Pancreatic Cancer: Symptoms, Causes, and Treatment

By Author : Dr. Deepanshu Siwach
  calender 16 January,2025
Pancreatic Cancer: Symptoms, Causes, and Treatment

We understand that getting diagnosed with pancreatic cancer can feel overwhelming and frightening. But remember, you are not alone in this journey. We are here to help you understand what this diagnosis means, what to expect, and the treatment options. This article covers everything you need to know about pancreatic cancer, including its symptoms, causes, risk factors, complications, and outcome.

What is Pancreatic Cancer?

Pancreatic cancer develops when cells in the pancreas grow out of control and form a tumor. The pancreas is a small, fish-shaped organ located behind your stomach. It plays a vital role in two main areas:

  • Digestion: The pancreas produces digestive enzymes (amylase, lipase, protease) that help break down food, especially fats and proteins.
  • Blood Sugar Control: It produces hormones like insulin and glucagon to regulate your blood sugar levels.

If cancer happens in the pancreas, it can disrupt these functions and cause a variety of symptoms. 

Types of Pancreatic Cancer

Pancreatic cancer is categorized into two major types: exocrine pancreatic cancer, which accounts for over 95% of cases, and neuroendocrine pancreatic cancer, making up less than 5%. 

  • Exocrine cancers arise from the exocrine cells that produce digestive enzymes and include several subtypes. The most common is adenocarcinoma, also called ductal carcinoma, which accounts for more than 90% of pancreatic cancer cases and originates in the lining of the pancreatic ducts.
  • A less common variant, acinar cell carcinoma, occurs in enzyme-producing cells, causing symptoms like skin rashes and joint pain due to elevated enzyme levels, though jaundice is less frequent.
  • Rare forms of exocrine cancer include squamous cell carcinoma, composed entirely of squamous cells unusual to the pancreas, which has a poor prognosis and is typically diagnosed after metastasis, and adenosquamous carcinoma, an aggressive tumor with traits of both adenocarcinoma and squamous cell carcinoma, accounting for 1%-4% of cases. 
  • Another rare type, colloid carcinoma, originates from benign cysts called intraductal papillary mucinous neoplasms (IPMNs). Surrounded by a gelatinous mucin substance, these tumors spread less often and are easier to treat, offering a better prognosis.
  • In contrast, neuroendocrine pancreatic cancers (NETs) develop in the endocrine cells that regulate blood sugar by producing hormones like insulin and glucagon. These tumors, also called islet cell tumors, are rare and behave differently from exocrine cancers, with symptoms and outcomes depending on their hormone-secreting characteristics. While most pancreatic cancers have a poor prognosis due to late detection, certain rare types, such as colloid carcinoma, have better treatment outcomes.

Understanding the type of pancreatic cancer you have will help guide the treatment approach.

Pancreatic cancer statistics underscore the severity and challenges of this disease. 

  • The stage at diagnosis significantly impacts treatment options and survival rates. If caught early and localized (stage 1), the 5-year relative survival rate is 44.0%. However, only 13.6% of cases are diagnosed at this stage. Pancreatic cancer's overall 5-year survival rate is approximately 13%, varying widely based on the stage at diagnosis.
  • In 2020, there were approximately 500,000 new cases and 470,000 deaths from pancreatic cancer globally, reflecting its high mortality. The worldwide incidence rate was 4.9 per 100,000 people, while the mortality rate was 4.5 per 100,000. 
  • Men are at a greater risk of developing pancreatic cancer than women, as shown by higher ratios of cases and deaths among men.
  • Geographically, the highest rates of pancreatic cancer in 2022 were reported in Europe and North America, while the lowest rates occurred in Africa and South-Central Asia.
  • In the United States, pancreatic cancer accounts for about 3% of all cancers but is responsible for around 7% of cancer deaths. It is the 10th most common cancer in men and the 9th in women but ranks as the 4th leading cause of mortality due to cancer.
  • Age is a notable risk factor for pancreatic cancer, as most cases are diagnosed in individuals over 60.
  • Even after surgical resection, tumor recurrence occurs in up to 80% of patients. 

While these numbers may seem daunting, advancements in treatment and early detection are improving outcomes.

What are the Signs and Symptoms of Pancreatic Cancer?

Pancreatic cancer is challenging to detect early because it often causes no noticeable symptoms in its initial stages. Additionally, its signs mimic many other illnesses. Symptoms often appear only after the cancer has spread. Here are the most common signs and symptoms:

  • Fatigue or Weakness: People with pancreatic cancer may experience fatigue or physical weakness unrelated to activity. This may also be accompanied by difficulty sleeping or depression.
  • Jaundice: Jaundice (yellowing of the eyes and skin) is common, especially in cancers starting near the pancreas head. It occurs due to a buildup of bilirubin provoked by an obstruction in the bile duct. Related signs include dark urine, light-colored or greasy stools, and itchy skin.
  • Weight Loss: Unintentional weight loss and a loss of appetite are frequent symptoms of pancreatic cancer.
  • Abdominal and Back Pain: Abdominal or back pain is common, particularly in cancers in the pancreas body or tail. These tumors may press on nearby organs or nerves, causing discomfort.
  • Digestive Problems: When a tumor presses on the far end of the stomach, it may cause partial blockage, leading to nausea, vomiting, and pain after eating. A blocked bile duct can cause the gallbladder to enlarge, forming a lump under the right rib cage. Cancer spreading to the liver can also cause it to enlarge, which may be felt during a physical exam or seen in imaging tests.
  • Blood Clots: Pancreatic cancer may cause blood clots in large veins, such as deep vein thrombosis (DVT) in the leg or pulmonary embolism (PE), if a clot travels to the lungs.
  • New-onset Diabetes: The cancer may destroy insulin-producing cells, causing diabetes with symptoms like thirst, frequent urination, and hunger. Subtle changes in blood sugar levels may occur before diabetes symptoms appear.

These symptoms can also occur with other conditions, so it's essential to consult a doctor for proper evaluation.

What are the Causes of Pancreatic Cancer?

Pancreatic cancer occurs when changes in DNA disrupt normal cell behavior. Healthy cells grow, multiply, and die in a controlled manner. Cancer cells, however, multiply rapidly and fail to die when they should. These cells can form a tumor that invades and damages healthy tissues. Over time, cancer cells may spread to other body parts.

The exact causes of mutations in the pancreatic cells are unclear, but certain factors increase the risk. Smoking and having a family history of pancreatic cancer are significant contributors. About 10% of cases are hereditary, meaning they result from inherited changes in DNA. However, most cases are caused by random mutations or external factors like obesity and aging.

If a first-degree relative has pancreatic cancer, your risk may be higher. Doctors recommend genetic testing for inherited mutations for affected family members. A negative test result often means no further testing is necessary. If results are positive or unclear, or if multiple family members have cancer, consulting a genetic counselor is advisable.

While the causes are not fully understood, early genetic testing and awareness of risk factors can help guide preventive strategies.

What are the Risk Factors for Pancreatic Cancer?

Pancreatic Cancer Risk Factors

Some factors make certain people more likely to develop pancreatic cancer. These include:

  • Age: Most cases are diagnosed in people over 60.
  • Smoking: Smokers are two to three times more likely to develop pancreatic cancer.
  • Family History: Having close relatives with pancreatic cancer increases your risk.
  • Obesity: Excess body weight may raise your risk.
  • Diabetes: Especially if it develops suddenly and without explanation.
  • Chronic Pancreatitis: Long-term inflammation of the pancreas.
  • Diet: Diets high in red meats and low in fruits and vegetables.

Are you aware of any of these factors in your own history? Understanding these can help address specific risks.

What are the Complications of Pancreatic Cancer?

Pancreatic cancer causes complications by affecting nearby structures, altering pancreatic function, or spreading to other areas. Some complications also occur due to the treatment. 

  • Pancreatic Enzyme Deficiency: Tumors reduce the production of digestive enzymes essential for breaking down fats, proteins, and carbohydrates. This deficiency leads to malnutrition, bloating, and weight loss despite adequate food intake. Enzyme replacement therapy helps restore digestive function.
  • Blocked Bile Duct: Tumors frequently block the bile duct, causing bile buildup and jaundice. Endoscopic stent placement relieves the obstruction and restores bile flow. Complications like stent blockages or infections may require additional treatment.
  • Digestive Obstruction: A growing tumor can block the stomach or small intestine, disrupting food passage. Doctors use stents or surgery to bypass the obstruction, enabling normal digestion.
  • Diabetes: Tumors damage insulin-producing cells, leading to diabetes or insulin resistance. High blood sugar can appear early or develop as the disease progresses. Patients often require tailored diabetes management to control symptoms.
  • Cancer-Associated Cachexia: Pancreatic cancer triggers a wasting syndrome, leading to severe weight loss and muscle depletion. A lack of digestive enzymes worsens malnutrition, making cachexia a critical issue. Nutritional support, including supplements, helps address this complication.
  • Increased Risk of Blood Clots: Many patients experience blood clots, such as DVT or pulmonary embolism, as the disease progresses. These clots may occur early and often signal advanced cancer. Anticoagulants reduce risks but require careful monitoring due to bleeding concerns.
  • Severe Pain: Advanced tumors press on nerves in the abdomen, causing persistent pain. Doctors manage pain with a combination of medications, radiation, or nerve blocks. Specialized care ensures effective pain relief throughout the illness.

By managing these complications proactively, doctors aim to improve treatment outcomes and quality of life, even in the advanced stages of pancreatic cancer.

How is Pancreatic Cancer Diagnosed?

Pancreatic cancer is challenging to detect early because the organ is placed deep in the abdomen, making it difficult to feel during routine exams. Additionally, small tumors are hard to see on standard imaging tests. If a doctor suspects pancreatic cancer, they may recommend a combination of tests, including imaging, blood tests, and genetic testing.

  • Imaging Tests: Imaging tests produce detailed pictures of the body to detect abnormalities and tumors in the pancreas. Common imaging methods include:
    • CT Scan (Computed Tomography): Produces cross-sectional images to identify tumors and check if cancer has spread.
    • MRI Scan (Magnetic Resonance Imaging): This procedure uses magnetic fields and radio waves to develop detailed images, which is especially useful for identifying small tumors.
    • PET Scan (Positron Emission Tomography): Tracks radioactive sugar injected into the body to detect cancerous areas.
    • Endoscopic Ultrasound (EUS): Endoscopic ultrasound combines ultrasound and endoscopy to obtain precise images of the pancreas and surrounding areas. A long tube with a camera is inserted through the throat into the stomach, and ultrasound waves produce detailed pictures.
  • Blood Tests: Blood tests can detect tumor markers (substances released by cancer cells). For pancreatic cancer, doctors check levels of:
    • CA19-9 (Carbohydrate Antigen 19-9): Elevated levels may indicate pancreatic cancer, although this test isn't definitive for diagnosis. Doctors may repeat this test during treatment to monitor progress.
  • Biopsy: A biopsy involves removing a tiny sample of tissue for laboratory testing to confirm a cancer diagnosis. In the lab, pathologists examine the sample for cancer cells and may perform genetic tests to identify DNA changes in the cancer. These results help doctors plan effective treatments. Methods include:
    • Endoscopic Biopsy: During an EUS, doctors pass special tools through the endoscope to collect tissue from the pancreas.
    • Fine-Needle Aspiration: The doctor inserts a thin needle through the skin and into the pancreas, guided by imaging.
  • Staging Laparoscopy: Surgeons sometimes use laparoscopy to determine the extent of pancreatic cancer and whether they can surgically remove it. During the procedure, they make small incisions in the abdomen and insert a camera-equipped tube to examine the area and collect biopsy samples.

Genetic Testing for Pancreatic Cancer

Doctors may recommend genetic testing if you are diagnosed with pancreatic cancer or have a family history of the disease. This testing identifies inherited gene mutations, such as BRCA1 and BRCA2, that increase the risk of pancreatic cancer and other cancers like breast, ovarian, or prostate cancer.

Why Consider Genetic Testing?

  • It helps determine treatment options, such as targeted therapies.
  • It informs family members about their cancer risk, enabling preventive measures.

Even if you carry a mutation, it does not guarantee you will develop cancer, but knowing your risk is essential for early detection and management.

How is Pancreatic Cancer Treated?

Pancreatic Cancer Treatment

Pancreatic cancer is treated using a range of approaches that depend on factors such as the type and stage of cancer, its location, the overall health of the patient, and their personal preferences. Treatments aim to remove the cancer, slow its growth, reduce signs, and improve quality of life. Options include surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy, and palliative care, often used alone or in combination.

Surgery

Surgical removal offers the potential for a cure in cases where the cancer is confined to the pancreas and can be completely removed. These are three main types of pancreatic cancer surgery:

  • Whipple Procedure (Pancreaticoduodenectomy): This surgery is performed for cancers located in the head of the pancreas. It involves the removal of the pancreas's head, the gallbladder, the duodenum (the first part of the small intestine), nearby lymph nodes, part of the bile duct, and sometimes a small portion of the stomach. The remaining portions of the digestive system are reconnected to maintain digestive function. Complications can include infections, bleeding, and delayed gastric emptying.
  • Distal Pancreatectomy: For cancers in the body or tail of the pancreas, this procedure removes the affected parts of the pancreas and often the spleen, which plays a role in immune function. After a splenectomy, patients may face an increased risk of infections and may require vaccinations.
  • Total Pancreatectomy: If cancer affects the entire pancreas but remains resectable, surgeons may remove the whole organ, along with the spleen, parts of the stomach, small intestine, and bile duct. While life without a pancreas is possible, patients will require lifelong insulin injections and pancreatic enzyme replacement therapy to manage diabetes and digestion.

Surgery can also be palliative, aiming to relieve symptoms rather than cure the disease. For example:

  • Biliary Bypass: If a tumor blocks the bile duct, the gallbladder or bile duct can be rerouted to the small intestine, bypassing the blockage.
  • Endoscopic Stent Placement: A stent can be inserted to keep the bile duct open, allowing bile to flow either into the small intestine or into a collection bag outside the body.
  • Gastric Bypass: If a tumor blocks food flow from the stomach, doctors can create a bypass by directly connecting the stomach to the small intestine.

Chemotherapy

Chemotherapy utilizes medications to kill cancer cells or stop their growth. Chemo can be administered intravenously or in pill form. It is often used in cycles, allowing the body to recover between treatments. Chemotherapy is usually the primary treatment for advanced cancer, used before surgery to shrink tumors or given after surgery to kill any remaining cancerous cells. Common chemotherapy drugs for pancreatic cancer include capecitabine, gemcitabine, fluorouracil (5-FU), irinotecan, oxaliplatin, and their combinations. Side effects of chemo vary but may include nausea, vomiting, hair loss, and fatigue.

Radiation Therapy

Radiation therapy employs high-energy X-rays or protons to target and kill cancer cells. This therapy can shrink tumors, make surgery possible, or relieve symptoms when surgery isn't an option. Treatments typically occur over several weeks, five days per week. Radiation may be combined with chemotherapy (chemoradiation) to enhance effectiveness. Side effects might include skin irritation, gastrointestinal issues, and fatigue, which usually improve after completing therapy.

Targeted Therapy

Targeted therapy uses drugs to attack specific molecules or proteins that drive cancer cell growth. Examples include erlotinib (an EGFR inhibitor) and PARP inhibitors like olaparib. Because they focus on cancer-specific pathways, targeted therapies generally have fewer systemic side effects than chemotherapy. They may be combined with other treatments for greater effectiveness.

Immunotherapy

Immunotherapy enhances the immune system's ability to identify and destroy cancer cells. It is particularly effective in tumors with certain genetic alterations that make them more visible to immune cells. PD-1 inhibitors, such as pembrolizumab, are an example of immunotherapy drugs used for pancreatic cancer. Treatment is administered as an infusion every two to three weeks. Side effects might include fatigue, skin rashes, and joint pain.

Palliative Care

Palliative care is an integral part of pancreatic cancer treatment, focusing on relieving symptoms and improving quality of life. It may involve managing pain (through medications, nerve blocks, or injections) and alleviating digestive issues caused by blockages in the bile duct or small intestine. Palliative radiation or surgery can reduce pain and complications caused by tumors. Additionally, psychological and emotional support is provided to address the mental health challenges associated with cancer.

Clinical Trials

Clinical trials give pancreatic cancer patients access to new and innovative treatments that are not yet available. These may include experimental drugs, new combinations of existing treatments, or advanced surgical techniques. Participation in a trial can provide hope, but patients should weigh potential risks and benefits with their care team.

Pain Management

Pancreatic cancer often causes significant pain, especially if it involves nearby nerves. Pain relief options include oral medications, anesthetic or steroid injections, and nerve blocks. These interventions help improve quality of life and enable patients to tolerate other treatments better.

Pancreatic Cancer Prognosis

Every case of pancreatic cancer is unique, and individual outcomes vary depending on the cancer's stage at diagnosis, treatment options, overall health, and response to therapy. While it's impossible to predict an exact prognosis for any individual, population-wide studies provide valuable insight into survival rates.

  • Five-Year Survival Rate for Pancreatic Cancer: The overall 5-year survival rate for pancreatic cancer in all stages is currently estimated at 13%. This means that 13 out of 100 patients diagnosed with pancreatic cancer will remain alive five years after their diagnosis.
  • Improved Outlook for Pancreatic Cancer: Over the last decade, the five-year survival rate has increased from 7% to 13%, reflecting advancements in early detection, surgical techniques, and treatments. While this progress is significant, it underscores the urgent need for continued research to improve survival further. Each percentage point translates into more lives extended beyond five years, with an increase from 7 to 13 people out of 100 surviving.

Survival Rates by Stage of Pancreatic Cancer

Survival rates for pancreatic cancer depend on the stage of the disease at the time of diagnosis:

  • Localized Disease (Confined to the Pancreas): When pancreatic cancer is detected early and confined to the pancreas, the five-year survival rate is 44%.
  • Regional Disease (Spread to Nearby Lymph Nodes): If the cancer has infiltrated lymph nodes near the pancreas, the five-year survival rate drops to 16%.
  • Distant Disease (Stage IV or Metastatic): Pancreatic cancer that has reached distant organs, such as the lungs or liver, has a five-year survival rate of 3%.

For patients with stage IV pancreatic cancer, exploring all available treatment options, including clinical trials, is critical.

Impact of Surgery on Survival

Surgery is one of the most effective interventions for pancreatic cancer when diagnosed early enough to allow tumor resection. For patients with tumors detected at the earliest stage (Stage IA), the five-year survival rate can exceed 80%, highlighting the importance of early detection.

Diagnosing pancreatic cancer at an operable stage can improve survival by more than tenfold compared to advanced-stage cases. Surgical candidates often undergo additional therapies, such as chemotherapy or radiation, to reduce recurrence risk and improve outcomes.

Advancements and Hope for the Future

While current survival rates reflect historical data, advancements in treatment are improving outcomes for many patients. New therapies, including targeted treatments, immunotherapies, and participation in clinical trials, provide opportunities for better survival and quality of life. Continued research, early detection initiatives, and personalized treatment approaches offer hope for a brighter future in combating pancreatic cancer.

Key Takeaway

Pancreatic cancer continues to be a serious health challenge, but advancements in diagnostic techniques, surgical procedures, and treatments provide hope for improved survival and quality of life. Although the journey with this disease can be demanding, it's important to remember that you are not alone. Support groups, counseling, and friends and family can offer invaluable assistance during this difficult time.

Author

Doctor of Pharmacy

Dr. Deepanshu Siwach is a skilled clinical pharmacist with a Doctor of Pharmacy degree. He has 4+ years of experience and has worked with thousands of patients. He has been associated with some of the top hospitals, such as Artemis Gurgaon.

Reviewer

Dr. Sajjan Rajpurohit is a leading medical oncologist in New Delhi. With over 22 years of experience in cancer treatment, he has performed more than 15,000 immunotherapy cycles. His specializations include immunotherapy, targeted therapy, and chemotherapy for solid tumors (breast, lung, gastrointestinal, genitourinary, head and neck, and sarcoma)....

Frequently Asked Questions

Pancreatic cancer is curable only in early-stage cases that can be treated with surgery. Total surgical removal of the tumor is a way of curing prostate cancer.

Quitting drinking and smoking, eating a healthy diet, regular screenings, maintaining body weight, and staying active can reduce the risk of pancreatic cancer.

Treatment duration for pancreatic cancer depends on the stage and chosen therapies. It can range from weeks for surgery recovery to months for chemotherapy or radiation.

Clinical trials provide pancreatic cancer patients access to innovative treatments, including experimental drugs and new surgical techniques. 

Getting diagnosed with pancreatic cancer can take a significant toll on mental health. Support groups, counseling, and stress-management techniques can help patients cope emotionally.

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