What Is Pancreatic Cancer?

Pancreatic cancer occurs when malignant (cancerous) cells form in the pancreas, an organ located between the stomach and the spine, deep within the abdomen.

Pancreatic tumors are either exocrine or neuroendocrine (endocrine) tumors. Knowing the type of tumor is important because each type behaves differently and responds to different treatments.

Exocrine Pancreatic Tumors

Neuroendocrine Pancreatic Tumors

The endocrine component of the pancreas is made up of clumps of cells located throughout the organ. These secrete hormones that play various roles in regulating the body’s metabolism. One of the most critical of these hormones is insulin, which helps control glucose levels in the blood.

• Bloating and gas
• Gastrointestinal discomfort or burning sensation in the stomach
• Foul-smelling diarrhea or greasy, floating stools
• Nausea or vomiting
• Weakness or fatigue
• Loss of appetite
• Unintended weight loss
• Upper back or upper abdomen pain
• Swelling in an arm or leg
• Signs of jaundice, like yellowing skin and eyes and dark urine
• Chills and sweats

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• Fever

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• Smoking About 25 percent of cases are thought to be caused by cigarette smoking.
• Being Overweight or Having Obesity People with obesity are about 20 percent more likely to develop pancreatic cancer.
• Type 2 Diabetes People who have had type 2 diabetes for five years or more have an increased risk of pancreatic cancer.
• Heavy Alcohol Use Heavy drinking can lead to pancreatitis, or inflammation of the pancreas, which is a risk factor for pancreatic cancer.
• High-Fat Diet Diets heavy in saturated fats and processed meats (such as bacon and salami) may increase the risk of pancreatic cancer.
• Chronic Pancreatitis Pancreatitis is often tied to heavy drinking and smoking.
• Workplace Exposure to Certain Chemicals Chemicals commonly used in dry cleaning and metal working may increase the risk for pancreatic cancer.

• Age Nearly all people with pancreatic cancer are over age 45, and about two-thirds are over age 65.
• Gender Men have a slightly higher risk than women.
• Race or Ethnicity Black Americans have a slightly higher risk than white Americans.
• Family History People with a family history of pancreatic cancer have a higher risk of developing the disease. The reason for this is not always known, though it may be due to specific inherited genes.
• Inherited Genetic Syndromes These include certain hereditary forms of breast and ovarian cancer, melanoma, and pancreatitis, as well as two rare disorders — Lynch syndrome and Peutz-Jeghers syndrome.

• Noninvasive Imaging Tests To get a better look at the pancreas, your doctor may order tests such as an ultrasound, computerized tomography (CT) scans, magnetic resonance imaging (MRI), or positron emission tomography (PET) scans.
• Endoscopic Ultrasound This test involves inserting a thin, flexible tube into the mouth, through the digestive tract, and into the small intestine, which is close to the pancreas. A probe at the end of the endoscope uses sound waves to create an image of the pancreas that may reveal cancer.
• Biopsy Your doctor may remove a small sample of tissue and examine it under a microscope to see if it contains cancerous cells. This is typically done during an endoscopic ultrasound but can also be performed by inserting a needle through the skin and into the pancreas.
• Blood Tests Blood tests can identify certain proteins — tumor markers shed by cancer cells that can help determine what type of pancreatic cancer you have and what treatment approach is likely to work best.

Resectable Staging

One system that doctors use for pancreatic cancer staging focuses on whether it’s possible to remove the entire tumor surgically. With this staging system, a tumor is described as:

• Resectable The tumor is contained within the pancreas and is small enough to remove.
• Borderline Resectable It’s possible surgery won’t get the entire tumor.
• Nonresectable The tumor within the pancreas is too large, or it has metastasized and spread to other organs and tissue.

TNM Staging

TNM stands for tumor, node, and metastasis.

• Tumor When doctors see at least some evidence of a tumor, they will assign a T category. Staging ranges from Tis, for carcinoma in situ (meaning the tumor is limited to the outer layers of pancreatic duct cells and is the easiest to treat), to T4, for cancer that has spread beyond the pancreas to surrounding organs, tissues, nerves, or large blood vessels.
• Node When doctors assess lymph nodes, they assign an N category. N0 is when they don’t see cancer in the nodes, and N1 is when cancer has spread to surrounding lymph nodes.
• Metastasis The cancer will be staged as M0 for cases when it has not reached surrounding tissues, organs, or lymph nodes, and M1 when it has.

Numerical Staging

• Stage 0 Abnormal cells are found in the lining of the pancreas and can potentially spread into nearby normal tissue.
• Stage 1 The tumor is confined to the pancreas If the tumor is less than 2 centimeters across, it is designated stage 1A, and stage 1B if the tumor is more than 2 centimeters across.
• Stage 2 The tumor may have grown outside of the pancreas and spread to nearby tissue and lymph nodes. If the cancer is confined to the pancreas and has not been found in nearby tissues or lymph nodes, it’s designated stage 2A. If the cancer has spread to nearby lymph nodes but has not spread to distant organs, it’s stage 2B.
• Stage 3 The tumor has grown into nearby large blood vessels or major nerves.
• Stage 4 The cancer has spread into parts of the body far from the pancreas. This can include the liver, lungs, or peritoneum (inner lining of the abdomen).

Surgery

Chemotherapy

• Folfirinox (combination of leucovorin calcium (folinic acid), fluorouracil, irinotecan hydrochloride, and oxaliplatin).
• gemcitabine and capecitabine (if Folfirinox is not tolerated)
• gemcitabine alone (in frail patients)
• gemcitabine and nab-paclitaxel (used to shrink tumors prior to surgery, when feasible)

Radiation

With radiation therapy, a machine delivers high-energy rays to areas of the body where cancer has been found. These rays can help stop cancer cells from continuing to grow and spread.

Targeted Therapy

Targeted therapies approved for exocrine pancreatic tumors include:

• dabrafenib and trametinib (Tafinlar and Mekinist)
• entrectinib (Rozyltrek)
• erlotinib (Tarceva)
• fam-trastuzumab deruxtecan-nxki (Enhertu)
• larotrectinib (Vitrakvi)
• olaparib (Lynparza)

Targeted therapies approved for neuroendocrine pancreatic tumors include:

• everolimus (Afinitor)
• sunitinib (Sutent )

Immunotherapy

Immunotherapy, delivered intravenously or as an oral medication, enhances the immune system’s ability to attack cancer.

• Quitting Smoking Smoking is considered the most significant risk factor for pancreatic cancer.
• Maintaining a Healthy Weight Losing weight if you are overweight or have obesity can help lower your risk of pancreatic cancer.
• Avoiding Drinking Heavy alcohol use is associated with pancreatic cancer; it’s also tied to a condition known as chronic pancreatitis, a known risk factor for the disease.
• Avoiding Workplace Chemicals Exposure to asbestos, some pesticides, and chemicals used in dry cleaning are associated with an increased risk of pancreatic cancer and other cancers.

Conditions that are associated with pancreatic cancer include pancreatitis and type 2 diabetes.

Some of the organizations that offer online or in-person support groups for pancreatic cancer patients, survivors, and families include:

The Pancreatic Cancer Action Network (PanCan) is a nationwide organization dedicated to patient education and advocacy. PanCan offers an up-to-date list of in-person pancreatic cancer support groups across the country, as well as online support services.

The American Cancer Society offers in-person support groups across the country, as well as online communities like the Cancer Survivors Network, which provides discussion boards and live chats for patients, survivors, and caregivers.

CancerCare is a national organization offering free emotional and practical support for cancer patients and their families. Online and in-person support groups, run by an oncology social worker, are available to people with pancreatic cancer and their loved ones.

• Pancreatic cancer occurs when cancerous cells form in the pancreas. Most of the time, by the time it is diagnosed, it has spread outside of the pancreas to other areas of the body.
• People who smoke, are heavy drinkers, have diabetes, or have chronic pancreatitis are at higher risk of developing pancreatic cancer. Genetics and race also affect risk.
• Pancreatic cancer can be treated with chemotherapy, radiation, surgery, and immunotherapy.
• Because it is an aggressive cancer, pancreatic cancer is often fatal, with an overall five-year survival rate of 13 percent.

Additional reporting by Christina Frank.