0, 1, and 2.
The five-year survival rate for regional pancreatic cancer that has spread to nearby structures or lymph nodes is 12 percent. Stages 2B and 3 fall into this category.
Distant pancreatic cancer, or stage 4 cancer that has spread to other sites like the lungs, liver, or bones, has a 3 percent survival rate.
When pancreatic cancer is discovered, doctors will likely perform additional tests to understand if or where the cancer has spread. Imaging tests, such as a PET scan, help doctors identify the presence of cancerous growths. Blood tests may also be used.
With these tests, doctors are attempting to establish the cancer’s stage. Staging helps explain how advanced the cancer is. It also helps doctors determine treatment options.
Once a diagnosis has been made, your doctor will assign a stage based on the test results:
- stage 1: tumors exist in the pancreas only
- stage 2: tumors have spread to nearby abdominal tissues or lymph nodes
- stage 3: the cancer has spread to major blood vessels and lymph nodes
- stage 4: tumors have spread to other organs, such as the liver
Stage 4 pancreatic cancer has spread beyond the original site to distant sites, like other organs, the brain, or bones.
Pancreatic cancer is often diagnosed at this late stage because it rarely causes symptoms until it has spread to other sites. Symptoms you might experience at this advanced stage include:
- pain in the upper abdomen
- pain in the back
- jaundice (yellowing of the skin)
- a loss of appetite
- weight loss
Stage 4 pancreatic cancer cannot be cured, but treatments can relieve symptoms and prevent complications from the cancer. These treatments can include:
The five-year survival rate for stage 4 pancreatic cancer is 3 percent.
Stage 3 pancreatic cancer is a tumor in the pancreas and possibly nearby sites, such as lymph nodes or blood vessels. Pancreatic cancer at this stage has not spread to distant sites.
Pancreatic cancer is called a silent cancer because it is often not diagnosed until it has reached an advanced stage. If you have symptoms of stage 3 pancreatic cancer, you may experience:
- pain in the back
- pain or tenderness in the upper abdomen
- a loss of appetite
- weight loss
Stage 3 pancreatic cancer is difficult to cure, but treatments can help prevent the spread of the cancer and ease symptoms caused by the tumor. These treatments may include:
- surgery to remove a portion of the pancreas (Whipple procedure)
- anti-cancer drugs
- radiation therapy
The five-year survival rate for stage 3 pancreatic cancer is 3 to 12 percent.
The majority of people with this stage of the cancer will have a recurrence. That’s likely due to the fact that micrometastases, or small areas of undetectable cancer growth, have spread beyond the pancreas as the time of detection.
Stage 2 pancreatic cancer is cancer that remains in the pancreas and may have spread to a few nearby lymph nodes. It has not spread to nearby tissues or blood vessels, and it has not spread to sites elsewhere in the body.
Pancreatic cancer is difficult to detect in the early stages, including stage 2. That’s because it’s unlikely to cause detectable symptoms. If you do have symptoms at this early stage, you may experience:
- changes in urine color
- pain or tenderness in the upper abdomen
- weight loss
- loss of appetite
Treatment may include:
- targeted drug therapies
Your doctor may use a combination of these approaches to help shrink the tumor and prevent possible metastases. The five-year survival rate for people with stage 2 pancreatic cancer is around 30 percent.
Treatment for pancreatic cancer depends on the stage of cancer. It has two goals: to kill cancerous cells and to prevent the spread of the disease.
Weight loss, bowel obstruction, abdominal pain, and liver failure are among the most common complications during pancreatic cancer treatment.
The decision to use surgery to treat pancreatic cancer comes down to two things: the location of the cancer and the stage of the cancer. Surgery can remove all or some portions of the pancreas.
This can eliminate the original tumor, but it will not remove cancer that has spread to other portions of the body. Surgery may not be suitable for people with advanced stage pancreatic cancer for that reason.
Other treatment options must be explored once the cancer spreads outside of the pancreas. Radiation therapy uses X-rays and other high-energy beams to kill the cancer cells.
In some cases, your doctor might combine other treatments with chemotherapy, which uses cancer-killing drugs to help prevent future growth of cancer cells.
This type of cancer treatment uses drugs or other measures to specifically target cancer cells and work to destroy them. These drugs are designed not to harm healthy or normal cells.
The survival rates for pancreatic cancer have been improving in recent decades. Research and new treatments are expanding the average five-year survival rate for people diagnosed with pancreatic cancer.
However, the disease is still considered difficult to cure. Because pancreatic cancer typically does not cause symptoms until the cancer is in advanced stages, the likelihood the cancer has spread, or metastasized, is high. That make it hard to treat or eliminate the cancer.
Combining alternative measures with traditional medical treatments may help to improve your quality of life. Yoga, meditation, and light exercise might promote a sense of well-being and make you feel better during treatment.
Early diagnosis significantly increases the chances of recovery. That’s why it’s best to visit your doctor if you’re experiencing any symptoms that won’t go away or recur regularly.
To make a diagnosis, your doctor will review your symptoms and medical history. They may order one or more tests to check for pancreatic cancer, such as:
- CT or MRI scans to get a complete and detailed image of your pancreas
- an endoscopic ultrasound, in which a thin, flexible tube with a camera attached is inserted down into the stomach to obtain images of the pancreas
- biopsy, or tissue sample, of the pancreas
- blood tests to detect if tumor marker CA 19-9 is present, which can indicate pancreatic cancer
Pancreatic cancer is one of the most deadly forms of cancer — unfortunately, many patients don’t receive a diagnosis until it has spread outside of the pancreas. The five-year survival rate for all stages of pancreatic cancer is 9 percent.
Following all of your doctor’s recommendations can help improve your chances of recovery and survival. You may also consider:
- pancreatic enzyme supplements to improve digestion
- pain medications
- regular follow-up care, even if the cancer is successfully removed
Pancreatic cancer is curable, if it’s caught early. Two types of surgery, Whipple procedure or a pancreatectomy, can remove a portion or all of the pancreas. This will eliminate the initial cancer tumor.
Unfortunately, the majority of pancreatic cancers are not found and diagnosed until the cancer is in an advanced stage and spread beyond the original site.
Surgery may not be suitable at late stages of pancreatic cancer. If the cancer has spread to other areas of the body, removing the tumor or pancreas will not cure you. Other treatments must be considered.
While the cause of this type of cancer is unknown, there are certain risk factors that may increase your chances of developing pancreatic cancer. You may be at an increased risk if you:
- smoke cigarettes — 30 percent of cancer cases are related to cigarette smoking
- are obese
- don’t exercise regularly
- eat diets high in fat content
- drink heavy amounts of alcohol
- have diabetes
- work with pesticides and chemicals
- have chronic inflammation of the pancreas
- have liver damage
- are African-American
- have a family history of pancreatic cancer or certain genetic disorders that have been linked to this type of cancer
Your DNA has a great influence on your health and the conditions you may develop. You can inherit genes that will increase your risk for pancreatic cancer.
If the tumor has remained confined to the pancreas, surgery may be recommended. Whether or not surgery is an option is based on the exact location of the cancer.
Tumors confined to the “head and neck” of the pancreas can be removed with a procedure called the Whipple procedure (pancreaticoduodenectomy).
In this procedure, the first part, or the “head” of the pancreas and about 20 percent of the “body,” or the second part, are removed. The bottom half of the bile duct and the first part of the intestine are also removed.
In a modified version of this surgery, a part of the stomach is also removed.
Two types of pancreatic cancer exist:
About 95 percent of pancreatic cancers are pancreatic adenocarcinomas. This type of pancreatic cancer develops in the exocrine cells of the pancreas. The majority of cells in the pancreas are these exocrine cells, which make pancreatic enzymes or make up the pancreatic ducts.
Pancreatic neuroendocrine tumors (NETs)
This less common type of pancreatic cancer develops in the endocrine cells of the pancreas. These cells are responsible for making hormones, including the ones that help manage blood sugar.
Researchers and doctors don’t yet understand what causes pancreatic cancer. That also means they don’t know steps you can take to prevent pancreatic cancer.
Some risk factors that increase the likelihood you will develop this type of cancer cannot be changed. These include your gender, age, and DNA.
However, some lifestyle changes and overall health approaches may reduce your risk. These include:
- Quit smoking: Smoking increases your risk for several types of cancer, including pancreatic cancer.
- Drink less: Heavy drinking may increase your risk for chronic pancreatitis and possibly pancreatic cancer.
- Maintain a healthy weight: Being overweight or obese is a leading risk factor for several types of cancer.