Pancreatic Cancer: Causes, Symptoms, Diagnosis and Treatment

What is Pancreatic Cancer?

Pancreatic cancer is a disease which affects the pancreas. The pancreas is a gland in the abdomen which aids digestion. It does this by producing the hormones which control blood sugar levels and by producing enzymes which help you to digest food.

Pancreatic cancer develops when the cells of the pancreas change (mutate) and then multiply in an uncontrolled way. This leads to the formation of a tumor. The disease usually starts in the ducts of the pancreas, which connect the pancreas to the common bile duct.

Biliary or bile duct cancer is a rare disease in which cancerous cells form in the bile ducts.

Unfortunately, pancreatic cancer has low survival rates. It is difficult to detect in the early stages as it usually doesn’t show up on imaging tests. Most patients are diagnosed when the disease has spread to other parts of the body. Pancreatic cancer is also difficult to treat as it is resistant to many commonly used cancer drugs.

There are two main types of pancreatic cancer:

Exocrine tumors: Most (over 90%) of pancreatic cancers are exocrine tumors. Also called adenocarcinoma, it begins in the cells that line the organs.

Neuroendocrine tumors: Much rarer, neuroendocrine tumors are also called islet cell carcinoma.

What are the Symptoms of Pancreatic Cancer?

Unfortunately, the symptoms of pancreatic cancer only emerge once the cancer has spread to other organs. Symptoms may include:

• Jaundice (yellowing of your skin).
• Light stools
• Dark urine
• Pain in the upper abdomen
• Pain in the middle of the back
• Tiredness/fatigue
• Nausea/vomiting
• Loss of appetite or weight loss
• Feeling bloated or gassy
• Itchy skin
• Blood clots
• Pancreatitis onset
• Diabetes onset.

Pancreatic neuroendocrine cancer may have slightly different symptoms to adenocarcinoma and might include diarrhea and/or anemia.

Symptoms can appear up to a year before pancreatic cancer is diagnosed, and many patients report that stomach or back pain were the first symptoms that they noticed.

What Causes Pancreatic Cancer?

Doctors don’t know what causes pancreatic cancer but there are some identified risk factors:

• Smoking or using any form of tobacco
• Obesity
• Diabetes, particularly Type 2 diabetes (sudden onset can be a sign of pancreatic cancer)
• Exposure to some chemicals, such as pesticides and petrochemicals
• Chronic pancreatitis (inflammation of the pancreas), including hereditary chronic pancreatitis
• Genetic conditions which cause mutations to the BRCA1 or BRCA2 genes.

Pancreatic cancer usually spreads to nearby blood vessels and lymph nodes, and then to other organs like the liver, lungs and the lining of the abdominal cavity. Most cases of pancreatic cancers have metastasized (spread) when they are diagnosed.

How Can I Prevent Pancreatic Cancer?

Pancreatic cancer can’t be prevented, but there are some things that you can do to lower the risk:

• Quit smoking and the use of any tobacco products
• Don’t drink alcohol
• Reduce exposure to the chemicals which are known to be risk factors (see above).

Other prevention strategies that you can incorporate into your lifestyle include:

• Maintain a healthy diet: Focus on a balanced diet rich in fruits, vegetables, whole grains, and lean proteins while limiting the consumption of processed foods and red meats.
• Engage in regular physical activity: Aim for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous exercise each week to promote a healthy digestive system.
• Understand your family history: Being aware of an increased risk due to family history is important.

There is no routine screening for pancreatic cancer, but if you have a close family member who has had pancreatic cancer, or if you have a genetic predisposition to the disease, your doctor may suggest monitoring with imaging tests or endoscopic ultrasounds.

How is Pancreatic Cancer Diagnosed?

It is difficult to diagnose pancreatic cancer in the early stages, as your doctor cannot feel the organ and tumors are hard to see on standard imaging tests.

If your pancreatic cancer is suspected, your doctor will recommend several tests, which may include:

Imaging tests

One or more of the following may be needed:

• CT (computed tomography) scan
• PET (positron emission tomography)
• MRI (magnetic resonance imaging)
• Endoscopic ultrasound.

Blood tests

A blood test can detect pancreatic tumor markers, a substance that can indicate cancer is present. High levels of a protein called carbohydrate antigen (CA) 19-9, which is released by pancreatic cancer cells, can also indicate pancreatic cancer.

Staging laparoscopy

Laparoscopy may be used to understand the extent of pancreatic cancer. It can also indicate whether removal of the pancreas is possible.

The procedure involves a surgeon inserting a long tube with a camera on the end through small incisions in the abdomen. The camera allows doctors to see inside the belly and detect abnormalities. A biopsy can be taken during the procedure for investigation in a lab.

Genetic testing

Genetic testing can let you know if there is a genetic reason that you developed pancreatic cancer. Some people who develop the disease have inherited mutations in the BRCA1 and BRCA2 genes. If you have a close relative (parent, sibling, or child) who has had pancreatic cancer, then your doctor may suggest testing. Having the mutation in these genes does not mean that you will go on to develop pancreatic cancer.

Genetic testing can also help inform your doctor which kind of treatment will be most effective.

Categories of Pancreatic Cancer

Once pancreatic cancer has been diagnosed, doctors will rank it into one of four categories:

• Resectable: The tumor is confined to the pancreas and hasn’t spread to blood vessels or organs nearby. The cancer can be removed with surgery.
• Borderline resectable: The tumor in pancreas has involved nearby blood vessels but can be removed with surgery.
• Locally advanced: The tumor has spread from the pancreas and involved a significant amount of blood vessels. Surgery may not be possible or safe to perform.
• Metastatic: Pancreatic cancer has spread to other areas of the body, such as the lungs, liver or abdominal cavity. It may also have spread to other organs, tissues or lymph nodes near the pancreas.

What are the Treatment Options for Pancreatic Cancer?

Pancreatic cancer has low survival rates, but recovery is possible with early detection and treatment that involves the surgical removal of the cancer.

The treatment given will depend on many factors, including the location of the tumor, its size, whether the cancer has spread, and the patient’s overall health. Treatment may include:

Surgery

Pancreatic cancer can be cured if surgery is able to remove all the cancer before it has spread. The cancer must be confined to only the pancreas, but sometimes even this does not guarantee removal of all the disease. Surgical techniques include:

Whipple procedure

Also called a pancreaticoduodenectomy, this surgery removes the head of the pancreas, the first part of the small (the duodenum), the gallbladder, a portion of the bile duct and the nearby lymph nodes. The remaining bile ducts and pancreas are then attached to the small intestine to maintain the digestive tract. The Whipple procedure is suitable if the cancer is in the widest part of the pancreas (the head of the pancreas).

Distal pancreatectomy

A distal pancreatectomy is performed if the cancer is in the tail of the pancreas. The tail is removed and part of the pancreas body. Usually, the spleen is also removed so vaccinations are recommended as the spleen helps the body fight infections.

Total pancreatectomy

The entire pancreas is removed if the cancer has spread throughout the whole organ. The surgery also removes the spleen, gallbladder, part of the stomach and small intestine. Removing the pancreas can cause major side effects such as diabetes, as no insulin or hormones that regulate blood sugar can be produced. Medication will also be needed to aid digestion.

Other treatment options for pancreatic cancer:

• Chemotherapy: Drugs are given, either orally or intravenously, which kill cancer cells. Chemotherapy may be given alone or prior to surgery to reduce the tumor size, or after surgery to kill any remaining cancer cells.
• Radiation therapy: High-energy X-rays are used to kill cancer cells. Radiation therapy may be given alone or in combination with chemotherapy. Radiotherapy can also ease the symptoms of pancreatic cancer if surgery is not possible.
• Targeted therapy: Drugs are given which target the proteins that control how cancer cells grow. It may be combined with other treatments.

Pain management

Pancreatic cancer often involves nearby nerves and can be very painful, so pain management will be a part of your treatment plan. It may include oral medications, anesthesia, or steroid injections.

Being diagnosed with pancreatic cancer can be a life changing event. Talk to your doctor about not only the medical support you will receive, but also psychological and emotional support services.

Gastrointestinal Cancer Program

A multidisciplinary cancer team, led by Western board-certified surgical oncologists, provide a comprehensive approach to care.

Learn More