Pancreatic cancer occurs when abnormal cells in the pancreas begin to grow uncontrollably, leading to the formation of a tumor. The pancreas is a gland located between the stomach and spine that helps in digestion by producing enzymes and also regulates blood sugar through hormones like insulin.

Though pancreatic cancer is relatively rare, making up about 3% of all cancer diagnoses in the United States, it remains one of the more difficult cancers to detect early. Risk factors such as smoking and obesity can increase the likelihood of developing the disease. Symptoms, including fatigue, jaundice, and abdominal pain, typically do not appear until the cancer has advanced. Treatment options include surgery, chemotherapy, and radiation therapy, which aim to reduce tumor size and alleviate symptoms.

Types of Pancreatic Cancer

Pancreatic cancer is classified based on the cell type where the tumor begins. The two primary types are exocrine and neuroendocrine cancers.

Exocrine Pancreatic Cancer

This is the most common form, accounting for about 93% of all pancreatic cancer cases. Exocrine cells produce enzymes essential for food digestion. The majority of exocrine tumors are adenocarcinomas, which start in cells lining the pancreatic ducts.

Less common types include:

  • Acinar cell carcinomas

  • Undifferentiated carcinomas

  • Adenosquamous carcinomas

  • Squamous cell carcinomas

  • Signet ring cell carcinomas

  • Undifferentiated carcinomas with giant cells

Neuroendocrine Pancreatic Cancer (PNETs)

Neuroendocrine tumors arise from islet cells, which produce hormones like insulin and glucagon. These tumors are rarer, making up about 7% of all pancreatic cancers, and are named based on the hormone they produce:

  • Insulinoma: produces insulin

  • Gastrinoma: produces gastrin

  • Glucagonoma: produces glucagon

  • Somatostatinoma: produces somatostatin

  • VIPoma: produces vasoactive intestinal peptides

  • ACTH-secreting tumors: produce adrenocorticotropic hormone

  • Nonfunctional tumors: do not produce hormones

Pancreatic Cancer Symptoms

In its initial stages, pancreatic cancer often presents no symptoms. As it progresses, the symptoms can be vague and easily confused with other conditions. Common signs include:

  • Fatigue

  • Jaundice

  • Light-colored, floating, or oily stools

  • Dark urine

  • Burning stomach sensation

  • Unexplained weight loss

  • Pain in the back, upper abdomen, or arms

  • Weakness

  • Loss of appetite

  • Nausea

  • Vomiting

  • Bloating

  • Chills

  • Sweating

Causes

Pancreatic cancer begins when genetic mutations occur in pancreatic cells, causing them to grow uncontrollably. While the exact cause of these mutations remains unclear, about 10% of cases are hereditary. The majority of mutations are acquired later in life due to environmental or lifestyle factors, such as exposure to carcinogens, poor diet, or alcohol use.

Risk Factors

Several risk factors are linked to an increased chance of developing pancreatic cancer:

  • Age over 55

  • Male gender

  • Tobacco use

  • Obesity

  • High-fat diet

  • Heavy alcohol consumption

  • History of diabetes or pancreatitis

  • Family history of the disease

  • Inherited syndromes like Lynch syndrome and Peutz-Jeghers syndrome

Diagnosis

Early diagnosis is critical yet difficult. It begins with a medical history and physical exam to identify potential signs. Diagnostic tests include:

  • Blood tests: Evaluate liver function and detect tumor markers.

  • Imaging scans: CT or MRI scans locate and assess tumors.

  • ERCP: An endoscopic procedure to visualize and sample pancreatic ducts.

  • PTC: Uses a needle and X-ray to examine bile ducts and collect tissue.

  • Biopsy: Confirms cancer presence by analyzing tissue samples.

Stages of Pancreatic Cancer

Staging helps determine the cancer's extent and guides treatment options. It is usually classified using the TNM system:

  • Tumor (T): Size and extent within the pancreas

  • Node (N): Involvement of nearby lymph nodes

  • Metastasis (M): Spread to distant organs

Cancer stages include:

  • Stage 0: Limited to the duct where it began

  • Stage 1A: Tumor ≤2 cm, confined to the pancreas

  • Stage 1B: Tumor >2 cm, confined to the pancreas

  • Stage 2A: Larger tumor, still within the pancreas

  • Stage 2B: Spread to 1-3 nearby lymph nodes

  • Stage 3: Involvement of multiple lymph nodes or nearby vessels

  • Stage 4: Spread to distant organs like the liver or lungs

Treatment

Treatment depends on the cancer stage, overall health, and personal preferences. Options include:

Surgery

Surgery is the most effective treatment for resectable pancreatic cancer. Types of surgery include:

  • Pancreaticoduodenectomy (Whipple procedure): Removes part of the pancreas and surrounding structures

  • Distal pancreatectomy: Removes the pancreas tail and part of the body

  • Total pancreatectomy: Removes the entire pancreas and other nearby organs

Radiation Therapy

Uses high-energy beams to target and kill cancer cells. It may be used before or after surgery. Common side effects are fatigue, skin irritation, nausea, and loss of appetite.

Chemotherapy

Involves drugs that destroy cancer cells throughout the body. It may be used alone or combined with surgery or radiation. Side effects include fatigue, nausea, hair loss, and increased infection risk. Common drugs include:

  • Abraxane

  • 5-fluorouracil (5-FU)

  • Irinotecan

  • Cisplatin or oxaliplatin

Targeted Therapy

This approach targets specific genetic or protein abnormalities in cancer cells. Testing is often done beforehand to determine suitability.

Immunotherapy

Helps the immune system identify and destroy cancer cells. Keytruda is an example used for tumors with specific genetic markers like MSI-H or MMR deficiencies.

How To Prevent Pancreatic Cancer

While prevention is not guaranteed, you can lower your risk by:

  • Quitting smoking

  • Maintaining a healthy diet

  • Reducing intake of processed and fatty foods

  • Limiting alcohol consumption

  • Staying physically active

Complications

Pancreatic cancer can lead to several complications, including:

  • Pancreatic exocrine insufficiency (PEI): Reduced enzyme production leading to poor nutrient absorption and malnutrition

  • Diabetes: Damage to insulin-producing cells can cause or worsen diabetes

  • Metastasis: Cancer may spread to distant organs, complicating treatment

  • Pain: Tumor growth can compress nearby nerves, causing severe discomfort

Living With Pancreatic Cancer

Managing pancreatic cancer can be emotionally and physically challenging. Support groups and open communication with loved ones can provide emotional relief. Advances in treatment and participation in clinical trials offer hope and access to newer therapies for many patients.