Pancreatic Cancer

The pancreas is an important abdominal organ that produces digestive enzymes and regulates insulin, the hormone that controls blood sugar levels. Pancreatic cancer is most commonly diagnosed in men over the age of 40 and makes up 2% of all cases of cancer. It can be difficult to detect early because it typically presents with very few or no signs or symptoms. 

This article will review symptoms and stages of pancreatic cancer, how it is diagnosed, and treatment options.

Pancreatic Cancer Symptoms

Pancreatic cancer is one of the most asymptomatic cancers. It is a difficult condition to detect as there are typically no early signs or symptoms. As the cancer progresses and spreads to other parts of the body, you may begin to notice changes to other organ systems.

Early Signs of Pancreatic Cancer

There are often no early signs of pancreatic cancer. By the time most symptoms appear, the cancer has already developed and spread to other parts of the body. The most common symptoms of pancreatic cancer are digestive issues, abdominal pain, and yellow skin and eyes. 

Symptoms After Progression

Approximately 70% to 80% of people with pancreatic cancer experience pain in the upper abdomen and stomach. This pain can radiate to the sides of the body and the back. Not moving or bending forward may decrease the pain.

Other symptoms of pancreatic cancer after progression include:

• Yellow skin and eyes (jaundice)
• Cholestasis
• Lack of appetite
• Indigestion
• Nausea
• Unexplained weight loss
• Depression 
• Fatigue

What Causes Pancreatic Cancer?

Pancreatic cancer is caused by genetic mutations that affect the growth and spread of cancer cells. Genetic mutations can naturally occur throughout your lifetime or be inherited from your family. The majority of cases of pancreatic cancer are linked to genetic mutations that can surface during your lifetime.

Pancreatic Cancer Risk Factors

Genetic changes that cause pancreatic cancer are more likely to occur due to high levels of inflammation throughout the body that occur with certain medical conditions or lifestyle habits. Factors that increase the likelihood of developing pancreatic cancer include older age, being overweight, smoking, long term alcohol use, diabetes, a family history of pancreatic cancer, and a history of chronic pancreatitis.

Is Pancreatic Cancer Hereditary?

About 10% of cases of pancreatic cancer are hereditary and linked to genetic changes passed down through your family. If you have a family history of pancreatic cancer, you may be at risk for developing the condition and should get screened early, especially since most cases of pancreatic cancer do not cause noticeable signs or symptoms in the early stages.

How Is Pancreatic Cancer Diagnosed?

Pancreatic cancer is diagnosed through testing that examines the structure and function of your pancreas. Diagnosis involves a variety of different tests and procedures, which include:

• Computed tomography (CT) scan: A series of multiple X-rays used to produce a three-dimensional image of the pancreas from different angles to check for cancer cell growth
• Magnetic resonance imaging (MRI): A three-dimensional imaging technique produced by magnetic waves used to check for cancer cell growth
• Biopsy: A procedure that removes abnormal fluid or tissue from the pancreas to test for cancer cells
• Endoscopic retrograde cholangiopancreatography (ECRP): A procedure that combines an endoscopy with X-rays to examine the pancreatic ducts for cancer cell growth
• Ultrasound: An imaging technique that uses sound waves to examine your pancreas for cancer cell growth
• Lab tests: Blood tests that can check for genetic markers in your DNA to see if you are at risk for pancreatic cancer

Pancreatic Cancer Stages

As pancreatic cancer cells continue to grow, pancreatic cancer will progress through different stages. A higher stage of pancreatic cancer indicates that the cancer is worsening and is spreading to other parts of the body. The stage of pancreatic cancer will influence what type of treatment is most appropriate.

Pancreatic cancer is staged based on both letter and number staging systems. 

TNM Stages

The TNM staging system uses three different letter grades to classify pancreatic cancer. 

T (tumor) categories describe the size of a tumor in the pancreas and whether it has spread to other areas of the body according to the following stages:

• TX: A pancreatic tumor cannot be assessed.
• T0: There is no evidence of a pancreatic tumor.
• Tis: A tumor is present in the pancreas but is limited to only the top layers of the pancreatic duct.
• T1: A pancreatic tumor 2 centimeters (cm) or smaller is present but has not grown outside of the pancreas.
• T2: A pancreatic tumor larger than 2 cm is present but has not grown outside of the pancreas
• T3: Pancreatic cancer has spread outside of the pancreas into nearby areas but has not spread to major blood vessels or nerves.
• T4: Pancreatic cancer has spread outside of the pancreas into major blood vessels or nerves.

N (lymph nodes) categories describe whether pancreatic cancer has spread to nearby lymph nodes, as follows:

• NX: Nearby lymph nodes cannot be assessed.
• N0: No spread of pancreatic cancer is detected in nearby lymph nodes.
• N1: Pancreatic cancer has spread to nearby lymph nodes.

M (metastasis) categories describe whether pancreatic cancer has spread to other parts of the body, as follows:

• MX: The spread of pancreatic cancer cannot be assessed.
• M0: Pancreatic cancer has not spread to distant organs or lymph nodes.
• M1: Pancreatic cancer has spread to distant organs or lymph nodes, including the liver, the lungs, and the lining of the abdominal cavity.

Number Stages

The numerical staging system combines the TNM stages to describe how pancreatic cancer is progressing and include:

• Stage 0: Abnormal cells are found in the lining of the pancreas (Tis, N0, M0).
• Stage 1: Cancer is found in the pancreas, forming a tumor 2 cm or smaller (stage 1A;T1, N0, M0) or larger than 2 cm (stage 1B; T2, N0, M0).
• Stage 2: Pancreatic cancer has spread to nearby areas, including only nearby tissues or organs (stage 2B; T3, N0, M0), or nearby tissues, organs, and lymph nodes (stage 2B; T1, T2, or T3; N1, M0).
• Stage 3: Pancreatic cancer has spread to major blood vessels but has not spread to distant areas (T4, any N, M0).
• Stage 4: Pancreatic cancer has spread to distant areas, including the liver, lungs, and lining of the abdominal cavity (any T, any N, M1).

Pancreatic Cancer Treatment

Treatment for pancreatic cancer will depend on what stage of cancer you are diagnosed with.

Surgery

Surgical removal of a cancerous tumor from the pancreas is the most effective treatment option if pancreatic cancer is caught early enough, before it spreads to other areas of the body. Because it is often diagnosed after spreading throughout the body, only 15% to 20% of people are eligible candidates for surgery.

Even so, pancreatic cancer can come back in up to 71% of patients even after the tumor is removed. In advanced stages of pancreatic cancer, the tumor has progressed to many areas, including to nearby blood vessels, making surgery either too dangerous or ineffective at removing enough of the cancer.

Radiation Therapy

Radiation therapy, also called radiotherapy, involves exposing the areas of the body with cancer cells to targeted high-energy radiation beams. Radiation beams are powerful enough to damage the DNA of cancer cells to destroy them and stop them from dividing. Radiation therapy is often used together with chemotherapy to treat cancer.

Chemotherapy

Chemotherapy involves the use of powerful medications that kill rapidly growing cancer cells. Chemotherapy and radiation therapy are typically the standard treatment for people with advanced stages of pancreatic cancer. Chemotherapy is often also administered after surgery to kill off any remaining cancer cells that were not removed from the body.

Immunotherapy

Immunotherapy is a type of treatment that uses biologic medications to enhance the body’s immune system to fight off cancer. Immunotherapy medications improve the function and activity of immune system cells so that they can better target cancer cells and stop or slow their growth.

Targeted Therapy

Targeted therapy involves the use of medications that target the genes that cause cancer cells to form and divide. Ongoing research is geared toward developing drugs that target these genetic mutations to stop abnormal cellular activity to decrease cancer growth and development.

How to Prevent Pancreatic Cancer 

Because pancreatic cancer is linked to genetic changes, the majority of which develop over a person’s lifetime, living a healthy lifestyle is important for preventing the development of pancreatic cancer. Managing your weight and blood sugar through a healthy diet and with exercise and limiting alcohol use play important roles.

Stopping smoking is also incredibly important as smokers are 2.2 times more likely to develop pancreatic cancer than nonsmokers.

Outlook for Pancreatic Cancer

Because pancreatic cancer is most often diagnosed after it has already spread throughout the body, most people have a poor survival rate of five years or less since treatment at this point is less effective in slowing cancer growth.

Every case of pancreatic cancer is different, however, and survival rates can vary from person to person depending on lifestyle factors and how early and aggressively treatment is administered after diagnosis.

Support and Resources for Pancreatic Cancer

You shouldn't have to go through a pancreatic cancer diagnosis alone. Support groups through online forums, chat rooms, and in-person and virtual meetings can help you manage your condition. You can check with your local hospital or national cancer organizations for helpful resources.