What Is Pancreatic Cancer?

Pancreatic cancer begins when abnormal cells in the pancreas grow and divide out of control and form a
tumor.

The pancreas is a gland located deep in the abdomen, between the stomach and the spine. It makes
enzymes that help digestion and hormones that control blood-sugar levels.

Organs, like the pancreas, are made up of cells. Normally, cells divide to form new cells as the body
needs them. When cells get old, they die, and new cells take their place.

Sometimes this process breaks. New cells form when the body does not need them, or old cells do not
die. The extra cells may form a mass of tissue called a tumor.

Some tumors are benign. This means they are abnormal but cannot invade other parts of the body.

A malignant tumor is called cancer. The cells grow out of control and can spread to other tissues and
organs.

Even when the cancer spreads to other areas of the body, it is still called pancreatic cancer if that is
where it started. Pancreatic cancer often spreads to the liver, abdominal wall, lungs, bones and/or
lymph nodes.

Types of Pancreatic Cancer

Pancreatic tumors are either exocrine or neuroendocrine (endocrine) tumors. This is based on the type

of cell they start in. Knowing the type of tumor is important because each type acts differently and
responds to different treatments.

About 93% of pancreatic cancers are exocrine tumors. The most common type of pancreatic cancer
is adenocarcinoma.

About 7% of pancreatic tumors are neuroendocrine tumors (pancreatic NETs or PNETs), also called islet
cell tumors. They often grow slower than exocrine tumors.

What Causes Pancreatic Cancer?

Changes in your DNA cause cancer. These can be inherited from your parents or can arise over time. The
changes that arise over time can happen because you were exposed to something harmful. They can
also happen randomly.

Pancreatic cancer’s exact causes are not well understood. About 5% to 10% of pancreatic cancers are
considered familial or hereditary. Most pancreatic cancer happens randomly or is caused by things such
as smoking, obesity and age.

You may have an increased risk of developing pancreatic cancer if you have:

 Two or more first-degree relatives who have had pancreatic cancer

 A first-degree relative who developed pancreatic cancer before the age of 50

  An inherited genetic syndrome associated with pancreatic cancer

If you have any of these, the Pancreatic Cancer Action Network strongly recommends consulting with a
genetic counselor to determine your risk and eligibility for a screening program.

A person may also be more likely to get pancreatic cancer because of:

 Long-standing diabetes

 Chronic and hereditary pancreatitis

 Smoking

 Race (ethnicity): African-American or Ashkenazi Jew

 Age: over the age of 60

 Gender: males slightly more likely

 Diets high in red and processed meats

 Obesity

This does not mean that everyone who has these risk factors will get pancreatic cancer or that everyone
who gets pancreatic cancer has one or more of these.
Signs and Symptoms of Pancreatic Cancer

What are the symptoms of pancreatic cancer?

Pancreatic cancer may cause only vague unexplained symptoms. Pain (usually in the abdomen or back),
weight loss, jaundice (yellowing of the skin and/or eyes) with or without itching, loss of appetite,
nausea, change in stool, pancreatitis and recent-onset diabetes are symptoms that may indicate
pancreatic cancer. If you are experiencing one or more of these symptoms, we urge you to speak to your
doctor immediately and reference pancreatic cancer.

What are the symptoms of pancreatic neuroendocrine tumors (pancreatic NETs or PNETs)?

Pancreatic neuroendocrine tumors (PNETs) are rare, accounting for about 7 percent of all pancreatic
tumors. PNETs may cause the pancreas to overproduce hormones. High levels of these hormones in the
blood result in symptoms such as weight loss, nausea, vomiting, muscle weakness and skin rash. Learn
more about the symptoms of pancreatic neuroendocrine tumors.

Abdominal Bloating (Ascites)

Ascites is the abnormal accumulation of fluid in the abdomen. This extra fluid causes the belly to
become swollen and distended. Learn more about ascites.

Pain (Usually in the Abdomen or Back)

Pain in the upper abdomen or mid-back may be caused by the tumor pushing against or invading nerves
or organs near the pancreas. Pain can also result if the tumor blocks the digestive tract. Learn more
about pancreatic cancer-related pain.

Digestive Problems

Poor appetite, indigestion and nausea are common in people with pancreatic cancer. Some or all of
these symptoms may occur when a tumor in the pancreas presses against the stomach or first portion of
the small intestine. If this happens, food may remain in the stomach and cause several digestive
difficulties, including nausea and vomiting. Digestive symptoms can also occur due to blockage of the
pancreatic duct through which the pancreatic enzymes flow or due to changes in pancreatic enzyme
production.

Jaundice

Jaundice is a yellowing of the skin and eyes caused by excess bilirubin (a component of bile) in the
blood. A tumor in the head of the pancreas can cause narrowing of the bile duct and block the bile
flowing from the gallbladder into the small intestine. Blockage of the bile duct causes a buildup of
bilirubin. People with jaundice may also experience itchiness of the skin, abnormally dark urine and light
or clay-colored stools.

Changes in Stools

Many pancreatic cancer patients experience diarrhea, constipation or both. Diarrhea consisting of loose,
watery, oily or foul-smelling stools can be caused by insufficient amounts of pancreatic enzymes in the
intestines. This leads to malabsorption as undigested food passes quickly through the digestive tract.
Constipation is also a common problem, particularly in patients taking pain medications. These
medications slow the passage of food through the intestines. If the digestive system works too slowly, it
can cause stools to become dry, hard and difficult to pass.

Unexplained Weight Loss

Cancer-induced weight loss (also known as cancer cachexia) is a complex problem that affects the way
the body uses calories and protein. Cancer cachexia can cause the body to burn more calories than
usual, break down muscle and decrease appetite. A person may also notice a change in appetite or
desire for certain foods.

Blood Clots

Cancer causes changes in the blood that can increase the likelihood of forming clots. Blood clots may go
unnoticed and cause no symptoms. However, they are often associated with swelling, pain and
tenderness in the affected area.

Diabetes

Diabetes is a condition in which the body does not make, or properly use, a pancreatic hormone called
insulin. Insulin helps the body use glucose (sugar) efficiently. Research suggests that a sudden onset of
type 2 diabetes in people age 50 or older may be an early symptom of pancreatic cancer, especially in
those who have a low body mass index (BMI), experience continuous weight loss or do not have a family
history of diabetes. A sudden change in blood sugar levels in diabetics who previously had well-
controlled diabetes may also be a sign of pancreatic cancer. Learn more about diabetes and pancreatic
cancer.
 How Is Pancreatic Cancer Diagnosed?

To be sure of a pancreatic cancer diagnosis, your doctors must get information from imaging tests and
tumor tissue samples. Blood tests can also give them good information.

Imaging Tests

Imaging studies give doctors visual information about the pancreas and surrounding tissues. They are
the only way to see a pancreatic tumor. So, imaging tests are critical in diagnosing and monitoring
pancreatic cancer.

Doctors often use a computed tomography (CT) scan to see if the cancer has spread to nearby organs. A
CT scan takes detailed pictures of the body.

Other imaging tests include:

 Magnetic Resonance Imaging (MRI): Uses radio waves and magnets to take pictures of organs
and structures inside the body by measuring their energy

 Positron Emission Tomography (PET) Scan: Makes images based on the level of chemical
reactions happening in cells

 Endoscopic Retrograde Cholangiopancreatography (ERCP): Takes x-ray pictures after a dye is

injected through a thin tube

 Endoscopic Ultrasound (EUS): A thin tube, called an endoscope, with an ultrasound probe is
passed through the patient’s mouth and into the stomach or duodenum to take pictures of the
pancreas, bile duct and digestive tract

 Laparoscopy: A surgeon inserts a camera through a small cut in the abdomen to look at the
organs

Blood Tests and Tumor Markers for Pancreatic Exocrine Tumors

There is no blood test or tumor marker to find or diagnose pancreatic exocrine tumors, the most
common type of pancreatic tumor.

A pancreatic tumor blocking the bile duct can cause higher bilirubin and liver enzyme levels in the blood.
High levels of these substances in blood can be a clue for doctors to look for pancreatic cancer. But this
does not happen in all pancreatic cancer patients.

After diagnosis, two blood tests may help your doctor see if your tumor is growing, staying the same or
responding well to treatment. These tests measure substances some pancreatic cancer cells release into
your blood, including:

 Carbohydrate antigen 19-9 (CA 19-9)

 Carcinoembryonic antigen (CEA)

Not all pancreatic tumors release these substances, and other cancer types and illnesses can also release
them. So, they cannot be used to diagnose pancreatic cancer.

Blood Tests and Tumor Markers for Pancreatic Neuroendocrine Tumors

There is not one specific blood test that can find or diagnose pancreatic neuroendocrine tumors
(PNETs). But some blood tests can help with diagnosis.

These tests measure:

 Chromogranin A (cgA): A molecule that is high in most people with PNETs

 Pancreatic polypeptide (PP): A hormone often high in people with PNETs

 Specific hormones made by pancreatic neuroendocrine tumors

Doctors can use these blood tests along with imaging tests to get more information to diagnose a
pancreatic neuroendocrine tumor.

Biopsy

The only way for your doctor to know if a mass or tumor is cancer is to get a tissue sample, called
a biopsy.

Your doctor can get a biopsy through surgery or procedures like endoscopic ultrasound
(EUS) or endoscopic cholangiopancreatography (ERCP).

Then, a pathologist looks at the tissue samples under a microscope. The shape, size and arrangement of
the cancer cells may help your doctors figure out the type of pancreatic cancer.

Molecular Profiling

After getting a tumor tissue sample, your doctor may run tests to understand your tumor’s biological
details. This is called molecular profiling. Your doctor may be able to use this information to make
treatment decisions.

Every pancreatic tumor is different. Patients who receive treatment based on their tumor’s biological
characteristics have better outcomes. The Pancreatic Cancer Action Network strongly recommends
molecular profiling of your tumor to help determine the best treatment options.
 Why Is Pancreatic Cancer Hard to Find?

The pancreas is located deep in the abdomen, so doctors usually cannot see or feel the tumor during a
physical exam. Also, pancreatic cancer symptoms are not always obvious and usually develop over time.

Doctors may use several tests to make a diagnosis. But, there is no standard test to diagnose pancreatic
cancer. This makes diagnosis even more complicated.
Risk Factors Associated with Pancreatic Cancer

Family History
Risk increases if a person has two or more first-degree relatives (parent, sibling or child) who have had
the disease, a first-degree relative who developed pancreatic cancer before the age of 50, or an
inherited genetic syndrome associated with pancreatic cancer. The risk increases if a greater number of
family members are affected. Also, the risk of pancreatic cancer increases if there is a history of familial
breast, ovarian or colon cancer, familial melanoma or hereditary pancreatitis. Approximately 10 percent
of pancreatic cancer cases are related to a family history of the disease.

Diabetes
Pancreatic cancer is more likely to occur in people who have long-standing (over 5 years) diabetes.

Chronic Pancreatitis and Hereditary Pancreatitis

People with chronic pancreatitis have an increased risk of developing pancreatic cancer. Chronic
pancreatitis is common in individuals who consume large amounts of alcohol for many years.

Hereditary pancreatitis causes recurrent episodes of inflammation of the pancreas that generally start
by the time a person is 20 years old. The risk of developing pancreatic cancer is even higher in
individuals who have hereditary pancreatitis.

Smoking
Smoking is a significant risk factor and may cause about 20-30 percent of all exocrine pancreatic cancer
cases. People who smoke cigarettes are 2 times more likely to develop pancreatic cancer than people
who have never smoked.

Race (Ethnicity)
African-Americans have a higher incidence of pancreatic cancer compared to individuals of Asian,
Hispanic or Caucasian descent. There is also a higher incidence of pancreatic cancer among Ashkenazi
Jews, possibly due to a mutation involving the breast cancer (BRCA2) gene that is found in about 1
percent of individuals of this background.

Age
The chance of developing pancreatic cancer increases with age. Most people diagnosed with pancreatic
cancer are over the age of 60.

Gender
Slightly more men are diagnosed with pancreatic cancer than women. This may be linked to higher
smoking rates in men.

Diet
The link of diet and the development of pancreatic cancer is still unclear. A diet high in red and
processed meats is thought to increase the risk of developing pancreatic cancer. A diet high in fruits and
vegetables may decrease the risk.

Obesity
Obese people have a 20 percent increased risk of developing the disease compared to people who are
of normal weight. The risk is even higher in people who are obese during early adulthood. People with
excessive abdominal fat may have an increased risk independent of general obesity.
Alcohol
Some research suggests a link between heavy alcohol consumption and pancreatic cancer. The risk of
developing pancreatic cancer is higher in people who consume more than three alcoholic drinks daily
compared to those who do not.

Environment
Research suggests that exposure to certain environmental chemicals and heavy metals may increase the
risk of developing pancreatic cancer. These include beta-naphthylamine, benzidine, pesticides, asbestos,
benzene and chlorinated hydrocarbons.

Periodontal Disease
Periodontal disease and tooth loss appear to be linked to pancreatic cancer, even when controlling for
other risk factors.
What Treatments Exist for Pancreatic Cancer?

Standard Treatments

Pancreatic cancer treatment depends on the patient’s general health and the disease stage. Staging is
the process doctors use to describe the cancer’s size and location.

The U.S. Food and Drug Administration (FDA) approves treatments for specific diseases. Treatment
accepted by medical experts as proper for a certain type of disease and that is widely used by healthcare
professionals is called “standard of care.”

Standard treatments for pancreatic cancer are surgery, chemotherapy, radiation or a mix of these.

Some chemotherapy drugs are FDA-approved for treating pancreatic cancer. Others are being studied in
clinical trials or have been studied in clinical trials in the past.

The FDA has approved one targeted therapy drug for pancreatic cancer and one immunotherapy for a
small group of pancreatic cancer patients. But, these treatments are not widely used. Most patients who
receive targeted therapy or immunotherapy will get it through a clinical trial.

Surgery

Although 20 percent of pancreatic cancer patients

may be eligible for surgery, data shows that up to half of those patients are told they are ineligible. The
Pancreatic Cancer Action Network strongly recommends you see a surgeon who performs a high volume
of pancreatic surgeries (more than 15 per year) to determine eligibility.

For eligible patients, surgery is the best option for long-term survival of pancreatic cancer. Data show
high volume surgeons at high volume hospitals have higher success rates and fewer complications. The
Pancreatic Cancer Action Network strongly recommends you have a high volume pancreatic surgeon
(more than 15 surgeries per year) perform the surgery.
Chemotherapy

Chemotherapy uses drugs to kill cancer cells by

stopping them from growing and dividing. These drugs travel through the bloodstream and damage
cancer cells throughout the body.

Chemotherapy may shrink the tumors or stop their growth. It can be given alone or with surgery,
targeted therapy, radiation or a mix of these.

Radiation Therapy

Radiation therapy uses energy in the form of particle or electromagnetic waves. It can damage cancer
cells to stop them from growing and dividing. A large machine directs the radiation through the
abdomen into the tumor.

The goal of radiation is to stop the tumor from growing or to shrink it while not harming the healthy
organs or tissue nearby.

Doctors may use radiation therapy to:

 Relieve pain the tumor causes

 Try to shrink the tumor before surgery

 Destroy cancer cells that may be in the area after surgery

Clinical Trials

Clinical trials are research studies that look at new treatments.

Clinical trials are the only way for researchers to see if new treatments help people with pancreatic
cancer. The FDA looks at information from successful clinical trials to decide if an experimental
treatment should be approved for a specific disease.

Pancreatic cancer patients who participate in clinical research have better outcomes. Every treatment
available today was approved through a clinical trial. The Pancreatic Cancer Action Network strongly
recommends clinical trials at diagnosis and during every treatment decision.

We have the most complete database of pancreatic cancer clinical trials in the United States. Patient
Central Associates can run a personalized search for you. You can also start your own search through our
Clinical Trial Finder.
CLINICAL TRIALS 

Immunotherapy

Immunotherapy is a treatment that helps your immune system attack cancer cells.

Your immune system helps your body fight germs and sickness. But, it often does not know that cancer
cells are dangerous, or it cannot get to them. Immunotherapy helps your body find and fight the cancer
cells like it fights other sickness.

There is one FDA-approved immunotherapy drug for pancreatic cancer patients with certain genetic
mutations. But, it is only an option for a small percentage of patients. Most immunotherapy drugs for
pancreatic cancer are in clinical trials.

Targeted Therapy

Targeted therapy uses drugs to attack unique aspects of cancer cells with little harm to healthy cells.
Targeted therapies often block the process that changes normal cells into cancer, stopping the tumor’s
growth.

There is only one FDA-approved targeted therapy for pancreatic adenocarcinoma, and it is not
commonly used. Other targeted therapies for pancreatic cancer are still being studied in the laboratory
or in clinical trials.

Precision Medicine

Every pancreatic tumor is different. The Pancreatic

Cancer Action Network strongly recommends molecular profiling of your tumor to help determine the
best treatment options.

Molecular profiling tells you about your tumor’s biology. This information can help your doctor find
precision treatments for you. Treatments based on your tumor’s biology may increase their success.
These may be standard treatments, clinical trials or off-label treatments.

Off-label treatments are FDA-approved to treat another cancer, not pancreatic cancer. But, these
treatments have shown some promise in pancreatic cancer. A doctor can prescribe them when it makes
sense for the patient.