Pancreatic Cancer

Pancreatic cancer often causes few or no symptoms in its early stages, so it is frequently diagnosed after the cancer has grown or spread. Early detection can provide more treatment options and improve outcomes.

If diagnosed while localized: 5-year relative survival is about 44%
If diagnosed after distant spread: 5-year relative survival is about 3%

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Types of Pancreatic Cancer

Pancreatic cancer is not a single disease. The two main types are:  

• Pancreatic ductal adenocarcinoma (PDAC) — This is the most common type. It begins cells that line the pancreatic ducts and makes up the majority of pancreatic cancers and is commonly referred to as “pancreatic cancer” or “pancreatic adenocarcinoma.”
• Pancreatic neuroendocrine tumors (pNETs) — This develops from the hormone-producing cells in the pancreas. These tumors are less common and behave and respond differently to different treatments than pancreatic adenocarcinoma.

Your treatment depends on the type of pancreatic cancer you have, as well as its stage and other factors.

Pancreatic cancer often causes no symptoms until later stages. Many of the symptoms below can also be caused by other, less serious conditions — but if you have any of them, contact your doctor:

• Upper abdominal pain that may spread to the middle or upper back
• Unexplained weight loss
• Jaundice — yellowing of the skin and the whites of the eyes, sometimes with severe itching
• Nausea and vomiting (often in later stages, if a tumor blocks part of the digestive tract)
• Digestive problems

Risk Factors

The exact cause of pancreatic cancer isn't fully known, but several factors are linked to higher risk:

• Smoking  
• Family history/genetic conditions  
• Age  
• Chronic pancreatitis  
• Diabetes  
• Obesity  
• Heavy alcohol use  
• Certain occupational exposures

Screening and Early Detection

There is currently no routine screening test for people at average risk of pancreatic cancer. Screening is generally recommended only for people who have a significantly higher risk because of their family history or an inherited genetic condition.

People at high risk may be monitored at specialized centers using tests such as:

• MRI/MRCP — detailed images of the pancreas and pancreatic ducts.  ‍
• Endoscopic ultrasound (EUS) — uses an ultrasound probe placed near the pancreas to look for abnormalities.

If you have a family history of pancreas cancer.

• Genetic testing and counseling may help identify inherited conditions that increase pancreatic cancer risk.  
• Early detection can make more treatment options available, including potentially curative surgery.

Doctors use a combination of imaging, blood tests, and sometimes a biopsy to diagnose pancreatic cancer and understand the disease.

Blood Tests

• Liver function tests check liver enzymes and bilirubin, which may be elevated.
• CA 19-9 and CEA are tumor markers that may be elevated in pancreatic cancer but can also be elevated for other reasons.
• CA 19-9 and CEA cannot diagnose pancreatic cancer by themselves and are not used to screen people for pancreatic cancer.

Imaging Tests

• CT scan — cross-sectional x-ray images of the body.
• MRI — detailed images using magnetic and radio-wave technology.
• MRCP — a specialized MRI focused on the pancreatic and bile ducts.
• Endoscopic ultrasound (EUS) — a probe passed through the mouth to the stomach, positioned right next to the pancreas for detailed images.
• ERCP — a thin camera-tipped tube passed through the mouth and stomach into the small intestine; dye is injected to highlight the ducts on x-ray.

Biopsy

A biopsy examines a tissue sample under a microscope and is commonly used to confirm a diagnosis. An EUS-guided biopsy is often used to obtain tissue. ERCP is primarily used to evaluate or treat duct problems, such as placing a stent to relieve an obstruction.

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Staging & Resectability

Doctors describe pancreatic cancer using both its stage and its resectability. Stage describes how far the cancer has spread. Resectability describes whether the tumor can be safely removed with surgery.

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Understanding Resectability

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Resectable: The tumor can be removed completely with surgery. Some people with higher-risk resectable disease may receive chemotherapy before surgery.

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Borderline Resectable: The tumor is close to or partially involves certain blood vessels. Treatment such as chemotherapy may be given first to improve the chances of successful surgery.

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Locally Advanced: The tumor has grown into or around major blood vessels or nearby structures and cannot be safely removed at diagnosis. Treatment may control the cancer and, in some cases, shrink it enough to reconsider surgery.

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Metastatic:  

The cancer has spread to distant organs. Treatment usually focuses on controlling the cancer, prolonging life, and managing symptoms.

Stage and resectability are important factors in choosing a treatment plan.

Genetic and Biomarker Testing

Your doctor may recommend testing your tumor for specific genetic or molecular changes. This is sometimes called biomarker testing, molecular testing, or tumor profiling.

The results may help your care team determine whether you could benefit from a targeted treatment or another specific therapy.

Depending on your cancer, testing may look for changes involving genes or biomarkers such as:

• BRCA1 or BRCA2  
• PALB2  
• KRAS  
• MSI/MMR  
• NTRK  
• BRAF  
• HER2  
• NRG1  
• RET

Not every test is appropriate for every patient, and treatment options continue to change as new targeted therapies become available.

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Genetic Testing

People diagnosed with pancreatic cancer should be offered germline genetic testing, even if they do not have a known family history of cancer. Testing may:

• Identify inherited cancer risk
• Help doctors choose certain treatments
• Help family members understand whether they may also be at increased risk
• Help determine whether additional cancer screening may be appropriate

Genetic counseling can help you understand what testing involves and what your results may mean for you and your family.

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Treatment and Clinical Trials

Treatment depends mainly on the type of pancreatic cancer, its stage, and whether the tumor can be removed with surgery.

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Surgery

If the tumor is contained within the pancreas and hasn't spread to major blood vessels, distant lymph nodes, or other organs, surgery to remove it may be possible. Local lymph node involvement doesn't necessarily rule out surgery — but spread to distant lymph nodes generally does.

• Whipple procedure (pancreatoduodenectomy) — the most common surgery, used for tumors in the head of the pancreas. Removes the head of the pancreas along with the duodenum, gallbladder, end of the bile duct, and sometimes part of the stomach; the remaining organs are then reconnected. A laparoscopic (minimally invasive) version may be available for some patients.
• Distal pancreatectomy — removes tumors in the tail of the pancreas often with the spleen.
• Total pancreatectomy — removes the entire pancreas, and sometimes the gallbladder, spleen, and other nearby tissue.

Surgery is usually followed by chemotherapy and radiation may be considered in selected situations. Both are used , to help prevent the cancer from returning.

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Locally Advanced Tumors

If the tumor involves major blood vessels, surgery is usually not recommended right away due to the risk of complications. Instead, chemotherapy is generally the initial treatment; radiation may be considered in selected situations. If it shrinks enough that blood vessels are no longer involved, surgery may become an option.

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Chemotherapy

Chemotherapy can be used before surgery (to shrink a tumor), after surgery (to prevent recurrence), or as the main treatment when surgery isn't possible. It has been shown to improve survival, especially over longer periods.

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Clinical Trials

Clinical trials give patients the opportunity to receive new or experimental treatments while helping researchers improve pancreatic cancer care. Clinical trials may study:

• New chemotherapy drugs or combinations  
• Targeted therapies  
• Immunotherapy  
• New surgical approaches  
• Radiation treatments  
• Cancer vaccines  
• Treatments based on specific genetic or molecular changes

Clinical trials may be available at different stages of pancreatic cancer. Ask your care team whether a clinical trial may be appropriate for you.

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Managing Symptoms & Side Effects

Treatment can bring its own challenges — pain, jaundice, itching, digestive issues, and depression are all common. Your care team may loop in pain management specialists, nutrition counselors, occupational therapists, or psychological counselors to help manage these, case by case.

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Complementary Therapies

These can be used alongside — never instead of — your medical treatment. Always check with your doctor before starting any of them.

• Physical activity— can reduce stress, pain, nausea, fatigue, and depression. Ask your doctor before starting; many patients begin with short walks (5–10 minutes, twice a day) and build up gradually.
• Meditation/relaxation — techniques like breathing exercises, progressive muscle relaxation, or guided imagery can help with sleep, pain, nausea, and anxiety.
• Yoga — biweekly practice has been shown to improve quality of life, stress, mood, and appetite in some patients.
• Massage therapy — can ease muscle discomfort, improve circulation, and promote relaxation; should be done by a licensed therapist.
• Acupuncture — involves thin needles at specific points on the body; may help with symptom relief for some patients.

Nutrition & Digestive Health

Pancreatic cancer and its treatment can affect digestion, appetite, weight, and blood sugar. Some people develop or present with exocrine pancreatic insufficiency (EPI) when the pancreas does not produce enough digestive enzymes.

Signs of EPI may include:

• Unexplained weight loss
• Bloating or gas
• Diarrhea
• Loose or oily stools
• Difficulty maintaining weight
• Nutritional deficiencies

Pancreatic enzyme replacement therapy (PERT) can help your body digest and absorb nutrients when the pancreas is not producing enough enzymes.

A registered dietitian who specializes in oncology or pancreatic disease can help you maintain adequate calories, protein, fluids, and nutrients during treatment.

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A pancreatic cancer diagnosis can feel overwhelming. Your care team will typically work through several steps to understand your cancer and determine the best treatment approach.

1. Confirm the diagnosis through imaging, pathology, and other testing.  
2. Determine the type of pancreatic cancer.  
3. Stage the cancer to determine whether and where it has spread.  
4. Determine whether the tumor is resectable.  
5. Consider genetic testing and tumor biomarker testing.  
6. Review treatment options with you and your supporters (family and/or friends).  
7. Consider a clinical trial when appropriate.  
8. Develop a plan for managing symptoms, nutrition, pain, and other needs.

A second opinion at a center experienced in treating pancreatic cancer can also be helpful, particularly when surgery or complex treatment decisions are being considered.

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After Treatment and Survivorship

Finishing treatment is an important milestone, but recovery can continue long after treatment ends.

Follow-up care may include:

• Regular appointments with your care team  
• Imaging and laboratory tests  
• Monitoring for cancer recurrence  
• Managing digestive problems or EPI (with pancreatic enzyme replacement therapy when needed)
• Monitoring blood sugar and diabetes  
• Managing fatigue and other treatment effects  
• Emotional and mental health support  
• Nutrition and physical activity

It is normal to have questions or concerns about the future after treatment. Your healthcare team can help you develop a long-term survivorship plan.

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Support for Patients and Caregivers

Pancreatic cancer affects more than physical health. A diagnosis can bring anxiety, depression, financial concerns, changes in relationships, and uncertainty about the future.

Support may come from:

• Support groups  
• Oncology social workers  
• Mental health professionals  
• Patient navigators  
• Financial counselors  
• Spiritual care providers  
• Family and friends  
• Caregiver support programs

Caregivers need support, too. Asking for help with transportation, meals, appointments, medications, or daily activities can make the demands of treatment more manageable.