Overview

What is pancreatic cancer? A Mayo Clinic expert explains

Learn more about pancreatic cancer from Mayo Clinic surgical oncologist Chee-Chee Stucky, M.D.

Hi. I'm Dr. Chee-Chee Stucky, a surgical oncologist at Mayo Clinic. In this video, we'll cover the basics of pancreatic cancer: What is it? Who gets it? What are the symptoms, diagnosis and treatment? Whether you're looking for answers for yourself or someone you love, we're here to give you the best information available. Understanding pancreatic cancer starts with understanding the pancreas. This small, fish-shaped organ sits behind the stomach, producing enzymes that aid digestion and hormones that regulate blood sugar. Pancreatic cancer typically starts in the ducts of the pancreas. Small changes in the cellular DNA result in uncontrolled multiplication and accumulation of cells in clusters called tumors. If untreated, these cancer cells can spread outside of the pancreas to other parts of the body.

Who gets it?

While anyone can get pancreatic cancer, there are certain risk factors to be aware of. Most pancreatic cancer is diagnosed after age 65. Smoking, diabetes, chronic pancreatitis or inflammation of the pancreas, family history of pancreatic cancer, and certain genetic syndromes are all known risk factors. Carrying extra weight that is unhealthy for your body may also be a contributing factor. New research has found that the specific combination of smoking, diabetes and poor diet increases the risk of pancreatic cancer the most beyond any one factor alone.

What are the symptoms?

Unfortunately, we don't usually see the signs of pancreatic cancer until it's in more advanced stages. When present, symptoms may include: Abdominal pain that radiates to the back. A loss of appetite or unintentional weight loss. Jaundice, which is the yellowing of your skin or eyes. Light colored stools. Dark colored urine. Particularly itchy skin. Diabetes that's becoming unusually difficult to control. Blood clots or fatigue.

How is it diagnosed?

If your doctors think you may have pancreatic cancer, they may recommend one or more diagnostic tests. For instance, imaging tests like an ultrasound, CT scan, MRI, or PET scan, can help your doctor see a clearer picture of your internal organs. An endoscopic ultrasound, or EUS, is when the doctor passes a tiny camera down the esophagus and into the stomach to get a close-up view of the pancreas. During the EUS, the doctor might collect a biopsy of the tissue for further testing. Sometimes pancreatic cancer can shed specific proteins called tumor markers in your blood. So your doctors may request blood tests to identify elevation of these markers, one of which is called CA 19-9. If a diagnosis is confirmed, the next step is to determine the extent or stage of the cancer. The stages are numbered one through four and may need to be determined by additional testing. Feel free to ask lots of questions during this process. Or get a second opinion to feel the most confident and empowered moving into treatment.

How is it treated?

When recommending treatment for pancreatic cancer, your doctor is considering many factors, including your overall health and personal preferences. They may recommend one or a combination of the following treatments: Chemotherapy uses drugs that release chemicals that enter the body and kill cancerous cells that may be throughout. Radiation, similarly kills the cancer cells, but with high-energy beams directed at the tumor. Surgery is used to physically remove the cancer and the immediate surrounding area. Ask your doctor if you qualify for clinical trials that test new treatments. And lastly, there is palliative care. This care is provided by a team of doctors, nurses, social workers, and other trained professionals who specialize in providing much needed relief from the pain and unpleasant symptoms of a serious illness.

What now?

Getting diagnosed with a life-threatening illness can be devastating to both the patient and their loved ones. But we have some of the following suggestions that may help patients cope: Learn about your condition. Knowledge is power and information can make you feel more confident in your treatment decisions. Find support. This can mean a support system of family and friends, a cancer support group of people going through the same experience, or qualified counselor like your therapist or religious leader. Lean on those around you when you're feeling helpless, overwhelmed, or uncertain. You may want to consider hospice care, which provides comfort and support to terminally ill patients and their loved ones. If you'd like to learn even more about pancreatic cancer, watch our other related videos or visit mayoclinic.org. We wish you well.

Pancreatic cancer is a type of cancer that begins as a growth of cells in the pancreas. The pancreas lies behind the lower part of the stomach. It makes enzymes that help digest food and hormones that help manage blood sugar.

The most common type of pancreatic cancer is pancreatic ductal adenocarcinoma. This type begins in the cells that line the ducts that carry digestive enzymes out of the pancreas.

Pancreatic cancer rarely is found at its early stages when the chance of curing it is greatest. This is because it often doesn't cause symptoms until after it has spread to other organs.

Your health care team considers the extent of your pancreatic cancer when creating your treatment plan. Treatment options may include surgery, chemotherapy, radiation therapy or a mix of these.

Symptoms

Pancreatic cancer often doesn't cause symptoms until the disease is advanced. When they happen, signs and symptoms of pancreatic cancer may include:

  • Belly pain that spreads to the sides or back.
  • Loss of appetite.
  • Weight loss.
  • Yellowing of the skin and the whites of the eyes, called jaundice.
  • Light-colored or floating stools.
  • Dark-colored urine.
  • Itching.
  • New diagnosis of diabetes or diabetes that's getting harder to control.
  • Pain and swelling in an arm or leg, which might be caused by a blood clot.
  • Tiredness or weakness.

When to see a doctor

Make an appointment with a health care professional if you have symptoms that worry you.

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Causes

It's not clear what causes pancreatic cancer. Doctors have found some factors that might raise the risk of this type of cancer. These include smoking and having a family history of pancreatic cancer.

Understanding the pancreas

The pancreas is about 6 inches (15 centimeters) long and looks something like a pear lying on its side. It releases hormones, including insulin. These hormones help the body process the sugar in the foods you eat. The pancreas also makes digestive juices to help the body digest food and take in nutrients.

How pancreatic cancer forms

Pancreatic cancer happens when cells in the pancreas develop changes in their DNA. A cell's DNA holds the instructions that tell a cell what to do. In healthy cells, the instructions tell the cells to grow and multiply at a set rate. The cells die at a set time. In cancer cells, the changes give different instructions. The changes tell the cancer cells to make many more cells quickly. Cancer cells can keep living when healthy cells would die. This causes there to be too many cells.

The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body.

Most pancreatic cancer begins in the cells that line the ducts of the pancreas. This type of cancer is called pancreatic ductal adenocarcinoma or pancreatic exocrine cancer. Less often, cancer can form in the hormone-producing cells or the neuroendocrine cells of the pancreas. These types of cancer are called pancreatic neuroendocrine tumors or pancreatic endocrine cancer.

Risk factors

Factors that might raise the risk of pancreatic cancer include:

  • Smoking.
  • Type 2 diabetes.
  • Chronic inflammation of the pancreas, called pancreatitis.
  • Family history of DNA changes that can increase cancer risk. These include changes in the BRCA2 gene, Lynch syndrome and familial atypical multiple mole melanoma (FAMMM) syndrome.
  • Family history of pancreatic cancer.
  • Obesity.
  • Older age. Most people with pancreatic cancer are over 65.
  • Drinking a lot of alcohol.

Complications

As pancreatic cancer progresses, it can cause complications such as:

  • Weight loss. People with pancreatic cancer might lose weight as the cancer uses more of the body's energy. Nausea and vomiting caused by cancer treatments or a cancer pressing on the stomach might make it hard to eat. Sometimes the body has trouble getting nutrients from food because the pancreas isn't making enough digestive juices.
  • Jaundice. Pancreatic cancer that blocks the liver's bile duct can cause jaundice. Signs include yellowing of the skin and the whites of the eyes. Jaundice can cause dark-colored urine and pale-colored stools. Jaundice often occurs without belly pain.

    If the bile duct is blocked, a plastic or metal tube called a stent can be put inside it. The stent helps hold the bile duct open. This is done using a procedure called endoscopic retrograde cholangiopancreatography, also called ERCP.

    During ERCP, a health care professional puts a long tube with a tiny camera, called an endoscope, down the throat. The tube goes through the stomach and into the upper part of the small intestine. The health professional puts a dye into the pancreatic ducts and bile ducts through a small tube that fits through the endoscope. The dye helps the ducts show up on imaging tests. The health professional uses those images to place a stent at the right spot in the duct to help hold it open.

  • Pain. A growing tumor may press on nerves in your abdomen, causing pain that can become severe. Pain medications can help you feel more comfortable. Treatments, such as radiation and chemotherapy, might help slow tumor growth and provide some pain relief.

    When medicines aren't helping, a health care professional might suggest a celiac plexus block. This procedure uses a needle to put alcohol into the nerves that control pain in the belly. The alcohol stops the nerves from sending pain signals to the brain.

  • Bowel blockage. Pancreatic cancer can grow into or press on the first part of the small intestine, called the duodenum. This can block the flow of digested food from the stomach into the intestines.

    A health care professional might suggest putting a tube called a stent in the small intestine to hold it open. Sometimes, it might help to have surgery to place a feeding tube. Or surgery can attach the stomach to a lower part of the intestines where the cancer isn't causing a blockage.

Prevention

Screening for people with a high risk of pancreatic cancer

Screening uses tests to look for signs of pancreatic cancer in people who don't have symptoms. It might be an option if you have a very high risk of pancreatic cancer. Your risk might be high if you have a strong family history of pancreatic cancer or if you have an inherited DNA change that increases the risk of cancer.

Pancreatic cancer screening might involve imaging tests, such as MRI and ultrasound. These tests are generally repeated every year.

The goal of screening is to find pancreatic cancer when it's small and most likely to be cured. Research is ongoing, so it's not yet clear whether screening can lower the risk of dying of pancreatic cancer. There are risks to screening. This includes the chance of finding something that requires surgery but later turns out to not be cancer.

Talk about the benefits and risks of pancreatic cancer screening with your health care team. Together you can decide whether screening is right for you.

Genetic testing for cancer risk

If you have a family history of pancreatic cancer, discuss it with a health care professional. The health professional can review your family history and help you understand whether genetic testing might be right for you.

Genetic testing can find DNA changes that run in families and increase the risk of cancer. If you're interested in genetic testing, you might be referred to a genetic counselor or other health care professional trained in genetics.

Ways to lower risk

You might reduce your risk of pancreatic cancer if you:

  • Stop smoking. If you smoke, talk to a member of your health care team about ways to help you stop. These might include support groups, medicines and nicotine replacement therapy.
  • Maintain a healthy weight. If you are at a healthy weight, work to maintain it. If you need to lose weight, aim for a slow, steady weight loss of 1 to 2 pounds (0.5 to 1 kilogram) a week. To help you lose weight, exercise most days of the week. Slowly increase the amount of exercise you get. Choose a diet rich in vegetables, fruit and whole grains with smaller portions.

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  1. AskMayoExpert. Pancreatic cancer (adult). Mayo Clinic; 2022.
  2. Groggins M, et al. Management of patients with increased risk for familial pancreatic cancer: Updated recommendations from the International Cancer of the Pancrease Screening (CAPS) Consortium. Gut. 2020; doi:10.1136/gutjnl- 2019- 319352.
  3. Debouk M, et al. The Multicenter Cancer of Pancreas screening study: Impact on stage and survival. Journal of Clinical Oncology. 2022; doi:10.1200/JCO.22.00298.
  4. Pancreatic adenocarcinoma. National Comprehensive Cancer Network. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1455. Accessed April 27, 2023.
  5. De la Fuente J, et al. How I approach screening for pancreatic cancer. American Journal of Gastroenterology. 2021; doi:10.14309/ajg.0000000000001305.
  6. Fernandez-del Castillo C. Clinical manifestations, diagnosis and staging of exocrine pancreatic cancer. https://www.uptodate.com/contents/search. Accessed April 26, 2023.
  7. Pancreatic cancer treatment (PDQ) — Health professional version. National Cancer Institute. https://www.cancer.gov/types/pancreatic/hp/pancreatic-treatment-pdq. Accessed April 26, 2023.
  8. Distress management. National Comprehensive Cancer Network. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1455 Accessed April 27, 2023.
  9. Ryan DP. Initial systemic chemotherapy for metastatic exocrine pancreatic cancer. https://www.uptodate.com/contents/search. Accessed April 26, 2023.
  10. AskMayoExpert. Pancreas ductal adenocarcinoma: Diagnosis and treatment (adult). Mayo Clinic; 2022.
  11. Fernandez-del Castillo C, et al. Overview of surgery in the treatment of exocrine pancreatic cancer and prognosis. https://www.uptodate.com/contents/search. Accessed April 26, 2023.
  12. NPF Centers of Excellence. National Pancreas Foundation. https://pancreasfoundation.org/patient-resources/npf-centers-of-excellence/. Accessed April 27, 2023.
  13. Niederhuber JE, et al., eds. Carcinoma of the pancreas. In: Abeloff's Clinical Oncology. 6th ed. Elsevier; 2020. http://www.clinicalkey.com. Accessed April 28, 2023.
  14. Sugumar A, et al. Distinguishing pancreatic cancer from autoimmune pancreatitis. Current Gastroenterology Reports. 2010;12:91.
  15. Ami T. Allscripts EPSi. Mayo Clinic. Feb. 28, 2022.
  16. Pancreatic Cancer Genetic Epidemiology (PACGENE) Study. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT00526578. Accessed April 26, 2023.
  17. Thind K et al. Immunotherapy in pancreatic cancer treatment: A new frontier. Therapeutic Advances in Gastroenterology. 2017;10:168.
  18. Tee MC, et al. Laparoscopic pancreaticoduodenectomy: Is it an effective procedure for pancreatic ductal adenocarcinoma? Advances in Surgery. 2015;49:143.
  19. Merrell KW, et al. Predictors of locoregional failure and impact on overall survival in patients with resected exocrine pancreatic cancer. International Journal of Radiation Oncology. 2016;doi:10.1016/j.ijrobp.2015.11.003.
  20. Moris M, et al. Risk factors for malignant progression of intraductal papillary mucinous neoplasms. Digestive and Liver Disease. 2015;47:495.
  21. Pancreatic cancer: Symptoms and signs. Cancer.Net. https://www.cancer.net/cancer-types/pancreatic-cancer/symtpms-and-signs. Accessed May 2, 2023.
  22. Loncle C, et al. The pancreatitis-associated protein VMP1, a key regulator of inducible autophagy, promotes KRAS-G12D-mediated pancreatic cancer initiation. Cell Death and Disease. 2016;7:32295.
  23. Thiels CA, et al. Outcomes of pancreaticoduodenectomy for pancreatic neuroendocrine tumors: Are combined procedures justified? Journal of Gastrointestinal Surgery. 2016;20:891.

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