Pancreatic Cancer

What Is Pancreatic Cancer?

Pancreatic cancer occurs when malignant cells in the pancreas grow out of control. About 95 percent of pancreatic cancers begin in the exocrine cells.

Pancreatic cancer is now the fourth leading cause of cancer death, according to the American Cancer Society. There will be an estimated 46,420 new pancreatic cancer cases in 2014, with the majority occurring in people 60 years of age or older.

Pancreatic Cancer

What Is the Pancreas?

The pancreas is a gland that produces juices that help digest food and hormones—such as insulin and glucagon—to help control blood sugar levels. Both of these hormones help the body use and store the energy it gets from food. There are two types of pancreas cells:

  • Exocrine pancreas cells produce the digestive juices
  • Endocrine pancreas cells produce the hormones

Pancreatic Cancer Symptoms

In the early stages of pancreatic cancer, there are often no symptoms. When the disease is more advanced, you may experience abdominal pain and indigestion.

Pancreatic Cancer Causes

While there are no specific causes of pancreatic cancer, there are certain risk factors that make you more likely to develop the disease. Know your risk factors so you can take steps to lower your risk.

Types of Pancreatic Cancer

There are many different types of pancreatic cancer, including adenocarcinoma of the pancreas, the most common type.

Pancreatic Cancer Diagnosis

We use advanced diagnostic procedures to confirm a diagnosis of pancreatic cancer. Tests include a specialized procedure called endoscopic retrograde cholangiopancreatography (ERCP).

Pancreatic Cancer Stages

Staging the cancer is the process of determining the size of the tumor and how far it has spread.

Pancreatic Cancer Treatments

We offer a wide range of treatments for pancreatic cancer, including advanced surgeries such as the Whipple procedure.

Pancreatic Cancer Prevention

While there is no sure way to prevent pancreatic cancer, you can take steps to lower your risk of developing the disease.

Pancreatic Cancer Symptoms

In the early stages of pancreatic cancer, you may not experience any symptoms. Or, the symptoms you feel may seem minor.

Pancreatic Cancer 2

Each individual may experience symptoms differently. In addition, although these are symptoms of pancreatic cancer, they may also be caused by other, less serious medical problems. If you have any of these symptoms, talk to your doctor to get a definitive diagnosis.

Symptoms of pancreatic cancer may include:

  • Indigestion or discomfort after eating fatty foods
  • Yellowing of your eyes, skin or nails (called jaundice)
  • Pain in your upper abdomen, upper back or both
  • Unexplained weight loss
  • Nausea
  • Fatigue
  • Gallbladder enlargement
  • Pale, greasy, bulky, foul-smelling stools that float on top of the water in the toilet
  • Dark yellow or brown urine
  • Lack of appetite
  • Blood clots
  • Uneven, lumpy fatty tissue under your skin

Pancreatic Cancer Diagnosis

Because there are so few symptoms in the early stages, pancreatic cancer is often not diagnosed until it’s in a more advanced stage. If you experience any unexplained symptoms, see your doctor for a diagnosis.

Types of Pancreatic Cancer

As part of your diagnosis, we will determine what type of pancreatic cancer you have.

There are several types of pancreatic cancers, including:

  • Adenocarcinoma of the pancreas: This is the most common pancreatic cancer, which occurs in the lining of the pancreatic duct.
  • Adenosquamous carcinoma: This is a rare pancreatic cancer.
  • Squamous cell carcinoma: This is another rare pancreatic cancer.

Pancreatic Tumors: Neuroendocrine Tumors

There are also tumors in the pancreas that are called endocrine tumors because they secrete hormones. They may be benign (noncancerous) or malignant (cancerous).

Neuroendocrine tumors in the pancreas include:

  • Gastrinoma: A tumor in the pancreas or duodenum. It may occur as part of a hereditary endocrine syndrome. Gastrinomas secrete above average levels of gastrin, a hormone that stimulates the stomach to secrete acids and enzymes. Gastrinoma can cause peptic ulcers.
  • Glucagonoma: A pancreatic tumor that secretes glucagon, a hormone that raises levels of glucose in the blood, leading to a rash.
  • Insulinoma: A rare pancreatic tumor that secretes insulin, the hormone that lowers glucose levels in the blood. This is often a genetic condition that runs in families.
  • VIPoma: A type of neuroendocrine pancreatic tumor that secretes vasoactive intestinal polypeptide (VIP). This leads to severe intermittent diarrhea that causes further problems, including dramatic potassium loss. Despite the name, there are rare instances where VIPomas secrete hormones other than VIP.

Pancreatic Cancer Diagnosis

The diagnosis phase will include a comprehensive physical examination as well as specialized tests.

First, we will ask you questions about your:

  • Medical history
  • Family history of cancer
  • Lifestyle habits, such as what you eat and whether you smoke
  • Exposure to other risk factors, such as working with pesticides

Diagnostic Tests for Pancreatic Cancer

In addition to a complete medical history and physical examination, diagnostic procedures for pancreatic cancer may include:


Ultrasound (Also Called Sonography)

The ultrasound may be performed using an external or internal device:

  • Transabdominal ultrasound: The doctor places an ultrasound device on the abdomen to create the image of the pancreas.
  • Endoscopic ultrasound (EUS): The doctor inserts an endoscope, a small, flexible tube with an ultrasound device at the tip, through the mouth and stomach, and into the small intestine. As the doctor slowly withdraws the endoscope, images of the pancreas and other organs are made.

CT scan


Endoscopic retrograde cholangiopancreatography (ERCP)

Endoscopic Retrograde Cholangiopancreatography (ERCP)

An endoscopic retrograde cholangiopancreatography is a procedure that allows the doctor to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas.

This procedure uses X-rays to look at the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes gallbladder cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope (a thin, lighted tube) is passed through the mouth, esophagus, and stomach into the first part of the small intestine. A catheter (a smaller tube) is then inserted through the endoscope into the bile ducts. A dye is injected through the catheter into the ducts and an X-ray is taken. This allows the doctor to examine the inside of these organs and detect any abnormalities. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken.

Percutaneous transhepatic cholangiography (PTC)

Percutaneous Transhepatic Cholangiography (PTC)

A percutaneous transhepatic cholangiography (PTC) is an X-ray examination of the bile ducts through an IV. A needle is introduced through the skin into the liver, depositing the dye (contrast). The bile duct structure is then viewable via the X-ray.

PET scan

What Is Positron Emission Tomography (PET) Scan?

Positron emission tomography, also called PET imaging or a PET scan, is a type of nuclear medicine imaging. A PET scan measures important body functions, such as blood flow, oxygen use, and sugar (glucose) metabolism, to help doctors evaluate how well organs and tissues are functioning.

PET is a powerful diagnostic test that is having a major impact on the diagnosis and treatment of disease. A PET scan (positron emission tomography scan) monitors the biochemical functioning of cells by detecting how they process certain compounds, such as glucose (sugar). PET can detect extremely small cancerous tumors, subtle changes of the brain and heart, and give doctors important early information about heart disease and many neurological disorders, like Alzheimer’s.

Most common medical tests, like CT and MRI scans, only show details about the structure of your body. PET scans give doctors images of function throughout the entire body, uncovering abnormalities that might otherwise go undetected. This allows doctors to treat these diseases earlier and more accurately. A PET scan puts time on your side. The earlier the diagnosis, the better the chance for treatment.

For example, a PET scan is the most accurate, non-invasive way to tell whether or not a tumor is benign or malignant, sparing patients expensive, often painful diagnostic surgeries and suggesting treatment options earlier in the course of the disease. Although cancer spreads silently in the body, PET can inspect all organs of the body for cancer in a single examination.

Today, most PET scans are performed on instruments that are combined PET and CT scanners. The combined PET/CT scans provide images that pinpoint the location of abnormal metabolic activity within the body. The combined scans have been shown to provide more accurate diagnoses than the two scans performed separately.

About nuclear medicine

Nuclear medicine is a branch of medical imaging that uses small amounts of radioactive material to diagnose or treat a variety of diseases, including many types of cancers, heart disease, and certain other abnormalities within the body. Depending on the type of nuclear medicine exam you are undergoing, the radiotracer is either injected into a vein, swallowed or inhaled as a gas and eventually accumulates in the organ or area of your body being examined, where it gives off energy in the form of gamma rays. This energy is detected by a device called a gamma camera, a PET scanner and/or probe.

Pancreas biopsy

Pancreas Biopsy

A biopsy is a procedure in which a sample of pancreatic tissue is removed (with a needle or during surgery) for examination under a microscope.

A biopsy can confirmthat you have cancer. It can also let your doctor know what kind of pancreatic cancer you have. The biopsy may be done as a separate procedure, during another test, or during surgery to remove the pancreas. A biopsy is usually done in one of three ways.

  • Fine Needle Aspiration (FNA) biopsy
    The doctor uses a CT scan or endoscopic ultrasound (EUS) to locate the tumor. Then the doctor inserts a long, thin needle through your skin and into the tumor. Cells are removed through the needle.
  • Brush biopsy
    This biopsy may be done during a procedure called an endoscopic retrograde cholangiopancreatography (ERCP) test. A long, thin tube called an endoscope is inserted through the mouth into the first part of the small intestine. The doctor then places a tiny brush through the endoscope and into your pancreatic or bile ducts. The brush rubs off some cells for testing.
  • Laparoscopy
    A surgeon makes a small cut on your abdomen to insert a thin tube with a light and a tiny video camera on the end. It lets your doctor see the pancreas and nearby areas. Your surgeon may make other small cuts to insert other tools to remove cells for testing.

Once the biopsy is done, a pathologist examines tissue samples under a microscope to check for cancer cells. It usually takes a few days for the results of your biopsy to come back.

Pancreatic Cancer Stages

“Stage” is the word doctors use to describe the size of a cancerous tumor and where and how far it has spread:

  • Primary site or primary tumor: The first place cancer is found in the body.
  • Metastatic cancer: When a cancer spreads to distant parts of the body.

Learn about how we determine the stage of the cancer and what the different stages mean:

The TNM System for Staging Pancreatic Cancer

The TNM System is a standard system for describing the extent of a cancer’s growth. This system was developed by the American Joint Committee on Cancer (AJCC). TNM refers to:

  • T (tumor): The size of the original tumor and whether or not it has invaded nearby organs.
  • N (node): Whether the lymph nodes in the area of the original tumor have become cancerous.
  • M (metastasis): Whether the cancer has spread to other, distant organs in the body, such as your bones, liver or lungs.

Stage Groupings of Pancreatic Cancer

The AJCC TNM classification defines cancers by Roman numbers 0 through IV. To determine the stage of your cancer, your doctor first assigns numbers for the T, N and M groups. These numbers are then combined in a process called stage grouping to give the cancer an overall stage. The lower the number, the less the cancer has spread. The higher the number, the more the cancer has spread.

The stages of pancreatic cancer are:

  • Stage 0: The tumor is only in the top layer of the pancreatic duct cells and has not invaded deeper. This is usually called pancreatic cancer in situ.
  • Stage IA: Cancer is only found in the pancreas and is no larger than two centimeters across. The cancer has not spread to the lymph nodes or to distant parts of the body.
  • Stage IB: Cancer is only found in the pancreas and is larger than two centimeters across. The cancer has not spread to the lymph nodes or to distant parts of the body.
  • Stage IIA: The cancer has spread to other areas near the pancreas. It has not spread to nearby lymph nodes, to major blood vessels or to distant sites.
  • Stage IIB: The cancer may or may not have spread to nearby areas. It has spread to nearby lymph nodes, but has not spread to nearby major blood vessels or nerves or to distant parts of the body.
  • Stage III: The cancer has spread to nearby major blood vessels or nerves and may have spread to nearby lymph nodes, but it has not spread to distant sites.
  • Stage IV: The cancer has spread to organs further away from the pancreas. This might include the liver, lining of the abdomen (called the peritoneum) or the lungs.

Pancreatic Cancer Stages: Resectable, Locally Advanced and Metastatic Cancer

While we use the TNM system to formally stage pancreatic cancer, there is a simpler system we use when determining the best treatment. We divide these cancers into three groups:

  • Resectable pancreatic cancer: These cancers can be surgically removed (resected). This includes many cancers that are still confined within the pancreas or have grown just outside of it.
  • Locally advanced pancreatic cancer: The cancer is only in the area around the pancreas, but it cannot be removed completely with surgery. Often this is because the cancer is growing into nearby blood vessels. Because the tumors can’t be removed with surgery, they are also called unresectable.
  • Metastatic pancreatic cancer: The cancers have spread to distant parts of the body, so they cannot be removed completely with surgery (unresectable).