General Information About Pancreatic Cancer

Pancreatic cancer is a type of cancer that forms in the tissues of the pancreas.

The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side. The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail. The pancreas lies between the stomach and the spine.

The pancreas has two main jobs in the body:

• to make juices that help break down food into substances the body can use
• to make hormones, such as insulin and glucagon, that help control blood sugar levels and help the body use and store the energy it gets from food

Pancreatic cancer can occur in exocrine pancreas cells, which produce digestive juices, or the endocrine pancreas cells, which produce hormones. About 95% of pancreatic cancers begin in exocrine cells.

This summary is about exocrine pancreatic cancer. For information about endocrine pancreatic cancer, see Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment.

Smoking and health history can affect the risk of pancreatic cancer.

Pancreatic cancer is caused by certain changes to the way pancreatic cells function, especially how they grow and divide into new cells. A risk factor is anything that increases the chance of getting a disease. Some risk factors for pancreatic cancer, like smoking, can be changed. However, risk factors also include things people cannot change, like their genetics and their family history. Learning about risk factors for pancreatic cancer can help you make changes that might lower your risk of getting it.

There are many risk factors for pancreatic cancer, but many do not directly cause cancer. Instead, they increase the chance of DNA damage in cells that may lead to pancreatic cancer. To learn more about how cancer develops, see What Is Cancer?

Having one or more of these risk factors does not mean that you will get pancreatic cancer. Many people with risk factors never develop pancreatic cancer, while others with no known risk factors do.

Risk factors for pancreatic cancer include:

• smoking
• having excess body weight
• having a personal history of diabetes or chronic pancreatitis
• having a family history of pancreatic cancer or pancreatitis
• having certain hereditary conditions, such as:
  • multiple endocrine neoplasia type 1 (MEN1) syndrome
  • hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome)
  • von Hippel-Lindau syndrome
  • Peutz-Jeghers syndrome
  • hereditary breast and ovarian cancer syndrome
  • familial atypical multiple mole melanoma (FAMMM) syndrome
  • ataxia-telangiectasia

Talk with your doctor if you think you might be at risk.

Signs and symptoms of pancreatic cancer include jaundice, pain, and weight loss.

Early on, pancreatic cancer may not cause any signs or symptoms, making it hard to detect. As the cancer grows, symptoms may include:

• jaundice (yellowing of the skin and whites of the eyes)
• light-colored stools
• dark urine
• pain in the upper or middle abdomen and back
• weight loss for no known reason
• loss of appetite
• fatigue

These symptoms may be caused by many conditions other than pancreatic cancer. It’s important to check with your doctor if you have any of these symptoms to find out the cause and begin treatment, if needed.

Pancreatic cancer is difficult to diagnose early.

Pancreatic cancer is difficult to detect and diagnose for the following reasons:

• There aren’t any noticeable signs or symptoms in the early stages of pancreatic cancer.
• The signs and symptoms of pancreatic cancer, when present, are like the signs and symptoms of many other illnesses.
• The pancreas is hidden behind other organs such as the stomach, small intestine, liver, gallbladder, spleen, and bile ducts.

Tests that examine the pancreas are used to diagnose and stage pancreatic cancer.

Pancreatic cancer is usually diagnosed with tests and procedures that make pictures of the pancreas and the area around it. The process used to find out if cancer cells have spread within and around the pancreas is called staging. Tests and procedures to detect, diagnose, and stage pancreatic cancer are usually done at the same time. To plan treatment, it is important to know the stage of the disease and whether the pancreatic cancer can be removed by surgery.

In addition to asking about your personal and family health history and doing a physical exam, your doctor may perform the following tests and procedures:

• Blood chemistry study is a laboratory test in which a blood sample is checked to measure the amounts of certain substances, such as bilirubin, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
• Tumor marker test checks a sample of blood, urine, or tissue to measure the amounts of certain substances, such as CA 19-9 and carcinoembryonic antigen (CEA), made by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the body. These are called tumor markers.
• MRI (magnetic resonance imaging) uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• CT scan (CAT scan) uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create 3-D views of tissues and organs. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A spiral or helical CT scan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.
• PET scan (positron emission tomography scan) uses a small amount of radioactive sugar (also called glucose) that is injected into a vein. Then a scanner rotates around the body to make detailed, computerized pictures of areas inside the body where the glucose is taken up. Because cancer cells often take up more glucose than normal cells, the pictures can be used to find cancer cells in the body. A PET scan and CT scan may be done at the same time. This is called a PET-CT.
• Abdominal ultrasound makes pictures of the inside of the abdomen. The ultrasound transducer is pressed against the skin of the abdomen and directs high-energy sound waves (ultrasound) into the abdomen. The sound waves bounce off the internal tissues and organs and make echoes. The transducer receives the echoes and sends them to a computer, which uses the echoes to make pictures called sonograms.
• Endoscopic ultrasound (EUS) is a procedure that uses an endoscope inserted into the body, usually through the mouth or rectum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.
• Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreatic cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope (a thin, lighted tube) is passed through the mouth, esophagus, and stomach into the first part of the small intestine. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken.
• Percutaneous transhepatic cholangiography (PTC) is a procedure to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body. This test is done only if ERCP cannot be done.
• Laparoscopy is a surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. The laparoscope may have an ultrasound probe at the end in order to bounce high-energy sound waves off internal organs, such as the pancreas. This is called laparoscopic ultrasound. Other instruments may be inserted through the same or other incisions to perform procedures such as taking tissue samples from the pancreas or a sample of fluid from the abdomen to check for cancer.
• Biopsy is the removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. There are several ways to do a biopsy for pancreatic cancer. A fine needle or a core needle may be inserted into the pancreas during an x-ray or ultrasound to remove cells. Tissue may also be removed during a laparoscopy or surgery to remove the tumor.

Some people decide to get a second opinion.

You may want to get a second opinion to confirm your pancreatic cancer diagnosis and treatment plan. If you seek a second opinion, you will need to get medical test results and reports from the first doctor to share with the second doctor. The second doctor will review the pathology report, slides, and scans. They may agree with the first doctor, suggest changes or another treatment approach, or provide more information about your cancer.

To learn more about choosing a doctor and getting a second opinion, see Finding Cancer Care. You can contact NCI’s Cancer Information Service via chat, email, or phone (both in English and Spanish) for help finding a doctor, hospital, or getting a second opinion. For questions you might want to ask at your appointments, see Questions to Ask Your Doctor about Cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis and treatment options depend on:

• whether the tumor can be removed by surgery
• the stage of the cancer (the size of the tumor and whether the cancer has spread outside the pancreas to nearby tissues or lymph nodes or to other places in the body)
• the patient’s general health
• whether the cancer has just been diagnosed or has recurred (come back)

Pancreatic cancer can be controlled only if it is found before it has spread, when it can be completely removed by surgery. If the cancer has spread, palliative treatment can improve the patient's quality of life by controlling the symptoms and complications of this disease.