Published: 18 Jun 2025

ICD9: 157.9      ICD10: C25.9      ICD11: 2C10

Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas, an organ located behind the stomach and in front of the spine.
The pancreas produces enzymes that help with digestion and hormones that help regulate blood sugar.

Here's a breakdown of important aspects of pancreatic cancer:

Understanding the Pancreas:

Location: Situated behind the stomach and in front of the spine.
Functions:
Exocrine: Produces enzymes (like amylase, lipase, and protease) that are released into the small intestine to help digest fats, proteins, and carbohydrates. This function is carried out by acinar cells.
Endocrine: Produces hormones (like insulin and glucagon) that regulate blood sugar levels. This function is carried out by islet cells.

Types of Pancreatic Cancer:

Exocrine Tumors (most common): These tumors develop from the cells that produce digestive enzymes.
Adenocarcinoma: The most common type, accounting for about 95% of cases. It starts in the cells lining the ducts that carry enzymes.
Endocrine Tumors (Pancreatic Neuroendocrine Tumors - PNETs): These tumors are less common and develop from the hormone-producing cells. They are often slower-growing and have a better prognosis than exocrine tumors.

Risk Factors:

While the exact cause of pancreatic cancer is often unknown, certain factors increase the risk:

Smoking: The most significant preventable risk factor.
Diabetes: Long-standing diabetes is associated with an increased risk.
Obesity: Being overweight or obese increases risk.
Chronic Pancreatitis: Long-term inflammation of the pancreas.
Family History: Having a family history of pancreatic cancer, or certain genetic syndromes (e.g., BRCA mutations, Lynch syndrome, Peutz-Jeghers syndrome).
Age: Risk increases with age, most commonly diagnosed after age 65.
Race: African Americans have a higher incidence than Caucasians.
Diet: A diet high in red and processed meats may increase risk.
Chemical Exposure: Certain chemicals used in metalworking and dry cleaning have been linked to increased risk.

Symptoms:

Pancreatic cancer is often difficult to detect early because symptoms are often vague and don't appear until the cancer has advanced. Symptoms can vary depending on the location and size of the tumor, but may include:

Abdominal Pain: Often a dull ache in the upper abdomen that may radiate to the back.
Jaundice: Yellowing of the skin and whites of the eyes. This is often caused by a tumor blocking the bile duct.
Weight Loss: Unexplained and significant weight loss.
Loss of Appetite: Feeling full quickly or not feeling hungry.
Nausea and Vomiting: Due to pressure on the stomach or intestines.
Changes in Bowel Habits: Diarrhea, constipation, or changes in stool appearance (e.g., pale or greasy stools).
New-Onset Diabetes: Especially in older adults who don't have other risk factors for diabetes.
Dark Urine: A sign of jaundice.
Itching: Another sign of jaundice.
Enlarged Gallbladder or Liver: May be felt during a physical exam.
Blood Clots: Sometimes, the first sign can be a blood clot, often in a leg vein (deep vein thrombosis, or DVT).

Diagnosis:

Diagnosing pancreatic cancer involves a combination of:

Physical Exam and History: A doctor will ask about your symptoms, medical history, and risk factors.
Blood Tests: To check liver function, blood sugar levels, and tumor markers (like CA 19-9).
Imaging Tests:
CT Scan (Computed Tomography): Provides detailed images of the pancreas and surrounding organs. Often the primary imaging test.
MRI (Magnetic Resonance Imaging): Can be helpful for visualizing the pancreas and detecting small tumors.
Endoscopic Ultrasound (EUS): A thin, flexible tube with an ultrasound probe is passed down the esophagus into the stomach and duodenum. It provides detailed images of the pancreas and can be used to obtain a biopsy.
ERCP (Endoscopic Retrograde Cholangiopancreatography): An endoscope is used to inject dye into the bile ducts and pancreatic ducts, allowing them to be seen on X-rays. Can be used to relieve blockages.
Biopsy: A sample of tissue is taken and examined under a microscope to confirm the diagnosis of cancer. This can be done during an EUS or ERCP, or with a needle biopsy guided by CT or ultrasound.

Staging:

Once a diagnosis is made, the cancer is staged to determine the extent of the disease. Staging helps doctors plan treatment. The staging system used is typically the TNM system (Tumor, Node, Metastasis).

Stage 0 (Carcinoma in Situ): Abnormal cells are found only in the lining of the pancreatic ducts.
Stage I: The tumor is confined to the pancreas.
Stage II: The tumor has spread to nearby tissues or lymph nodes.
Stage III: The tumor has spread to major blood vessels or nearby organs.
Stage IV: The cancer has metastasized (spread) to distant sites, such as the liver, lungs, or peritoneum.

Treatment:

Treatment options depend on the stage, location, and type of cancer, as well as the patient's overall health. Treatment may involve:

Surgery:
Whipple Procedure (Pancreaticoduodenectomy): Removal of the head of the pancreas, part of the small intestine, the gallbladder, and part of the stomach. The most common surgery for pancreatic cancer located in the head of the pancreas.
Distal Pancreatectomy: Removal of the tail and body of the pancreas, and sometimes the spleen.
Total Pancreatectomy: Removal of the entire pancreas, spleen, gallbladder, part of the stomach, and part of the small intestine. Rarely performed.
Chemotherapy: Using drugs to kill cancer cells. Chemotherapy can be used before surgery (neoadjuvant), after surgery (adjuvant), or as the main treatment for advanced cancer.
Radiation Therapy: Using high-energy rays to kill cancer cells. Radiation can be used after surgery to kill any remaining cancer cells, or to relieve symptoms of advanced cancer.
Targeted Therapy: Using drugs that target specific molecules involved in cancer cell growth and survival.
Immunotherapy: Using drugs to help the body's immune system fight cancer. Immunotherapy is not commonly used for pancreatic cancer, but it may be an option for some patients.
Palliative Care: Focuses on relieving symptoms and improving quality of life for patients with advanced cancer. This can include pain management, nutritional support, and emotional support.

Prognosis:

The prognosis (outlook) for pancreatic cancer is generally poor, especially when the cancer is diagnosed at a late stage. However, the prognosis varies depending on the stage of the cancer, the patient's overall health, and the response to treatment. Early detection and aggressive treatment can improve the chances of survival. Pancreatic neuroendocrine tumors (PNETs) generally have a better prognosis than pancreatic adenocarcinomas.

Important Considerations:

Early Detection: Because pancreatic cancer is often diagnosed at a late stage, early detection is crucial. People with risk factors for pancreatic cancer should talk to their doctor about screening options. However, there is no widely recommended screening test for the general population.
Clinical Trials: Participating in clinical trials can provide access to new and promising treatments.
Multidisciplinary Team: Treatment for pancreatic cancer is best managed by a multidisciplinary team of specialists, including surgeons, oncologists, radiation oncologists, gastroenterologists, and palliative care specialists.
Support Groups: Support groups can provide emotional support and practical advice for patients and their families.

In summary, pancreatic cancer is a serious disease, but advances in diagnosis and treatment are improving outcomes for some patients. It is important to be aware of the risk factors and symptoms of pancreatic cancer and to seek medical attention if you have any concerns.