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:
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.
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:
Talk with your doctor if you think you might be at risk.
Early on, pancreatic cancer may not cause any signs or symptoms, making it hard to detect. As the cancer grows, symptoms may include:
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 detect and diagnose for the following reasons:
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:
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.
The prognosis and treatment options depend on:
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.
Cancer stage describes the extent of cancer in the body, such as the size of the tumor, whether it has spread, and how far it has spread from where it first formed. It is important to know the stage of the pancreatic cancer to plan the best treatment.
There are several staging systems for cancer that describe the extent of the cancer. Pancreatic cancer staging usually uses the TNM staging system. You may see your cancer described by this staging system in your pathology report. Based on the TNM results, a stage (I, II, III, or IV, also written as 1, 2, 3, or 4) is assigned to your cancer. When talking to you about your cancer, your doctor may describe it as one of these stages.
To learn how doctors stage pancreatic cancer, see tests to diagnose and stage pancreatic cancer. Learn more about Cancer Staging.
The information in this section is about staging for exocrine pancreatic cancer, the most common type of pancreatic cancer.
In stage 0, abnormal cells are found in the lining of the pancreas. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
In stage I, cancer has formed and is found in the pancreas only. Stage I is divided into stages IA and IB, depending on the size of the tumor.
Stage II is divided into stages IIA and IIB, depending on the size of the tumor and where the cancer has spread.
In stage III, the tumor is any size, and cancer has spread to:
In stage IV, the tumor is any size, and cancer has spread to other parts of the body, such as the liver, lung, or peritoneal cavity (the body cavity that contains most of the organs in the abdomen).
Stage IV pancreatic cancer is also called metastatic pancreatic cancer. Metastatic cancer happens when cancer cells travel through the lymphatic system or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if pancreatic cancer spreads to the liver, the cancer cells in the liver are actually pancreatic cancer cells. The disease is called metastatic pancreatic cancer, not liver cancer. Learn more in Metastatic Cancer: When Cancer Spreads.
Resectable pancreatic cancer can be removed by surgery because it has not grown into major blood vessels near the tumor.
Borderline resectable pancreatic cancer has grown into a major blood vessel or nearby tissue or organs. It may be possible to remove the tumor, but there is a high risk that all of the cancer cells will not be removed with surgery.
Locally advanced pancreatic cancer has grown into or close to nearby lymph nodes or blood vessels, so surgery cannot completely remove the cancer.
Metastatic pancreatic cancer has spread to other organs, so surgery cannot completely remove the cancer.
Recurrent pancreatic cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the pancreas or in other parts of the body. Tests will be done to help determine where the cancer has returned in your body. The type of treatment for recurrent pancreatic cancer will depend on where it has come back.
Learn more in Recurrent Cancer: When Cancer Comes Back. Information to help you cope and talk with your health care team can be found in the booklet When Cancer Returns.
Different types of treatments are available for people with pancreatic cancer. You and your cancer care team will work together to decide your treatment plan, which may include more than one type of treatment. Many factors will be considered, such as the stage of the cancer, your overall health, and your preferences. Your plan will include information about your cancer, the goals of treatment, your treatment options and the possible side effects, and the expected length of treatment.
Talking with your cancer care team before treatment begins about what to expect will be helpful. You’ll want to learn what you need to do before treatment begins, how you’ll feel while going through it, and what kind of help you will need. To learn more, see Questions to Ask Your Doctor about Treatment.
One of the following types of surgery may be used to take out the tumor:
If the cancer has spread and cannot be removed, the following types of palliative surgery may be done to relieve symptoms and improve quality of life:
Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Pancreatic cancer is sometimes treated with external beam radiation therapy. This type of radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
Learn more about External Beam Radiation Therapy for Cancer and Radiation Therapy Side Effects.
Chemotherapy (also called chemo) uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
Chemotherapy for pancreatic cancer is usually systemic, meaning it is injected into a vein or given by mouth. When given this way, the drugs enter the bloodstream to reach cancer cells throughout the body.
Chemotherapy drugs used to treat pancreatic cancer may include:
Combinations of these drugs may be used. Other chemotherapy drugs not listed here may also be used.
Chemotherapy may also be combined with other kinds of treatment. For example, it may be combined with radiation therapy or targeted therapy.
Learn more about how chemotherapy works, how it is given, common side effects, and more at Chemotherapy to Treat Cancer and Chemotherapy and You: Support for People With Cancer.
Chemoradiation therapy combines chemotherapy and radiation therapy to increase the effects of both.
Targeted therapy uses drugs or other substances to identify and attack specific cancer cells. Erlotinib is a targeted therapy drug used to treat pancreatic cancer.
Learn more about Targeted Therapy to Treat Cancer.
Pain can occur when the tumor presses on nerves or other organs near the pancreas. When pain medicine is not enough, there are treatments that act on nerves in the abdomen to relieve the pain. The doctor may inject medicine into the area around affected nerves or may cut the nerves to block the feeling of pain. Radiation therapy with or without chemotherapy can also help relieve pain by shrinking the tumor. Learn more about Cancer Pain.
Surgery to remove the pancreas may affect its ability to make pancreatic enzymes that help to digest food. As a result, patients may have problems digesting food and absorbing nutrients into the body. To prevent malnutrition, the doctor may prescribe medicines that replace these enzymes.
For some people, joining a clinical trial may be an option. There are different types of clinical trials for people with cancer. For example, a treatment trial tests new treatments or new ways of using current treatments. Supportive care and palliative care trials look at ways to improve quality of life, especially for those who have side effects from cancer and its treatment.
You can use the clinical trial search to find NCI-supported cancer clinical trials accepting participants. The search allows you to filter trials based on the type of cancer, your age, and where the trials are being done. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
Learn more about clinical trials, including how to find and join one, at Clinical Trials Information for Patients and Caregivers.
For information about side effects caused by treatment for cancer, visit our Side Effects page.
As you go through treatment, you will have follow-up tests or check-ups. Some tests that were done to diagnose or stage the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back).
Treatment of resectable or borderline resectable pancreatic cancer may include:
Surgery to remove the tumor may include Whipple procedure, total pancreatectomy, or distal pancreatectomy.
Palliative therapy can be started at any stage of disease. See the Palliative Therapy section for information about treatments that may improve quality of life or relieve symptoms in people with pancreatic cancer.
Learn more about these treatments in the Treatment Option Overview.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Treatment of pancreatic cancer that is locally advanced may include:
Palliative therapy can be started at any stage of disease. See the Palliative Therapy section for information about treatments that may improve quality of life or relieve symptoms in patients with pancreatic cancer.
Learn more about these treatments in the Treatment Option Overview.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Treatment of pancreatic cancer that has metastasized or recurred may include:
Palliative therapy can be started at any stage of disease. See the Palliative Therapy section for information about treatments that may improve quality of life or relieve symptoms in patients with pancreatic cancer.
Learn more about these treatments in the Treatment Option Overview.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Palliative therapy can improve the patient's quality of life by controlling the symptoms and complications of pancreatic cancer.
Palliative therapy for pancreatic cancer may include:
Learn more about these treatments in the Treatment Option Overview.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For more information from the National Cancer Institute about pancreatic cancer, see:
For general cancer information and other resources from the National Cancer Institute, visit:
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