Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive form of cancer and the most common type of pancreatic cancer. It makes up more than 90% of pancreatic cancers and leads to nearly half a million deaths per year worldwide.

The yearly number of cases is expected to more than double in the next 10 years in Europe and the United States due to our aging society as well as increased rates of obesity and type 2 diabetes.

PDAC survival rates are slowly improving, but the outlook remains poor. PDAC tends to quickly spread to other body spots, and a lack of symptoms in the early stages frequently leads to late diagnosis.

Here’s what we know so far about PDAC including risk factors, symptoms, and treatment.

Most pancreatic cancers are exocrine cancers. These cancers develop in glands and ducts that produce and carry enzymes from your pancreas to your intestines and help you digest your food.

About 95% of exocrine pancreatic cancers are classified as adenocarcinoma. Most of these cancers develop in the linings of ducts and are called PDAC.

PDAC tends to be aggressive. It often spreads to the liver, gastrointestinal organs, nervous system, and blood vessels.

Pancreatic ductal adenocarcinoma develops when cells lining the ducts in your pancreas replicate uncontrollably.

Like with most other types of cancer, researchers don’t know exactly why this happens, but a combination of environmental and genetic factors probably contribute.


The chances of developing PDAC are reportedly 6.79 times higher in people with a family member with PDAC than those without. The risk increases to 9.31 times if a family member develops PDAC before the age of 50.

About 5% to 6% of people with PDAC have mutations in genes associated with PDAC, including:

  • BRCA1/2
  • ATM
  • MLH1
  • TP53
  • CDKN2A

A number of genetic syndromes are also associated with an increased risk of developing PDAC. They include:

Genetic syndromeRisk of PDAC (compared to general population)
hereditary pancreatitis60 to 87 times
hereditary breast and ovarian cancer syndrome4.1 to 5.8 times
Peutz-Jeghers syndrome132 times
familial atypical multiple mole melanoma syndrome13 to 22 times
hereditary colorectal adenomatous polyposis4.4 times
hereditary nonpolyposis colorectal cancer8.6 times

Other health conditions and habits

Some lifestyle habits and medical conditions seem to be associated with a higher risk of developing PDAC. These habits and conditions include:

Health condition or lifestyle habitRisk of PDAC (compared to general population)
obesity1.1 times risk for a 5 kg/m2 increase in body mass index
smoking1.68 times
alcohol consumption1.22 times in heavy drinkers
diabetes538 times within one year of diabetes diagnosis
chronic pancreatitis14.6 times risk within 4 years
intraductal papillary mucinous neoplasms15.8 to 26 times
red meat consumption1.25 to 1.76 times
chlorinated hydrocarbon occupational exposure2.21 times

PDAC often doesn’t cause symptoms in the early stages, which can lead to delayed diagnosis. Most symptoms aren’t unique to pancreatic cancer.

It’s important to visit your doctor if you develop any of the following potential symptoms of pancreatic cancer:

Pancreatic cancer diagnosis starts with a primary doctor. They’ll start the process by performing a physical exam and considering your medical and family history. They’ll look for signs that could suggest pancreatic cancer like a swollen abdomen or jaundice.

They may recommend blood and urine tests to look for signs of cancer and measure your overall health.

If cancer is suspected, your doctor may refer you to a specialist for imaging tests. Many types of imaging tests can be used to help diagnose pancreatic cancer. They include:

The only way to be certain that you have pancreatic cancer is with a small tissue sample called a biopsy.

Treatment depends on factors like how far PDAC has progressed, your age, and your overall health.

Standard treatment for pancreatic cancer includes:

Surgery is the preferred option for cancer that’s contained to the pancreas or hasn’t spread far outside. It’s usually followed by chemotherapy.

Only about 15 to 20% of people with PDAC are eligible for surgery.

Here’s a look at treatment options per stage, according to the National Cancer Institute.

Treatment of resectable or borderline resectable pancreatic cancer

“Resectable” means that the cancer is considered surgically removable. Borderline resectable means it might be removable. Treatment options are:

  • chemotherapy with or without radiation followed by surgery
  • surgery
  • surgery followed by chemotherapy
  • surgery followed by chemotherapy and radiation therapy
  • clinical trial of chemotherapy or radiation or both before surgery
  • clinical trial of different types of radiation therapy

Treatment of locally advanced pancreatic cancer

Locally advanced means the cancer has spread to nearby tissues but not distant parts of your body. Treatment options are:

  • chemotherapy with or without targeted therapy
  • chemotherapy or chemotherapy and radiation
  • surgery to cure cancer
  • palliative surgery to manage symptoms
  • clinical trial of new cancer drugs with chemotherapy or chemotherapy and radiation therapy
  • clinical trial of radiation therapy during surgery or internal radiation therapy

Treatment for metastatic or recurrent pancreatic cancer

Metastatic cancer means the cancer has spread to distant body parts. Treatment options are:

  • chemotherapy with or without targeted therapy
  • clinical trials of new cancer drugs with or without chemotherapy

PDAC tends to have a very poor prognosis compared to other cancers, but researchers are continuing to examine the best way to treat it. Survival rates have been improving slowly over time. Currently, only about 10% of people live at least 5 years after their diagnosis.

PDAC has the best outlook when caught in the early stages and can be removed surgically. However, only about 2% of cancers are diagnosed in stage 0 or 1. Researchers have found that people with stage 1 PDAC who receive surgery have a 5-year survival rate of 38.2% compared to 2.9% in people who don’t get surgery.

About half of people with PDAC live fewer than 10 to 12 months. Less than 20% percent of people survive one year if cancer has spread to distant body parts.

About 60% to 70% of cases of PDAC are found in the head of the pancreas. They’re usually diagnosed earlier than tumors in the body or tail and have a better outlook.

PDAC is the most common type of pancreatic cancer and has a poor outlook. It often doesn’t cause symptoms in the early stages until it’s grown large or spread past the pancreas.

Researchers are continuing to improve their understanding of how to best treat PDAC.

If you have any warning signs of pancreatic cancer, it’s important to see your doctor for a proper diagnosis. Catching pancreatic cancer in the early stages is one of the most important factors for having a good outlook.