Pancreatic Cancer

The pancreas has two main types of cells: exocrine and endocrine. Most are exocrine cells, which form the exocrine glands and produce enzymes that aid digestion. Endocrine cells form small clusters that produce hormones, including insulin and glucagon, which help control blood sugar levels.

The two cell types form different types of cancers, each with its own risk factors, symptoms, diagnostic methods and treatments. 

Most pancreatic cancers are exocrine cancers. These include:

• Pancreatic adenocarcinoma
• Ampullary adenocarcinoma

Pancreatic adenocarcinoma

Pancreatic adenocarcinoma represents about 95% of exocrine cancers. Most start in the ducts of the pancreas. If they start in the cells that form the pancreatic enzymes, they are known as acinar cell carcinomas.

Ampullary cancer (Ampulla of Vater cancer)

Ampullary cancer is an exocrine cancer that starts where the bile duct and pancreatic duct come together (the ampulla of Vater) and empty into the small intestine. Ampullary cancers often block the bile duct; as a result, bile builds up in the body and causes yellowing of the eyes and skin, known as jaundice.

Pancreatic neuroendocrine tumors (NETs)

Endocrine tumors are less common than exocrine tumors and make up less than 5% of pancreatic cancers. They include many types of cancers and are referred to as pancreatic NETs or pancreatic islet cell tumors. Not all of these tumors are cancerous, but surgery may be needed to determine whether a tumor is cancerous. Learn more on the various types of functioning and non-functioning NETs. 

No one knows for sure what causes pancreatic cancer, but several risk factors increase the likelihood of developing the disease. 

The most common pancreatic risk factors include:

Tobacco use

Smoking is a major risk factor for pancreatic cancer. Smokers have about twice the risk of developing pancreatic cancer compared to people who have never smoked. About 20% to 30% of pancreatic cancers may be caused by smoking cigarettes; pipes, cigars and smokeless tobacco also increase risk.

Weight

Obesity increases the risk of pancreatic cancer by about 20%. People who carry excess weight around the waistline (even if they are not obese) may have an increased risk as well.

Chemical exposure

People who work in the dry cleaning and metal working industries may be exposed to certain chemicals that raise pancreatic cancer risk.

Age

Pancreatic cancer risk increases with age. About two-thirds of people diagnosed with the disease are at least 65 years old.

Chronic pancreatitis

Chronic pancreatitis refers to long-term inflammation of the pancreas. It may raise the pancreatic cancer risk, but most people with chronic pancreatitis don’t develop pancreatic cancer. If chronic pancreatitis is caused by an inherited gene mutation, the risk of pancreatic cancer is higher.

Cirrhosis

Cirrhosis, a disease that damages the liver, appears to increase the risk of pancreatic cancer.

Family history

A family history of pancreatic cancer is a risk factor, but most people who develop the disease don’t have a family history of it.

Inherited gene mutations

About 10% of pancreatic cancers may be linked to inherited genetic syndromes passed down in families.

Talk to your doctor about your risk and whether you should consider genetic counseling.

For some types of cancer, routine screening exams can help detect tumors early, even if a person doesn’t have symptoms or a high risk of developing the disease. But no routine screening is available for pancreatic cancer in people who do not have an increased risk. Also, tumors in the pancreas are usually too small for doctors to feel during a physical exam, so tumors may not be found until they have spread beyond the pancreas.

Taking steps to reduce the risk factors within your control may help with pancreatic cancer prevention. You may be able to lower your risk of pancreatic cancer by taking these steps:

• Avoid tobacco use
• Maintain a healthy weight
• Limit alcohol use
• Avoid exposure to chemicals in the workplace

Most people don’t notice pancreatic cancer symptoms until the disease has reached an advanced stage. Exocrine pancreatic cancer symptoms can be different than pancreatic neuroendocrine cancer symptoms.

Exocrine pancreatic cancer symptoms may include:

• Jaundice, or yellowing of the eyes and skin
• Dark urine
• Light-colored or greasy stools
• Itchy skin
• Pain in the abdomen or back
• Unintended weight loss
• Poor appetite
• Nausea and vomiting
• Enlarged gallbladder or liver
• Blood clots, especially in the leg

Pancreatic neuroendocrine tumors often release excess hormones. Symptoms can vary depending on the type of tumor and the hormones released, and include:

• Excess stomach acid that leads to stomach ulcers
• Diarrhea
• Unintended weight loss
• Red rash with swelling and blisters (necrolytic migratory erythema)
• Low blood sugar
• Abdominal pain
• Nausea or vomiting

Having any of these symptoms doesn’t mean you have pancreatic cancer. In fact, most of these symptoms are more likely to be caused by other conditions. Still, if you have symptoms that persist or worsen, it’s important to have them checked by a doctor so that the cause can be found and treated, if needed.

Scripps cancer specialists are experts in diagnosing and staging pancreatic cancer to plan the best course of treatment. Our gastroenterologists, pathologists and radiologists use advanced diagnostic testing methods to detect pancreatic cancer.

Ultrasound

Ultrasound uses sound waves to show any growths on the pancreas, which may be tumors.

Computed tomography (CT) scan

A CT scan uses X-rays to provide detail about the size, shape and location of any growths in the pancreas or surrounding areas.

Magnetic resonance imaging (MRI)

An MRI uses radio waves to provide detailed images of the pancreas and any abnormal growths.

Blood tests

Blood tests look for chemical or hormonal imbalances or substances called tumor markers that may indicate the presence of tumors in the body.

Biopsy

A gastroenterologist usually performs a biopsy of the suspicious tissue through an upper endoscopy. This procedure involves the insertion of a thin tube with a light and camera at the end to explore the upper digestive track. Recovery is usually very quick after this procedure. Following the biopsy, a pathologist will analyze the tissue sample and test it for any abnormalities.

A patient’s pancreatic cancer stage is determined by how advanced the disease is, and whether it has spread beyond the pancreas. 

Stage 0

Stage 0 pancreatic cancer affects only a single layer of cells in the pancreas and has not spread.

Stage I

Stage I pancreatic cancer is found in the pancreas only but affects more than a single layer of cells.

Stage II

Stage II pancreatic cancer has spread outside the pancreas or to lymph nodes.

Stage III

Stage III pancreatic cancer has spread into major blood vessels or nerves, but has not affected other organs.

Stage IV

Stage IV pancreatic cancer may have spread to other organs.

Resectable and unresectable pancreatic cancer

While staging provides information about the severity of pancreatic cancer, it doesn’t indicate how the cancer should be treated. Doctors generally need to know whether the tumor can be removed with surgery (resectable) and may group pancreatic cancer into one of the following:

• Resectable pancreatic cancer, when the cancer can be removed with surgery
• Borderline resectable pancreatic cancer, when the cancer is located next to blood vessels, but surgery may still be a treatment option
• Unresectable pancreatic cancer, when the cancer is either locally advanced or has spread to other parts of the body (metastatic) and cannot be treated with surgery

No one wants to hear that they have pancreatic cancer. You may feel frightened, overwhelmed, anxious or sad. All of these feelings are perfectly normal. The more you learn about your diagnosis and next steps, the sooner you can begin to make informed decisions about your treatment.

Questions and considerations

Here are some questions you may want to ask your doctor or health insurance provider regarding your pancreatic cancer diagnosis:

• Should I get a second opinion?
• How do I find a specialist?
• What is my cancer treatment plan?
• Will I have to miss work/school?
• What are the side effects of pancreatic cancer treatment?
• How successful is my treatment likely to be?
• What costs will be covered by insurance?
• Which costs will I be responsible for?

Your Scripps cancer care team is here to help you find the answers you need to take an active role in your care. In addition, there are a number of community resources that provide education, information and helpful resources — often at no cost.

Learn more about the many cancer patient resources available to you and your loved ones at Scripps.

Our pancreatic cancer specialists take a collaborative approach to your care and make sure you are included in treatment decisions every step of the way. Learn more about how Scripps puts you at the center of care.

Several factors determine the most effective treatments for pancreatic cancer, including the type and stage of the cancer, other medical conditions, and the patient’s age and overall health.

In most cases, surgery is the best treatment for pancreatic cancer that has not spread beyond the pancreas. Radiation therapy may be used after pancreatic cancer surgery, or for patients who cannot have surgery. Chemotherapy also may be an option for some patients before or after surgery.

Pancreatic cancer surgery

Surgery for pancreatic cancer is technically challenging. Our team of highly skilled and accomplished pancreaticobiliary surgeons have years of experience with these complex procedures.

Pancreaticoduodenectomy

During pancreaticoduodenectomy — a surgery also known as a Whipple procedure — Scripps surgeons remove the head of the pancreas and, in some cases, the body of the pancreas and part of the small intestine, bile duct, gallbladder and lymph nodes. This is usually an open surgery, but Scripps surgeons may perform some procedures using minimally invasive laparoscopic techniques.

Distal pancreatectomy

With distal pancreatectomy, Scripps surgeons remove the tail of the pancreas, or the tail and a part of the pancreas body. Typically, surgeons remove the spleen as well.

Total pancreatectomy

Total pancreatectomy is a surgery that completely removes the pancreas and spleen. This procedure can also be performed with robot-assisted surgery though the Scripps Minimally Invasive Robotic Surgery Program.

Palliative surgery

When pancreatic cancer has spread too far to be completely removed, Scripps surgeons may perform palliative surgery to help relieve or prevent symptoms.

Radiation therapy

Scripps radiation specialists offer the latest advances in highly focused external beam radiation. Radiation may be used before surgery to shrink the tumor, or after surgery to help prevent the cancer from returning. Radiation therapy also may be an option for patients whose health would make them unable to have complex pancreatic surgery.

Chemotherapy

Chemotherapy may be used as part of a treatment plan to shrink pancreatic cancer tumors before surgery. It can also be used after surgery to help prevent cancer recurrence.

New chemotherapy drugs are providing pancreatic cancer patients new hope. Through pancreatic cancer clinical trials, Scripps is playing a key role in the study of these new drugs. Scripps Clinic’s Pancreas and Biliary Cancer Program serves as a member of the Pancreatic Cancer Research Team, the only pancreatic cancer clinical trials consortium dedicated to developing new drugs for pancreatic cancer treatment.

Find out more about our current clinical trials for we which we’re now enrolling or our general guide on determining with your cancer care team whether a clinical trial is right for you.

Your Scripps cancer team will develop a customized treatment plan outlining the treatments and therapies we recommend for your care. Before you begin treatment, you and your physician will review your plan together and discuss any questions or concerns you may have.

Your pancreatic cancer treatment plan generally includes:

• Family and medical history
• A summary of your cancer diagnosis and staging information
• Diagnostic testing completed (e.g., imaging, biopsy, lab tests)
• Plans for surgery, radiation, chemotherapy and/or other treatments
• Potential side effects of treatments
• Contact information for your cancer care team members

Along with helping you understand your course of treatment and encouraging discussion between you and your physician, your plan helps your team coordinate your care. You also can share your treatment plan with other providers who may be involved in your medical care.

Your pancreatic cancer care team includes health and medical professionals from a wide range of specialties. Scripps will customize your team to ensure you have the expertise and support you need. 

Your team may include:

• Gastroenterologists
• Surgeons and surgical oncologists
• Radiation oncologists
• Medical oncologists
• Registered nurses
• Nurse navigators
• Dietitians
• Oncology social workers

Visit your cancer care team for more on Scripps' multidisciplinary approach to treatment.

In support of our patients, survivors, their family members and the community, we host a handful of cancer support groups as well as a range of free workshops and health and wellness events on a number of topics such as:

• Nutrition
• Expressive writing
• Yoga
• Meditation

Check the current list of support offerings or contact your oncology social worker or cancer care coordinator.

For info about other cancer support groups in the San Diego community, call the American Cancer Society at 800-227-2345.