Overview

Pancreatic cancer starts when cells in the pancreas develop mutations in their DNA.

These abnormal cells don’t die off, as normal cells do, but continue to reproduce. It’s the buildup of these cancerous cells that creates a tumor.

This type of cancer usually starts in the cells that line the ducts of the pancreas. It can also begin in the neuroendocrine cells or other hormone-producing cells.

Pancreatic cancer runs in some families. A small percentage of the genetic mutations involved in pancreatic cancer are inherited. Most are acquired.

There are a few other factors that can increase your risk of developing pancreatic cancer. Some of these can be changed, but others cannot. Keep reading to learn more.

What causes pancreatic cancer, and who’s at risk?

The direct cause of pancreatic cancer can’t always be identified. Certain gene mutations, both inherited and acquired, are associated with pancreatic cancer. There are quite a few risk factors for pancreatic cancer, though having any of them doesn’t mean you’ll get pancreatic cancer. Talk with your doctor about your individual risk level.

Inherited genetic syndromes associated with this disease are:

  • ataxia telangiectasia, caused by inherited mutations in the ATM gene
  • familial (or hereditary) pancreatitis, usually due to mutations in the PRSS1 gene
  • familial adenomatous polyposis, caused by a defective APC gene
  • familial atypical multiple mole melanoma syndrome, due to mutations in the p16/CDKN2A gene
  • hereditary breast and ovarian cancer syndrome, caused by BRCA1 and BRCA2 gene mutations
  • Li-Fraumeni syndrome, the result of a defect in the p53 gene
  • Lynch syndrome (hereditary nonpolyposis colorectal cancer), usually caused by defective MLH1 or MSH2 genes
  • multiple endocrine neoplasia, type 1, caused by a faulty MEN1 gene
  • neurofibromatosis, type 1, due to mutations in the NF1 gene
  • Peutz-Jeghers syndrome, caused by defects in the STK11 gene
  • Von Hippel-Lindau syndrome, the result of mutations in the VHL gene

“Familial pancreatic cancer” means it runs in a particular family where:

  • At least two first-degree relatives (parent, sibling, or child) have had pancreatic cancer.
  • There are three or more relatives with pancreatic cancer on the same side of the family.
  • There’s a known family cancer syndrome plus at least one family member with pancreatic cancer.

Other conditions that can increase the risk of pancreatic cancer are:

Other risk factors include:

  • Age. More than 80 percent of pancreatic cancers develop in people between the ages of 60 and 80.
  • Gender. Men have a slightly higher risk than women.
  • Race. African-Americans have a slightly higher risk than Caucasians.

Lifestyle factors can also increase the risk of pancreatic cancer. For example:

  • Smoking cigarettes doubles your risk of developing pancreatic cancer. Cigars, pipes, and smokeless tobacco products also raise your risk.
  • Obesity raises the risk of pancreatic cancer by about 20 percent.
  • Heavy exposure to chemicals used in the metalworking and dry-cleaning industries can raise your risk.

How common is pancreatic cancer?

It’s a relatively rare type of cancer. About 1.6 percent of people will develop pancreatic cancer in their lifetime.

Symptoms to watch for

Most of the time, symptoms aren’t obvious in early stage pancreatic cancer.

As the cancer advances, signs and symptoms may include:

  • pain in your upper abdomen, possibly radiating to your back
  • loss of appetite
  • weight loss
  • fatigue
  • yellowing of the skin and eyes (jaundice)
  • new onset of diabetes
  • depression

When to see your doctor

There’s no routine screening test for people at average risk of pancreatic cancer.

You might be considered at increased risk if you have a family history of pancreatic cancer or have chronic pancreatitis. If that’s the case, your doctor may order blood tests to screen for gene mutations associated with pancreatic cancer.

These tests can tell you if you have the mutations, but not if you have pancreatic cancer. Also, having the gene mutations doesn’t mean you will get pancreatic cancer.

Whether you’re at average or high risk, symptoms such as abdominal pain and weight loss don’t mean that you have pancreatic cancer. These can be signs of a variety of conditions, but it’s important to see your doctor for diagnosis. If you have signs of jaundice, see your physician as soon as possible.

What to expect from diagnosis

Your doctor will want to take a thorough medical history.

After a physical examination, diagnostic testing may include:

  • Imaging tests. Ultrasound, CT scans, MRI, and PET scans can be used to create detailed pictures to look for abnormalities of your pancreas and other internal organs.
  • Endoscopic ultrasound. In this procedure, a thin, flexible tube (endoscope) is passed down your esophagus and into your stomach to view your pancreas.
  • Biopsy. The doctor will insert a thin needle through your abdomen and into the pancreas to get a sample of the suspicious tissue. A pathologist will examine the specimen under a microscope to determine if the cells are cancerous.

Your doctor can test your blood for tumor markers that are associated with pancreatic cancer. But this test isn’t a reliable diagnostic tool; it’s usually used to assess how well treatment is working.

What happens next?

After diagnosis, the cancer needs to be staged according to how far it has spread. Pancreatic cancer is staged from 0 to 4, with 4 being the most advanced. This helps to determine your treatment options, which may include surgery, radiation therapy, and chemotherapy.

For treatment purposes, pancreatic cancer can also be staged as:

  • Resectable. It appears that the tumor can be surgically removed in its entirety.
  • Borderline resectable. Cancer has reached nearby blood vessels, but it’s possible that the surgeon can totally remove it.
  • Unresectable. It can’t be completely removed in surgery.

Your doctor will consider this, along with your complete medical profile, to help decide on the best treatments for you.