What is pancreatic cancer?
Pancreatic cancer is a disease where malignant (cancerous) cells form in the tissues of the pancreas. 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.
Pancreatic tumors are classified as either exocrine or neuroendocrine (endocrine) based on the cell type of origin. More than 90% of pancreatic cancers are exocrine tumors, most commonly pancreatic adenocarcinoma. Less than 10% are pancreatic neuroendocrine tumors (PNETs or islet cell tumors), which often grow more slowly.
Early stages often have no symptoms. When they do appear, they may include jaundice (yellowing of skin and eyes), abdominal or back pain, unexplained weight loss, and digestive problems such as nausea and vomiting. Pancreatic cancer is frequently diagnosed at an advanced stage, making treatment challenging.
What causes pancreatic cancer?
Pancreatic cancer arises when pancreatic cells acquire genetic changes that allow uncontrolled growth. Risk factors include:
- Genetic mutations: inherited BRCA2, Lynch syndrome, familial pancreatitis
- Smoking: tobacco users have nearly double the risk
- Age: most cases occur after age 45, with peak incidence in those over 65
- Chronic pancreatitis: often linked to heavy alcohol use and smoking
- Diabetes: both long-standing and newly diagnosed
- Obesity: BMI ≥ 30 increases risk by about 20%
- Diet: high in red or processed meats; low in fruits and vegetables
- Family history: first-degree relatives with pancreatic cancer or pancreatitis
- Occupational exposures: certain pesticides, dyes, and metal-refining chemicals
Mechanisms include DNA damage from carcinogens, chronic inflammation, and metabolic changes related to obesity and diabetes.
What are the symptoms of pancreatic cancer?
Symptoms often appear late and resemble other conditions:
- Jaundice: yellowing of skin/eyes, dark urine, light stools, itchy skin
- Abdominal or back pain, worse after eating or lying flat
- Unexplained weight loss and loss of appetite
- Digestive issues: nausea, vomiting, bloating, feeling full quickly
- New-onset diabetes, especially after age 50
- Fatigue and weakness
- Blood clots (deep vein thrombosis or pulmonary embolism)
- Enlarged gallbladder or liver from bile duct blockage
- Changes in stool or urine color
Early detection can improve outcomes, especially in high-risk individuals with family history or genetic predisposition.
How is pancreatic cancer diagnosed?
Diagnosis involves:
Medical history and physical exam
- Symptom assessment: pain, weight loss, jaundice, digestion
- Risk factor review: smoking, pancreatitis, diabetes, family history
- Physical exam: check for jaundice, abdominal tenderness, enlarged liver or gallbladder
Imaging studies
- CT scan: detailed images of pancreas and spread
- MRI/MRCP: visualize pancreas and bile/pancreatic ducts
- Endoscopic ultrasound (EUS): biopsy guidance
- PET scan: detect metastases elsewhere
- ERCP: dye injection into ducts, stent placement if needed
Laboratory tests
- Blood tests: liver function, CBC, kidney function
- Tumor markers: CA 19-9 and others
- Blood sugar: assess impact on insulin production
Biopsy
- Fine-needle aspiration via EUS or imaging guidance
- Endoscopic biopsy during endoscopy
- Laparoscopic surgical biopsy for inaccessible areas
Staging
- Stage I: confined to pancreas
- Stage II: local spread to nearby tissues or lymph nodes
- Stage III: involvement of major blood vessels
- Stage IV: distant metastases (liver, lungs, etc.)
How is pancreatic cancer treated?
Treatment depends on stage, tumor location, and patient health. Options include:
Surgery
- Whipple procedure: remove head of pancreas, duodenum, gallbladder, part of bile duct, and lymph nodes
- Distal pancreatectomy: remove body/tail of pancreas, often spleen
- Total pancreatectomy: remove entire pancreas, requires lifelong insulin and enzyme replacement
Chemotherapy
- Gemcitabine, 5-FU, capecitabine, albumin-bound paclitaxel, platinum agents, irinotecan
- Given neoadjuvantly (before surgery) or adjuvantly (after surgery), or for advanced disease
Radiation therapy
- External beam radiation, stereotactic body radiation
- Often combined with chemotherapy
Targeted therapy
- NTRK, BRAF, RET, KRAS, EGFR, PARP inhibitors based on tumor genetics
Immunotherapy
- Checkpoint inhibitors such as pembrolizumab or dostarlimab for select patients
Clinical trials
- Experimental drugs, vaccines, novel combinations
Palliative care
- Symptom management: pain control, nutritional and psychosocial support
After treatment, regular follow-up with physical exams, imaging, and blood tests is essential to detect recurrence. Long-term therapy may be needed for many patients.
Sources
- Niederhuber JE, et al. Carcinoma of the pancreas. In: Abeloff’s Clinical Oncology. 6th ed. Elsevier; 2020.
- National Comprehensive Cancer Network. Pancreatic adenocarcinoma. Accessed Oct. 7, 2024.
- National Cancer Institute. Pancreatic cancer treatment (PDQ) — Health professional version. Accessed Oct. 7, 2024.
- Pancreatic Cancer Network. What Is Pancreatic Cancer? Accessed Oct. 7, 2024.
- American Cancer Society. Pancreatic Cancer. Accessed Oct. 7, 2024.