Pancreatic Cancer

Your pancreas is a fish-shaped organ in your upper abdomen between your stomach and intestines. It’s composed of two lobes that work together to help you digest food and produce hormones, including insulin and glucagon, to keep your blood sugar in balance.

Types of Pancreatic Cancer

When cells inside your pancreas grow abnormally, it’s called pancreatic cancer. Cells clump into masses called tumors. There are several types of pancreatic cancer. Each type is diagnosed and treated differently. It is critical to have a skilled and experienced pathologist determine what type of pancreatic cancer you have.

Risk Factors

Pancreatic cancer makes up just 2.8% of new cancer diagnoses in the US, according to the American Cancer Society. About 46,000 people will be diagnosed here. The numbers in the US and Europe are growing relative to the rate of other types of cancer. Pancreatic cancer is the fourth leading cause of cancer in the US.

Because symptoms of pancreatic cancer are rather general, most people are not diagnosed until after it has spread and is hard to cure. Risk factors include:

• Age. Most people are diagnosed with pancreatic cancer between the ages of 60 and 80.
• Race and ethnicity. African Americans have a higher rate of pancreatic cancer, as do people of Ashkenazi Jewish descent.
• Smoking. People who smoke cigarettes are about twice as likely to develop pancreatic cancer as those who don’t. And smoking-related tumors tend to grow faster and develop about 10 years earlier than other tumors. About 20% of pancreatic cancer is associated with smoking.
• Diabetes. People who have diabetes are twice as likely to develop pancreatic cancer as those without the disease. However, doctors don’t fully understand the relationship between the two diseases. Glucose intolerance, a sign of diabetes, sometimes is caused by changes cancer makes to the pancreas.
• Pancreatitis. This acute or chronic inflammation of the pancreas increases your risk of pancreatic cancer. Chronic pancreatitis is typically diagnosed between ages 35 and 45. Genetic factors, malformed pancreas ducts, trauma, and heavy alcohol use can cause this disease. Some people have inherited genetic mutations that lead to pancreatitis at an early age. These genes also increase the risk for pancreatic cancer.
• Family history. If your mother, father, sibling, or child has had pancreatic cancer, your risk increases by two to three times—more if multiple people have had it. Doctors have linked several inherited gene mutations with this increased risk, including the genes responsible for breast cancer, ovarian cancer, and melanoma.
• Diet. Eating a lot of red meat and fat is associated with pancreatic cancer.
• Obesity. A BMI above 25 can increase the risk of developing pancreatic cancer.
• Chemical exposure. Exposure at work or elsewhere to pesticides, dyes, or gasoline-related chemicals can increase pancreatic cancer risk.
• Pancreatic cysts. Some types of cysts inside your pancreas can progress to cancer. We have a screening program dedicated to people with these cysts.

Signs of Pancreatic Cancer

Pancreatic cancer can have symptoms similar to viral hepatitis or gallstones, or no symptoms at all. Because of this, it’s often diagnosed after it has spread. Symptoms may include:

• Pain in the upper abdomen, often with pain in the back directly behind the upper abdomen
• Unexplained weight loss
• Jaundice
• Itchy skin
• Nausea
• Loss of appetite
• Diarrhea
• Fatigue
• Floating or foul-smelling stools
• Depression
• Ascites, a condition in which excessive fluid builds up in the abdominal cavity causing swelling and distention of the belly and, sometimes, pain and difficulty breathing
• New or sudden worsening of diabetes
• Dark stools
• Difficulty swallowing, which becomes worse over time
• Excessive burping
• General decline in health
• Loss of appetite or feeling full early after starting to eat
• Nausea
• Vomiting blood
• Weakness or fatigue

Screening and Diagnosis

Symptoms of pancreatic cancer aren’t always obvious. The disease can also develop gradually and be mistaken for other conditions. Sometimes tumors are found accidentally when you’re being evaluated for another medical condition. If your doctor suspects pancreatic cancer, you may have many or all of these tests.

These tests can also help doctors visualize the cancer’s spread and determine if it can be removed, called staging.

Staging

When your doctor estimates your prognosis based on how much cancer is in your body and where it is, that’s called staging.

• Stage 0. Carcinoma in situ. In this early stage of cancer, abnormal cells grow in your pancreas’s ducts or lining but have not spread outside of the organ.
• Stage I. Cancer is confined to your pancreas. A stage IA tumor is 2 cm or smaller. A stage IB tumor is larger than 2 cm.
• Stage II. Cancer has spread to nearby lymph nodes but doesn’t involve local blood vessels or distant parts of your body.
• Stage III. Cancer has spread to nearby blood vessels, but has not invaded distant organs or tissue. Cancer may or may not be in local lymph nodes.
• Stage IV. Cancer has spread outside the pancreas to other parts of your body.