Experts often stress the importance of understanding risk factors in staying healthy. This is for a good reason: There are many health conditions that have few or no symptoms until they become more advanced. It’s true of more minor issues like tooth decay and all the way up to various cancers, including pancreatic cancer.
Cancer of the pancreas – the organ below your stomach that produces substances to help manage digestion and blood sugar – is difficult to treat and generally has no early symptoms. Learn when symptoms appear, what they are, risk factors to be aware of and what treatment looks like at different stages.
The pancreas helps regulate important systems within the body
The pancreas is a pear-shaped gland that’s around six inches long. It’s located on the right side of your abdomen underneath your stomach, and near your gallbladder, liver, spleen and intestines.
As a gland, the pancreas’ job is to produce substances that help your body work the way it’s supposed to. These include a variety of enzymes that are released into the duodenum (the connecting point between the stomach and the small intestine) to aid with the digestion of fats, carbohydrates and proteins. Additionally, the pancreas produces the hormones insulin and glucagon, which the body uses to maintain healthy blood sugar levels. Insulin lowers blood sugar, while glucagon raises it.
There are several types of pancreatic cancer, but adenocarcinomas are the most common
More than 80% of pancreatic cancers are adenocarcinomas, meaning that they start in the exocrine glands, which produce digestive enzymes. Nearly all of these adenocarcinomas start in the lining of the smaller ducts that lead to the main pancreatic duct, which transports the enzymes to the duodenum.
Other, less common forms of pancreatic cancer include:
- Cancer of the acinar cells, which are at the end of the ducts that lead to the main pancreatic duct.
- Pancreatoblastoma, a cancer of developing cells that mainly occurs in children. It’s very rare and is sometimes related to uncommon genetic conditions like familial adenomatous polyposis.
- Pancreatic sarcoma, which is an extremely rare cancer of the pancreas’ connective tissue.
- Pancreatic lymphoma, which is considered a form of non-Hodgkin lymphoma. The lymphatic system runs throughout the body, so cancer can spread from it to the pancreas or start in the lymphatic nodes of the pancreas.
There are often no early signs of pancreatic cancer
Pancreatic cancer generally has no signs or symptoms until it’s in advanced stages, which makes understanding your risk factors very important. The symptoms it causes also aren’t unique to pancreatic cancer, and include:
- Appetite loss (which can result in weight loss)
- Belly or back pain
- Blood clots
- Diabetes and related symptoms
- Fatigue or feelings of general weakness
- Gallbladder or liver enlargement
- Jaundice (yellowing of the eyes and skin, dark urine, pale stools and itchiness)
- Nausea or vomiting
Pancreatic cancer is caused by genetic changes in the cells of the pancreas. These changes can be inherited, but often occur on their own. In many cases, the exact cause of the changes is unknown. However, there are factors that are known to increase one’s risk of pancreatic cancer. These risk factors include:
- Being overweight
- Chronic inflammation of the pancreas (pancreatitis), which can result from heavy alcohol use and smoking
- Diabetes
- Family history of certain genetic conditions, such as Lynch syndrome, Peutz-Jeghers syndrome and familial atypical mole melanoma syndrome
- Family history of pancreatic cancer
- Heavy exposure to certain chemicals, such as those used in dry cleaning and metalworking
- Getting older (particularly after age 45)
- Using tobacco in any form
Some risk factors, like aging and family history, can’t be controlled. But if you have other risk factors from this list, making the appropriate lifestyle changes – such as losing weight, quitting tobacco or keeping diabetes well-managed – can help reduce your risk of pancreatic cancer.
Genetic testing can help you understand your risk of pancreatic cancer
There are no universal screening recommendations for pancreatic cancer. But if you have a heightened risk of developing it, such as a strong family history of pancreatic cancer or one of the genetic conditions that are known risk factors, you may be eligible for genetic testing.
Genetic testing can confirm whether you have the gene changes that heighten your risk of developing pancreatic cancer, which can determine whether you should get more regular screenings. If you’re interested in genetic testing, talk with your primary care doctor. They can refer you to a genetic counselor if necessary.
Pancreatic cancer is diagnosed using blood, urine and imaging tests
There are a variety of tests that a doctor may use to diagnose pancreatic cancer. In addition to a physical examination, they may use blood and urine tests to rule out other possible causes of your symptoms, as well as to assess your overall health and organ function. They’ll also look for tumor markers and genetic changes in your bodily fluids and in a tissue sample (biopsy).
Along with this, your doctor will want to see what’s going on in your pancreas and the surrounding structures. They may order a combination of imaging tests, such as an ultrasound to look for abnormal growths and blood flow, a CT scan for structural changes or an MRI scan for more detailed imaging. They may also use an endoscopic imaging test to get a closer look at your pancreas, liver, gallbladder and bile ducts.
Diagnosing pancreatic cancer also determines its stage
Pancreatic cancer stages are defined by how large the cancer tumor is, whether it has spread to nearby lymph nodes, and whether it has spread to distant sites:
- Stage 0 – The cancer is in the top layer of duct cells and hasn’t spread beyond the pancreas.
- Stage 1A – The cancer is less than 2 cm across, and it hasn’t spread beyond the pancreas.
- Stage 1B – The cancer is between 2-4 cm across.
- Stage 2A – The cancer is larger than 4 cm across but still hasn’t spread beyond the pancreas.
- Stage 2B – The cancer has spread to no more than three nearby lymph nodes. The size of the cancer may vary.
- Stage 3 – The cancer has spread to four or more nearby lymph nodes, or has spread out into nearby major blood vessels with or without affecting lymph nodes. The size of the cancer may vary.
- Stage 4 – The cancer has spread to distant sites, such as the liver, bones or abdominal lining.
Treatment for pancreatic cancer depends on its stage and location
There are a variety of methods that are used to treat pancreatic cancer. It’s possible to cure pancreatic cancer with surgery, but since it often isn’t found until it’s become advanced, it frequently has to be treated by other means. Depending on the stage and spread of the cancer, doctors place it into one of four treatment categories:
- Resectable – The cancer has not spread beyond the pancreas or has spread just beyond it without affecting nearby blood vessels. It may be possible to remove the cancer entirely with surgery. Chemotherapy and radiation therapy may be used to shrink the cancer before surgery and may be used after to ensure the cancer doesn’t grow back.
- Borderline resectable – The cancer has spread to a major blood vessel or other nearby structure. Surgery may still be possible following chemotherapy and radiation therapy, but it’s less likely to remove all of the cancer.
- Locally advanced (unresectable) – The cancer has not spread to distant sites, but it has spread to nearby blood vessels or lymph nodes. Surgery cannot fully remove it, so a combination of other treatments may be used instead. These may include chemotherapy and radiation therapy, and may also involve taking medicines that disrupt cancer cell function (targeted therapy) and that help the immune system fight cancer cells (immunotherapy).
- Metastatic – The cancer has spread to other organs and cannot be removed surgically. Various therapies may be used to slow its growth and relieve symptoms.
Talk with an expert if you have symptoms or risk factors of pancreatic cancer
If you have possible symptoms of pancreatic cancer, talk with your primary care doctor. They can help rule out other possible causes and refer you to a specialist if necessary.
A primary care doctor can also help you understand your risk of pancreatic cancer. They can recommend ways to manage any changeable risk factors you have and help you get genetic testing if you’re eligible.
