Pancreatic Cancer: Symptoms, Causes & Treatment

What Is Pancreatic Cancer?

Pancreatic cancer occurs when malignant cells form in the tissues of the pancreas, a gland located behind the stomach. The most common type, ductal adenocarcinoma, accounts for about 90% of cases. The cancer often spreads to nearby organs and lymph nodes before causing noticeable symptoms, which is why early detection is so challenging.

Cancer of the pancreas develops when cells in the pancreatic tissue begin to grow uncontrollably, forming a tumor. The pancreas is a vital organ that performs two essential functions in the body: it produces digestive enzymes that help break down food in the small intestine, and it produces hormones like insulin that regulate blood sugar levels.

The location of the pancreas deep within the abdomen, surrounded by other organs, contributes to the difficulty in detecting pancreatic cancer early. By the time symptoms become noticeable enough to prompt medical evaluation, the cancer has often already spread to nearby structures such as lymph nodes, the liver, the peritoneum (the lining of the abdominal cavity), or the lungs.

It's important to understand that not all tumors in the pancreas are cancerous. Some tumors may be precancerous (meaning they could develop into cancer over time) or benign (non-cancerous). The distinction is important because treatment approaches differ significantly. This article focuses primarily on ductal adenocarcinoma, which is the most common form of pancreatic cancer.

How the Pancreas Functions

The pancreas is a long, flat gland located horizontally behind your stomach, extending from the duodenum (the first part of the small intestine) to the spleen. Understanding its functions helps explain why pancreatic cancer causes certain symptoms.

The exocrine function involves producing digestive enzymes that flow through a duct system into the small intestine. These enzymes break down proteins, fats, and carbohydrates from the food you eat. When pancreatic cancer blocks these ducts or destroys enzyme-producing tissue, digestion problems can occur.

The endocrine function involves specialized cell clusters called islets of Langerhans that produce hormones directly into the bloodstream. The most important hormone is insulin, which regulates blood sugar. This is why new-onset diabetes can sometimes be an early sign of pancreatic cancer.

Types of Pancreatic Cancer

Pancreatic cancers are classified based on which type of cells they originate from. Exocrine tumors, which include ductal adenocarcinoma, arise from the cells that produce digestive enzymes and account for approximately 95% of all pancreatic cancers. Endocrine tumors (also called neuroendocrine tumors or islet cell tumors) develop from hormone-producing cells and are much rarer, accounting for less than 5% of cases.

Neuroendocrine tumors of the pancreas generally have a better prognosis than ductal adenocarcinoma because they tend to grow more slowly and may be detected earlier when they cause hormone-related symptoms.

What Are the Symptoms of Pancreatic Cancer?

Pancreatic cancer symptoms often appear gradually and can include jaundice (yellowing of skin and eyes), unexplained weight loss, upper abdominal pain radiating to the back, loss of appetite, nausea, and new-onset diabetes. Symptoms depend on the tumor's location in the pancreas and may not appear until the cancer has advanced.

One of the most challenging aspects of pancreatic cancer is that it typically produces no symptoms in its early stages, or the symptoms are so vague that they are easily attributed to other, more common conditions. As the tumor grows and potentially spreads, symptoms become more noticeable. The specific symptoms often depend on where in the pancreas the cancer is located.

Tumors in the head of the pancreas (the wider end, near the duodenum) are more likely to cause jaundice because they can compress or block the bile duct. Tumors in the body or tail of the pancreas may grow larger before causing symptoms, often presenting with pain or weight loss rather than jaundice.

Jaundice and Related Symptoms

Jaundice is one of the most common early symptoms of pancreatic cancer, particularly when the tumor is located in the head of the pancreas. It occurs when the tumor blocks the common bile duct, preventing bile from flowing from the liver into the intestines. Bile then builds up in the bloodstream, causing characteristic symptoms:

• Yellowing of the skin and whites of the eyes: This is often the most visible sign of jaundice
• Dark urine: Excess bilirubin in the blood is filtered by the kidneys, producing dark, tea-colored urine
• Pale or clay-colored stools: Without bile reaching the intestines, stool loses its normal brown color
• Intense itching: Bile salts depositing in the skin can cause severe, widespread itching

While jaundice can be caused by many conditions other than cancer—including gallstones and hepatitis—it should always prompt medical evaluation, especially in adults over 50.

Abdominal and Back Pain

Pain is a common symptom of pancreatic cancer, affecting approximately 70-80% of patients at some point during their illness. The pain typically occurs in the upper abdomen and may radiate straight through to the back. It is often described as a dull, gnawing pain that may worsen after eating or when lying flat, and may improve when leaning forward.

The pain occurs because the tumor presses on nerves in the abdomen or because the cancer has spread to nerves surrounding the pancreas. However, abdominal and back pain are extremely common symptoms with many possible causes, so pain alone—without other symptoms—is not usually a reliable indicator of pancreatic cancer.

Unexplained Weight Loss and Appetite Changes

Unintentional weight loss is one of the most common symptoms of pancreatic cancer, occurring in approximately 85% of patients. Several factors contribute to this weight loss:

• Reduced appetite: Many patients experience a significant decrease in appetite and may feel full quickly after eating small amounts
• Malabsorption: When the cancer blocks pancreatic ducts, digestive enzymes cannot reach the intestines, preventing proper absorption of nutrients, especially fats
• Cancer cachexia: The cancer itself triggers metabolic changes that cause muscle wasting and weight loss
• Nausea and vomiting: These symptoms can further reduce food intake

If you are losing weight without trying, particularly if combined with other symptoms like abdominal pain or changes in bowel habits, it's important to see a healthcare provider.

New-Onset Diabetes

The sudden development of diabetes, particularly in adults over 50 who are not overweight, can sometimes be an early warning sign of pancreatic cancer. This occurs when the tumor destroys insulin-producing cells in the pancreas or affects insulin function. Conversely, existing diabetes may suddenly become more difficult to control if pancreatic cancer develops.

Research suggests that up to 1% of new diabetes cases in adults over 50 may be related to pancreatic cancer. This connection is an area of active research, as it may offer opportunities for earlier detection.

When Should You See a Doctor?

Seek medical attention if you experience unexplained jaundice (yellow skin or eyes), persistent upper abdominal or back pain, unexplained weight loss, or new-onset diabetes. Seek emergency care immediately if you develop jaundice with fever and chills, which may indicate a serious infection.

Many of the symptoms associated with pancreatic cancer are non-specific, meaning they can be caused by many different conditions. However, certain combinations of symptoms or symptoms that persist should prompt a medical evaluation.

Contact your healthcare provider if you experience:

• Yellowing of your skin or the whites of your eyes (jaundice)
• Persistent upper abdominal pain that radiates to your back
• Unexplained weight loss of more than 5% of body weight
• Persistent nausea, vomiting, or loss of appetite
• Dark urine with pale, oily stools
• New diagnosis of diabetes, especially if you're over 50 and not overweight

How Is Pancreatic Cancer Diagnosed?

Pancreatic cancer is diagnosed through a combination of imaging tests (CT scan, MRI, endoscopic ultrasound), blood tests including tumor markers like CA 19-9, and tissue biopsy. Diagnosis typically follows a standardized pathway when pancreatic cancer is strongly suspected to ensure rapid evaluation.

Diagnosing pancreatic cancer involves several steps, beginning with a thorough medical history and physical examination. Your doctor will ask about your symptoms, when they started, risk factors, and family history. A physical exam may reveal jaundice, an enlarged gallbladder (Courvoisier sign), or tenderness in the abdomen.

When pancreatic cancer is suspected, patients are typically evaluated through a standardized diagnostic pathway designed to provide rapid, comprehensive assessment. This may involve multiple specialists including gastroenterologists, oncologists, radiologists, and surgeons.

Imaging Studies

CT scan (Computed Tomography) with contrast is usually the first imaging test performed when pancreatic cancer is suspected. A specialized "pancreas protocol" CT can show the size and location of tumors, involvement of blood vessels, and whether the cancer has spread to lymph nodes or other organs. CT scanning is essential for determining whether surgical removal might be possible.

MRI (Magnetic Resonance Imaging) may be used to provide additional detail about the pancreas and bile ducts. MRCP (Magnetic Resonance Cholangiopancreatography) can visualize the bile and pancreatic ducts without invasive procedures.

Endoscopic Ultrasound (EUS) involves passing a thin tube with an ultrasound device through the mouth into the stomach and duodenum. This provides very detailed images of the pancreas and allows for biopsy of suspicious areas. EUS is particularly useful for detecting small tumors that may not be visible on CT.

Blood Tests

Several blood tests are useful in the evaluation of suspected pancreatic cancer:

• Liver function tests: May be abnormal if the bile duct is blocked
• CA 19-9: A tumor marker that is elevated in approximately 80% of pancreatic cancer patients, though it can also be elevated in other conditions
• CEA (Carcinoembryonic Antigen): Another tumor marker sometimes measured
• Complete blood count and chemistry panel: Assess overall health

It's important to understand that tumor markers like CA 19-9 cannot be used alone to diagnose pancreatic cancer—they must be interpreted alongside imaging and other findings. Some patients with pancreatic cancer may have normal CA 19-9 levels.

Biopsy

A tissue sample (biopsy) is typically needed to confirm the diagnosis of pancreatic cancer and determine its specific type. The biopsy is usually obtained through one of the following methods:

• EUS-guided fine needle aspiration: A thin needle is passed through the endoscope to obtain cells from the tumor
• CT-guided percutaneous biopsy: A needle is inserted through the skin, guided by CT imaging
• ERCP with brushing: During endoscopic examination of the bile duct, cells can be collected

In some cases, if surgery is planned and imaging is strongly suggestive of pancreatic cancer, biopsy may be deferred until the time of surgery.

How Is Pancreatic Cancer Treated When Surgery Is Possible?

When pancreatic cancer is confined to the pancreas and hasn't spread, surgical removal offers the best chance for cure. The Whipple procedure (pancreaticoduodenectomy) is the most common surgery for tumors in the head of the pancreas. Surgery is typically followed by chemotherapy to reduce the risk of recurrence.

Only about 15-20% of patients with pancreatic cancer are candidates for surgery at the time of diagnosis, usually because the cancer has already spread or involves critical blood vessels. However, for those who can undergo surgery, it provides the best opportunity for long-term survival.

Before surgery, extensive evaluation is performed to ensure the cancer is resectable (removable) and that the patient is healthy enough to tolerate a major operation. This includes detailed imaging, assessment of heart and lung function, and nutritional evaluation.

Preparing for Surgery

Preparation for pancreatic surgery is crucial for optimizing outcomes. Patients are advised to:

• Stop smoking: Smoking increases surgical complications and should be stopped at least 4 weeks before surgery if possible
• Avoid alcohol: Alcohol consumption should be stopped before and after surgery
• Optimize nutrition: Nutritional support may be needed, including supplements or special drinks
• Manage other conditions: Diabetes, heart disease, and other conditions should be optimally controlled

Types of Surgery

Whipple procedure (Pancreaticoduodenectomy): This is the most common surgery for tumors in the head of the pancreas. It involves removing the head of the pancreas, the duodenum, part of the stomach, the gallbladder, and part of the bile duct. The remaining organs are then reconnected to allow digestion to continue.

Distal pancreatectomy: Used for tumors in the body or tail of the pancreas, this surgery removes the left side of the pancreas, often along with the spleen.

Total pancreatectomy: Rarely, the entire pancreas must be removed. This results in permanent diabetes requiring insulin and lifelong enzyme supplementation.

Recovery After Surgery

Recovery from pancreatic surgery typically requires 8-14 days in the hospital, though this varies based on individual circumstances and any complications. Common challenges during recovery include:

• Managing pain
• Gradually resuming eating
• Managing blood sugar (diabetes may develop or worsen)
• Taking pancreatic enzyme supplements to aid digestion

Follow-up appointments typically occur about one month after discharge, and then regularly thereafter. Most patients also receive chemotherapy after surgery to reduce the risk of cancer recurrence.

Chemotherapy After Surgery

Adjuvant (post-surgical) chemotherapy is typically recommended for patients who have undergone surgical removal of pancreatic cancer. Treatment usually lasts about six months and may include regimens such as FOLFIRINOX or gemcitabine-based combinations. This treatment has been shown to significantly improve survival compared to surgery alone.

In some cases, chemotherapy is given before surgery (neoadjuvant therapy) to shrink the tumor and make it easier to remove, or to treat cancer that initially appears borderline resectable.

What Treatment Options Exist When Surgery Isn't Possible?

When pancreatic cancer cannot be surgically removed due to spread or involvement of major blood vessels, treatment focuses on controlling the cancer and relieving symptoms. Options include chemotherapy to slow cancer growth, radiation therapy, and palliative care to manage pain and other symptoms.

The majority of patients with pancreatic cancer are diagnosed at a stage when surgical removal is not possible because the cancer has spread beyond the pancreas or involves critical blood vessels. In these situations, treatment aims to control cancer growth, relieve symptoms, and maintain quality of life for as long as possible.

It's important to understand that even when cure is not possible, effective treatments exist that can extend life and significantly improve comfort and well-being.

Chemotherapy for Advanced Disease

Chemotherapy can slow the progression of pancreatic cancer in approximately two-thirds of patients with advanced disease. The specific regimen depends on the patient's overall health and functional status:

• FOLFIRINOX: A combination of four drugs that is highly effective but can cause significant side effects; typically used for patients in good overall health
• Gemcitabine combinations: May be used for patients who cannot tolerate FOLFIRINOX
• Single-agent chemotherapy: May be appropriate for patients with reduced functional status

Chemotherapy is given in cycles, with treatment days followed by rest periods. Between treatments, patients typically live at home and can continue many normal activities.

Managing Symptoms and Complications

Effective symptom management is a crucial component of pancreatic cancer care. Several common symptoms can be addressed:

Pain management: Pancreatic cancer pain can be effectively controlled using various approaches, including oral pain medications (including opioids when needed), nerve blocks (celiac plexus block), and radiation therapy for cancer-related bone pain. No one should suffer unnecessarily from pain.

Jaundice and bile duct obstruction: If the tumor blocks the bile duct, a stent (small tube) can be placed during an ERCP procedure to allow bile to drain normally. This typically relieves jaundice and itching within a few weeks.

Weight loss and nutrition: A dietitian can help with nutrition strategies, and pancreatic enzyme supplements can improve digestion. Specialized nutrition drinks may be recommended to maintain weight.

Nausea and vomiting: If the tumor blocks the intestine, a stent can sometimes be placed to restore passage. Anti-nausea medications are also effective.

Fatigue: While common in cancer, fatigue may be improved with gentle physical activity, adequate rest, and treating underlying causes such as anemia.

What Causes Pancreatic Cancer?

The exact cause of pancreatic cancer is unknown, but several risk factors increase susceptibility. Smoking is the most significant modifiable risk factor, approximately doubling the risk. Other factors include chronic pancreatitis, obesity, diabetes, and family history. About 5% of cases are hereditary.

While we cannot pinpoint exactly what causes any individual case of pancreatic cancer, research has identified several factors that increase the likelihood of developing the disease. Understanding these risk factors can help identify individuals who might benefit from closer monitoring and can guide preventive strategies.

Smoking

Smoking is the most important modifiable risk factor for pancreatic cancer. Smokers are approximately twice as likely to develop pancreatic cancer compared to non-smokers. The risk increases with the amount and duration of smoking but decreases after quitting. Approximately 20-25% of pancreatic cancers are attributed to smoking.

Chronic Pancreatitis

Long-term inflammation of the pancreas (chronic pancreatitis) significantly increases pancreatic cancer risk. This is particularly true for hereditary pancreatitis, a rare genetic condition that causes recurring pancreatitis episodes. The chronic inflammation damages pancreatic tissue and promotes genetic changes that can lead to cancer.

Family History and Genetics

Approximately 5-10% of pancreatic cancer cases occur in individuals with a family history of the disease. Having one first-degree relative (parent, sibling, or child) with pancreatic cancer approximately doubles your risk. Several inherited genetic conditions also increase risk:

• BRCA1 and BRCA2 mutations (also associated with breast and ovarian cancer)
• Lynch syndrome (hereditary non-polyposis colorectal cancer)
• Familial atypical multiple mole melanoma syndrome (FAMMM)
• Peutz-Jeghers syndrome
• Hereditary pancreatitis

Genetic counseling and testing may be recommended for individuals with a strong family history of pancreatic cancer or related cancers.

Other Risk Factors

Age: Risk increases significantly with age, with most cases diagnosed in people over 65.

Diabetes: Long-standing diabetes (but not new-onset diabetes, which may be a symptom) is associated with moderately increased risk.

Obesity: Being overweight increases pancreatic cancer risk, possibly by 20-30% for those with BMI over 30.

Diet: High consumption of red and processed meats may slightly increase risk, while diets rich in fruits and vegetables may be protective.

What Is Life Like After a Pancreatic Cancer Diagnosis?

Living with pancreatic cancer involves adapting to physical changes including dietary modifications and enzyme supplements, managing the emotional impact of diagnosis, and working with a healthcare team to optimize quality of life. Support from family, healthcare providers, and support groups can make a significant difference.

A pancreatic cancer diagnosis affects not only the patient but their entire family and support network. Learning to navigate this new reality takes time and support.

Adjusting to Dietary Changes

After pancreatic cancer treatment, particularly surgery, most patients need to make dietary adjustments. The pancreas plays a crucial role in digestion, so its function may be impaired:

• Smaller, more frequent meals: Eating 5-6 small meals per day instead of 3 large ones is often easier to tolerate
• Enzyme supplements: Pancreatic enzyme replacement therapy helps digest food properly
• Lower fat intake: Reducing dietary fat may improve digestion and reduce discomfort
• Blood sugar management: Regular monitoring and treatment may be needed if diabetes develops or worsens

A registered dietitian specializing in oncology can provide personalized guidance on nutrition.

Emotional Support

Receiving a cancer diagnosis triggers a range of emotions—fear, anger, sadness, and uncertainty are all normal responses. Many patients find it helpful to:

• Speak with a counselor or psychologist experienced in cancer care
• Join a support group for pancreatic cancer patients and families
• Connect with patient advocacy organizations
• Communicate openly with family members about feelings and needs

It's also important to address the needs of family members and caregivers, who often experience significant stress and may benefit from their own support resources.

Talking to Children

When a parent or close family member has pancreatic cancer, children need information appropriate to their age and developmental level. While difficult, involving children in an age-appropriate way—rather than hiding the illness—typically helps them cope better. Ask your healthcare team or a child life specialist for guidance on these conversations.