Pancreatic cancer is currently the third leading cause of cancer deaths in the United States and has the highest mortality rate of all major cancers. The American Cancer Society estimates that in 2022 an estimated 62,210 Americans will be diagnosed with pancreatic cancer in the U.S., and more than 49,830 will die from the disease. For all stages combined, the 5-year relative survival rate is 12%.
One of the major challenges associated with pancreatic cancer is that the condition often goes undetected for a long period of time because signs and symptoms seldom occur until advanced stages. By the time symptoms occur, cancer cells are likely to have spread (metastasized) to other parts of the body, often preventing surgical removal of tumours. If diagnosed early, the 5-year survival rate for pancreatic cancer patients is above 80 percent. If pancreatic cancer is detected late, the 5-year survival rate drops to less than 10 percent
Pancreatic cancer is a major focus of cancer research, and much progress is being made in understanding the risks of pancreatic cancer, diagnosing and treating it, and the genetics behind the condition. Because of this research, the survival rate for pancreatic cancer has increased to 11%, a 5% increase over the past decade.
Pancreatic cancer research funding has increased to $200 million since 2000, when only $22 million was spent on research. Research findings and advancements are being published on an ongoing basis, helping to advance medical knowledge and improve patient quality of life.
NPF’S Primary Mission
The National Pancreas Foundation’s primary mission is to raise and direct funds to worthy research projects in the field of pancreas disease. NPF is the only foundation that supports research in pancreatic cancer and acute pancreatitis, chronic pancreatitis and pediatric pancreatitis. NPF has provided over $5 million to fund pancreatic research.
Symptoms of pancreatic cancer may include:
the development of type 2 diabetes
some tumours may cause jaundice leading to an earlier diagnosis.
Risk Factors Risks for Pancreatic Cancer
The exact cause of pancreatic cancer is yet to be determined. However, genetics appear to play a large role, as they do with other cancers. People with family members who have been diagnosed with pancreatic cancer are at a greater risk of developing it themselves.
Age. The vast majority of cases of pancreatic cancer occur in individuals aged 65 years and older.
Race. Black men and women have a greater likelihood of developing pancreatic cancer. Persistent healthcare inequities and disparities for communities of color compound, the devastation of pancreatic cancer. The incidence rate for pancreatic cancer among Black Americans is 20 percent higher than that of any other racial demographic. The pancreatic cancer death rate is 17 percent higher for Black men than for White men.
Sex. Men are more likely to develop pancreatic cancer.
Excess alcohol. People who drink 9 or more alcoholic drinks every day are at increased risk for developing pancreatic cancer.
Cigarette smoking. Smokers are 2 to 3 times more likely to develop pancreatic cancer than non-smokers. Smoking is the single greatest risk factor, associated with almost one-third of all cases of pancreatic cancer.
Diabetes. Multiple large studies have shown that people diagnosed with diabetes (abnormal glucose metabolism) are at significantly increased risk of developing pancreatic cancer.
Weight. Multiple large studies have shown that people who are obese, with a body mass index (BMI) 30 or greater, are at increased risk for developing pancreatic cancer (a large study showed that the risk was 47% greater compared to people who were not obese).
Diet. Diets high in animal fats and low in fruits and vegetables are more likely to develop pancreatic cancer. A large study has also shown that consumption of processed meat and red meat is associated with an increased risk of developing pancreatic cancer
Chemical exposure. Individuals working with petroleum agents such as gasoline and fuel oils are at increased risk of developing pancreatic cancer.
Bacteria. Helicobacter pylori (H. pylori) is a bacterium that can infect the gut, and it is one of the most common gut infections in humans, affecting approximately one-third of the US population. H. pylori is well known to cause ulcers, but many studies are now linking it to the development of pancreatic cancer.
ABO blood type has also been shown to be associated with a risk of developing pancreatic cancer.
A Black African American’s Guide to Pancreas Disease
The National Pancreas Foundation has created a Black/African American Initiative to address health disparities and access to healthcare in underserved populations.
Our interactive DigiReach guide was created to educate and encourage individuals to improve their health and take preventive measures to reduce their risk of pancreatic cancer and pancreatitis.
This FREE interactive guide can be downloaded, printed, listen to the audio version and watch videos to help you manage your pancreatic condition.
Pancreas Disease, Pancreatic Cancer, and Black/African American People
Living with Pancreas Disease
Signs and Symptoms
Signs and Symptoms of Pancreatic Cancer
In many cases, there are no symptoms of pancreatic cancer until it’s later stages. The following is a list of symptoms that could indicate pancreatic cancer, but many other conditions can present with similar symptoms.
If you exhibit any of the below symptoms, contact your physician as soon as possible:
Upper abdominal pain that may extend to the middle or upper back
Weight loss Jaundice—yellowing of the skin and whites of the eyes. This condition is fairly common among patients with pancreatic cancer and develops when blood cells become worn out and break down into bilirubin. Normally, bilirubin is eliminated in the bile, which is a fluid produced by the liver. However, if a pancreatic tumour blocks the flow of bile, jaundice may occur. Severe itching may occur, owing to a build-up of bile acids.
Nausea and vomiting can occur during later stages if a pancreatic tumour has grown sufficiently large to block a portion of the digestive tract (usually the duodenum).
Digestive problems can occur because the pancreas is an integral part of the digestive system.
Diagnosis of Pancreatic Cancer
Your physician may select one or more of the following tests to help diagnose pancreatic cancer. The following is an overview of tests which can be ordered to assist in the diagnosis of pancreatic cancer.
Genetic/Early Detection Testing
When it comes to cancer, there are many factors that can increase your risk…Age, diet, physical activity and even your weight all play into the equation. Fortunately, they are also factors that you can control to limit your risk and hopefully avoid that cancer diagnosis. However, there is one factor that significantly influences your chances of ending up with any number of deadly cancers that you’re simply born with — your genetics. In fact, up to 10 percent of all cancers are thought to be related to gene mutations that are inherited or passed down through your family, including pancreatic cancer. In other words, they are cancers you’re at higher risk for just because your family members were at higher risk. And while you may think the possibility of genetic cancer is something you can do little about because you can’t change your genes, think again… The truth is, even if your genes indicate higher risk for cancer, there are still steps you can take to lower those risks. You can also ensure early detection, giving you the best chance of defeating the disease, if it develops, because you and your doctor will know what to look for. For many diseases, regular screening makes sense. But — because pancreatic cancer often has no noticeable symptoms — screening is vital for people with major risk factors. By taking action early, you have the chance to detect signs that cancer may be growing. Early intervention leads to more timely treatment. And — because early-stage cancers are easier to treat — this early intervention can lead to better outcomes.
Liver Function Test
Measures liver enzymes and levels of bilirubin (pancreatic cancer causes elevated bilirubin in the blood) CA19-9: Measures a type of protein in the blood that is often associated with pancreatic cancer (this protein can be present in non-cancerous conditions as well) Carcinogenic Antigen (CEA): Measures a type of protein in the blood (different from CA19-9) that is often associated with pancreatic cancer (this protein can be present in non-cancerous conditions as well)
Diagnostic Imaging Tests
Diagnostic imaging tests can see the location of a tumour and indicate whether cancer cells have spread, or metastasized, to other parts of your body.
Computed tomography (CT):
Provides the physician with computer-generated, cross-sectional images of the body by taking multiple x-rays from different angles.
Magnetic resonance imaging (MRI)
Provides the physician with computer-generated, detailed images of the body by using magnetic/radiofrequency technology.
Magnetic resonance cholangiopancreatography (MRCP)
Type of imaging test used in the evaluation of patients with known or suspected pancreatic cancer. An MRCP is a type of MRI programmed to look at the pancreatic and biliary tree.
Endoscopic ultrasound (EUS)
An ultrasound performed while patient is under anesthesia – the ultrasound probe is inserted through the mouth and advanced to a position in the stomach that is right next to the pancreas. Because of this anatomical positioning, the EUS can provide a detailed image of the pancreas using ultrasound technology. Learn more
Type of endoscopic procedure used in the evaluation of patients with known or suspected pancreatic cancer. The Mayo Clinic defines ERCP as follows: “Endoscopic retrograde cholangiopancreatography (ERCP) uses a dye to highlight the bile ducts. During ERCP, a thin, flexible tube (endoscope) with a camera on the end is gently passed down your throat, through your stomach and into the upper part of your small intestine. Air is used to inflate your intestinal tract so that your doctor can more easily see the openings of your pancreatic and bile ducts. A dye is then injected into the ducts through a small hollow tube (catheter) that’s passed through the endoscope. Finally, x-rays are taken of the ducts.”
Although there are multiple diagnostic approaches to detecting pancreatic cancer, the most accurate way is by taking a sample of tissue (biopsy), which can be evaluated under a microscope. A biopsy can be performed during EUS or ERCP, or by a radiologist inserting a needle to withdraw tissue while under anesthesia.
Staging of Pancreatic Cancer in the Tumour, Node, Metastasis (TNM) model
Tumour size, lymph node status, and metastasis are measured separately, each with its own number scale.
For tumor (T) size:
T1 denotes a tumour size less than 2 cm across in any direction
T2 denotes a tumour larger than 2 cm across
T3 denotes a tumour that has started to grow into the duodenum and bile ducts that surround the pancreas
T4 denotes that the tumour has invaded the spleen, large intestine, and major blood vessels
For lymph node (N) status:
N0 indicates that there are no lymph nodes containing cancer
N1 indicates that there are lymph nodes containing cancer, and therefore, the tumour has likely metastasized beyond the pancreas.
For metastasis (M) status:
M0 indicates that the tumour has not spread
M1 indicates that it has spread.
The second model of pancreatic cancer has 4 numbered stages, as follows:
Stage I. The tumour has not progressed outside of the pancreas. The TNM equivalent would be T1 or 2, N0, M0, meaning that there has been no spread, and that the tumour is relatively small.
Stage II. The tumour has grown into nearby tissues and perhaps the duodenum. Lymph nodes are not affected. The TNM equivalent would be T3, N0, M0.
Stage III. The tumour may be quite large and has spread to the lymph node system, and thus is capable of spread to other organs. The TNM equivalent would be T1–3, N1, M0.
Stage IV. This stage is often divided into 2 sub-stages: Stage IVA describes a situation in which cancer has grown into nearby organs, including the spleen and/or stomach, as well as large blood vessels. The TNM equivalent would be T4, N1 or 2, M0.
Stage IVB describes a situation in which cancer has spread to other organs, such as the liver or lungs, with a TNM equivalent of T1–4, N0 or 1, M1.
Treatment of Pancreatic Cancer
Treatment options for pancreatic cancer depend on the type and stage of the cancer. Medical research is ongoing to determine the best methods for relieving pain and eliminating cancer.
Palliative treatment options include stenting of the obstructed biliary tree (to relieve jaundice), surgical biliary bypass (especially in younger patients), and complex pain-relief options. In addition, enzyme supplements may be useful because the main pancreatic duct is usually blocked.
Chemotherapy is an option and has been shown to increase the chance of survival, especially over longer periods of time.
Curative treatment options include partial or total removal of the pancreas to prevent metastasis. Postoperative morbidity is high (30%–40%), and patients generally require intensive care for at least 24 hours after surgery.
Survival rates also depend on the stage and type of pancreatic cancer. For current information on survival rates and statistics, please visit the National Cancer Institute.
Localized Pancreatic Tumour: If a tumour of the pancreas is localized and blood vessels are not impacted by the tumour, surgery is often recommended to remove the tumour. In many cases after surgery, the physician will recommend additional therapy to prevent the cancer from growing back, such as chemotherapy, radiation therapy, or both.
There are several different types of surgeries used to remove a localized pancreatic tumour. As technology has advanced, options for surgical intervention have advanced, but the type of surgery recommended depends on the stage of cancer and the location of the tumour.
Whipple Procedure is often used to remove tumours in the head of the pancreas.
The Whipple procedure is the most common operation to remove pancreatic cancers. The Whipple procedure may also be used to treat some benign pancreatic lesions and cysts and cancers in the bile duct and beginning part of the small intestine (duodenum).
At the time of diagnosis, pancreatic cancer is often found to have already metastasized (spread to other organs) and these patients will not benefit from surgical removal of their primary tumour. Surgery can be performed as a potentially curative measure if the cancer is contained within the pancreas and has not spread to blood vessels, distant lymph nodes or other organs. (Local lymph nodes are not an exclusion to surgery. Distant lymph nodes generally do preclude surgery.) This treatment option should be discussed with your physician to see if it is a viable option. The type of operation performed for the removal of pancreatic cancer is based on the location of the tumour. For tumours of the head and neck of the pancreas, the Whipple procedure is performed. Tumours that grow in the body and tail of the pancreas are removed through a surgery known as a distal pancreatectomy.
The goal of the Whipple procedure (pancreatoduodenectomy) is to remove the head of the pancreas. This is where most tumours occur. Because the pancreas is so integrated with other organs, the surgeon must also remove the first part of the small intestine (duodenum), the gallbladder, the end of the common bile duct and sometimes a portion of the stomach. In the reconstruction phase of the operation, the intestine, bile duct and remaining portion of the pancreas is reconnected.
A laparoscopic Whipple procedure may be offered to select individuals. The laparoscopic Whipple procedure is performed through small incisions in the abdominal wall. A laparoscope, a long thin tube with a lighted camera at its tip, is inserted through one incision. The surgeon operates using specially designed surgical instruments placed through the remaining incisions, guided by the laparoscope images shown on a monitor in the operating room. Conventional surgeries require a longer incision and wider opening of the abdomen. With laparoscopic procedures, surgeons are generally able to reduce blood loss and the risk of infection for the patient.
Complications and Outcomes
The most common post-surgical complication of pancreatoduodenectomy is the leaking of pancreatic juices from the incision. If this occurs, a drain may be inserted through the skin to allow drainage for several weeks after surgery. Weight loss is another frequent complication of the Whipple procedure. Diabetes is a potentially serious concern for some people (a minority) after surgery. In general, although many people do very well after the Whipple procedure, some develop immediate complications that affect their quality of life. How to select the physician and medical center?
Questions and Terminology
How many of these operations do you (and your group) perform each year?
What are your complication rates? How many of your patients survive the operation?
Distal pancreatectomy is often used to remove tumours in the tail of the pancreas.
Total pancreatectomy is the removal of the entire pancreas, and often removal of the gallbladder, spleen, and other areas as deemed necessary by the surgeon.
Central pancreatectomy is the removal of the middle of the pancreas
Locally Advanced Tumour: If a tumour impacts blood vessels, surgery is not usually recommended because of potential complications. For many locally advanced tumours, physicians will recommend chemotherapy and radiation therapy to try to shrink the tumour and prevent its spread. If the locally advanced tumour shrinks enough and blood vessels are no longer involved, surgery may be recommended.
Patients who undergo treatment for pancreatic cancer can experience different symptoms, such as significant pain, jaundice and itching, digestion problems, and depression. Your physician will treat these symptoms if they occur on a case-by-case basis, and may bring in other team members, such as pain management specialists, nutritional counselling, occupational therapy, and psychological counselling/therapy.
Alternative therapies are therapies that can be used along with medical treatment to help the patient feel better. No one should begin an alternative therapy without speaking with his or her physician.
Research has found that patients with chronic pancreatitis who practice yoga on a biweekly basis can experience an improvement in overall quality of life, symptoms of stress, mood changes, alcohol dependence and appetite.
Massage therapy involves touch and different techniques of stroking or kneading the muscles of the body. It can involve only part of the body or a full body massage. Massage may be done through one’s clothing or on the exposed skin. It can be done in specialized chairs or on a table. Massage therapy should only be done by a licensed massage therapist. Massage is used for muscle and bone discomfort, improvement of circulation, reduction in swelling, relaxation, and pain control. It can be used as a complement to other treatments and as a stress reducer and feel-good therapy. Studies have shown that massage can improve the relaxation response and the general sense of well being.
Therapeutic Touch is a process of energy exchange in which the practitioner uses the hands as a focus to help the healing process. It is based on the idea that human beings are a form of energy. When we are healthy, the energy is freely flowing and balanced. Disease on the other hand, is believed to be an imbalance or disturbance of the energy flow. Therapeutic Touch treatment may vary from 5-30 minutes depending on the needs of the individual. Exact methods vary between practitioners, but generally they will hold their hands 2-4 inches away from your fully clothed body, moving them from your head to toe, and over your front and back. Research has demonstrated that therapeutic touch promotes relaxation, and a sense of comfort and well-being. Research has shown it to be effective in decreasing anxiety and altering the perception of pain.
Physical exercise improves the overall functioning of the body and quality of life. Exercise therapy may decrease stress, pain, nausea, fatigue and depression. Regular exercise affects your hormonal balance as well as most of your body systems. Regular participation in physical activity raises the heart rate and maintains an increased heart rate for a period of time. Depending on your physical condition, and after the advice of your physician, you may begin walking 5-10 minutes twice a day with a goal of increasing activity for 45 minutes at least three times each week. It is important that your exercise time be without interruptions. This is time for yourself. If you are unable to walk, there are other ways to exercise (i.e., stretching, and isometric exercises).
Meditation or relaxation is a state of being free from anxiety, tension, and distress. A state of relaxation can be achieved using different styles, such as diaphragmatic breathing, progressive muscle relaxation, repetitive affirmation, prayer, yoga, and guided/visual imagery. When practiced regularly, meditation can improve sleep, concentration, and the ability to cope with stress. It can help with the management of pain, nausea, and anxiety. You may find free tapes or booklets about meditation at libraries or low-cost materials in stores. You may also choose to attend groups or work groups for no or minimal fees. Once you have learned the technique, meditation can be practiced without cost.
The term acupuncture describes a family of procedures involving stimulation of anatomical points on the body by a variety of techniques. American practices of acupuncture incorporate medical traditions from China, Japan, Korea, and other countries. The acupuncture technique that has been most studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.
I came down with an acute case of pancreatitis while on a business trip on the west coast. It was the worst pain I’ve ever felt – and I’ve broken bones playing sports. I went to the emergency room. I flew home to New York City the next day and was admitted into Weill-Cornell Medical Center where I spent ten days in the hospital.
The doctors at Weill-Cornell diagnosed acute pancreatitis and told me it was manageable. My wife was concerned that it was cancer. She insisted they do a biopsy to rule out cancer. The doctor insisted there was no relationship between pancreatitis and pancreatic cancer (this was back in 2013, now doctors routinely look for cancer when treating pancreatitis). Grudgingly, the doctor agreed to do a biopsy after my wife repeatedly insisted. I was put on a liquid diet and sent home. Two days later the doctor called and told us to come back to the hospital, they needed to have an urgent conversation about my health. At that moment I knew the doctors had been wrong – I knew it was pancreatic cancer. The doctor refused to acknowledge the diagnosis and the news had to be delivered face-to-face. I quickly realized that had my wife not insisted on the biopsy, I might have died from pancreatic cancer within months.
Early Detection Video Series
The NPF and Mission Cure created a video series for early detection and risk factors for pancreatic cancer. Mission Cure spoke with the National Pancreas Foundation representatives on the basics of pancreatic cancer – from early screening to genomic and non-genomic risk factors.