Pancreatic cancer: Full guide

What is pancreatic cancer?

The pancreas is an organ that sits deep in the belly, behind the stomach. It makes juices (enzymes) that help you digest food. It also makes insulin, a hormone that controls blood sugar.

Pancreatic cancer starts when cells in the pancreas grow out of control and form a tumor. Most pancreatic cancers start in the cells that line the small tubes (ducts) of the pancreas. This type is called adenocarcinoma.

Because the pancreas is so deep in the body, this cancer often causes no signs early on. Many people learn they have it after it has already spread. Common first signs are yellow skin or eyes (jaundice), belly or back pain, weight loss, and new diabetes.

Risk factors include smoking, extra weight, older age, and diabetes. Long-term swelling of the pancreas (chronic pancreatitis) also raises risk. Some people are born with gene changes that raise the risk.

This is a serious cancer. But treatment has improved, and some people with early cancer are cured. Good symptom care helps people feel better at every stage. Your care team will explain what this means for you.

Types

Pancreatic adenocarcinoma

By far the most common type. It starts in the cells lining the pancreas ducts. Most of this page is about this type.

Adenosquamous and squamous cancers

Rare types that look a bit different under the microscope. They are treated the same way as adenocarcinoma.

Cancer in the head of the pancreas

The head is the wide part near the small intestine. Tumors here often block the bile duct and cause jaundice early. This means they are often found sooner.

Cancer in the body or tail of the pancreas

These parts are farther from the bile duct. Tumors here often cause no signs until later, so they are more often found after they have spread.

IPMN (a type of pancreas cyst)

Intraductal papillary mucinous neoplasm. It is a fluid-filled growth that is not cancer, but some can turn into cancer over time. Many are watched with scans. Some need surgery.

Pancreatic neuroendocrine tumors

Rare tumors that start in the hormone-making cells of the pancreas. They often grow more slowly and are treated very differently. Ask your team if you are not sure which type you have.

Tests you may have

Pancreas-protocol CT scan

A special CT scan (detailed X-ray) with contrast dye, taken at set times. It shows the tumor and nearby blood vessels. This helps decide if surgery is possible.

MRI and MRCP

MRI uses magnets to make pictures. MRCP is a type of MRI that shows the bile duct and pancreas duct. It can also check the liver for spread.

Endoscopic ultrasound (EUS) with biopsy

A thin tube with a camera and a small ultrasound goes through your mouth into your stomach. The doctor can see the pancreas up close and take a small sample with a needle. You are sedated.

ERCP and stent

A thin tube with a camera goes through your mouth to the bile duct. If a tumor is blocking the duct, the doctor can place a small tube (stent) to keep bile flowing. This often clears up jaundice.

CA 19-9 blood test

A tumor marker made by many pancreatic cancers. It can help track how treatment is working. It can also rise from a blocked bile duct or infection. Some people do not make it at all.

Staging laparoscopy

A short surgery using small cuts and a camera to look inside the belly. It can find small spots of cancer that scans miss. It may be done before a big surgery.

Germline (inherited) gene testing

A blood or saliva test for gene changes you were born with, like BRCA. Experts advise this for everyone with pancreatic cancer, even without a family history.

Tumor gene testing

Tests on the tumor tissue, often using broad panels called next-generation sequencing (NGS). They look for changes that may point to a targeted medicine or a clinical trial.

Blood tests

These check your blood counts, liver, kidneys, and blood sugar. They help plan treatment and watch for side effects.

What the stage means

Pancreatic cancer does have number stages (1 to 4). But doctors mostly group it by one key question: can the tumor be safely and fully removed with surgery?

The answer depends a lot on whether the tumor touches or wraps around major blood vessels near the pancreas. A team of surgeons, oncologists, and radiologists usually reviews the scans together.

Medicine (chemotherapy) is part of treatment at every stage.

Resectable

The tumor has not spread and does not involve the main blood vessels. Surgery to remove it is possible. Chemotherapy is given too, before surgery, after it, or both. The goal is cure.

Borderline resectable

The tumor touches nearby blood vessels, but surgery may still be possible. Chemotherapy, sometimes with radiation, is usually given first to shrink it. Then the team decides about surgery.

Locally advanced

The tumor has not spread to distant organs, but it wraps around major blood vessels. Surgery is not safe right away. Chemotherapy, sometimes with radiation, is used. In some people, the tumor shrinks enough for surgery later.

Metastatic

The cancer has spread to other organs, most often the liver, lungs, or lining of the belly. Treatment uses medicines that travel through the whole body. The goals are to control the cancer, help you live longer, and keep you feeling as well as possible.

Gene tests: inherited and tumor

There are two kinds of gene testing. Both matter in pancreatic cancer.

Germline testing looks for gene changes you were born with. About 1 in 10 people with pancreatic cancer has one. A positive result can change your treatment. It can also help your blood relatives check their own risk.

Tumor testing looks for changes inside the cancer itself. Most results will not change your first treatment. But a few rare changes have their own targeted medicines, and some open the door to clinical trials.

BRCA1, BRCA2, and PALB2

Inherited changes in these genes raise the risk of pancreatic, breast, ovarian, and prostate cancers. Tumors with these changes often respond well to platinum chemotherapy (like cisplatin or oxaliplatin). A pill called a PARP inhibitor may also be an option later on.

Other inherited syndromes

Changes linked to Lynch syndrome, ATM, CDKN2A, STK11 (Peutz-Jeghers), and others also raise risk. A genetic counselor can explain what your results mean for you and your family.

KRAS

The most common gene change in pancreatic cancer. It is found in about 9 out of 10 tumors. It helps drive the cancer. Newer medicines that block the RAS pathway are now becoming part of care. Ask your team if one may fit you.

KRAS G12C

A specific KRAS change that is uncommon in pancreatic cancer. Targeted pills made for this change may be used after other treatment.

MSI-high or dMMR

These mean the tumor has trouble fixing mistakes in its DNA. This is very rare in pancreatic cancer (fewer than 1 in 100). When present, immunotherapy may work.

KRAS wild-type (no KRAS change)

About 1 in 10 tumors have no KRAS change. These tumors are more likely to have rare changes like NTRK, NRG1, or BRAF. Each of these has its own targeted medicine.

NTRK, NRG1, and BRAF

Rare changes that can be targeted with specific medicines. They are found only with broad tumor testing, which is why testing every tumor matters.

Main treatments

Whipple surgery

Also called a pancreaticoduodenectomy. It removes the head of the pancreas and part of the small intestine. The gallbladder and end of the bile duct are removed too. It is a big operation with a long recovery. It is best done at a hospital that does many of them each year.

Distal pancreatectomy

Surgery to remove the body and tail of the pancreas, often with the spleen. It is used for tumors in those parts.

Perioperative chemotherapy

Chemotherapy given before surgery, after surgery, or both. Most people have about 6 months in total. Giving some before surgery can shrink the tumor and treat hidden cancer cells early.

Chemotherapy combinations

The main ones are mFOLFIRINOX, gemcitabine plus nab-paclitaxel, and NALIRIFOX. Your team will choose based on your health, energy level, and gene results. Some combinations are stronger but have more side effects.

Radiation therapy

High-energy beams that kill cancer cells. It is sometimes given with chemotherapy (chemoradiation) before surgery or for locally advanced cancer. It can also ease pain.

Maintenance therapy

If the cancer is controlled after several months, some people switch to lighter treatment. Some may take a PARP inhibitor pill. This can ease side effects while keeping the cancer in check.

Targeted therapy

Medicines that block a specific change in the cancer. Newer medicines that block RAS, and medicines for rare changes like NTRK or NRG1, are used for some people.

Tumor Treating Fields

A device worn on the belly that sends mild electric fields to slow cancer cell growth. It is used with chemotherapy for some people with locally advanced cancer. It needs to be worn most of the day.

Clinical trials

Research studies that test new treatments. They are a very important option in pancreatic cancer at every stage. Ask about them early.

Palliative care

A team that focuses on pain, symptoms, stress, and quality of life. Experts advise seeing them early, at any stage, along with cancer treatment. It is not the same as hospice.

Symptoms, side effects, and what helps

Pain

Belly or back pain is common. Pain medicines work well when taken on a regular schedule. A nerve block (celiac plexus block) numbs the nerves that carry pain from the pancreas. It often helps more than pills alone.

Digestion problems and oily stools

The pancreas may stop making enough digestive enzymes. Stools can be loose, greasy, or smelly, and you may lose weight. Enzyme capsules taken with meals and snacks help a lot. Take them with your food, not before. You usually do not need a low-fat diet.

Jaundice and itching

A blocked bile duct can turn your skin and eyes yellow, darken your urine, and cause itching. A stent usually fixes this. Call if jaundice comes back, or you get fever or chills, since the stent can get blocked.

Blood clots

Pancreatic cancer raises the risk of clots in the legs and lungs. Your team may suggest a blood thinner to prevent them. Call right away for leg swelling or sudden trouble breathing.

High blood sugar

Many people develop diabetes because the pancreas makes less insulin. It may need pills or insulin. Your team or a diabetes specialist can help.

Nausea and feeling full fast

This can come from chemotherapy or from the stomach emptying slowly. Anti-nausea medicines help. Small, frequent meals help too. Vomiting that will not stop can mean a blockage and needs a call.

Weight loss and low appetite

Very common. A dietitian can help with high-calorie, high-protein foods, nutrition drinks, and enzyme use. Every bit of nutrition helps you handle treatment.

Fatigue

Feeling very tired is common. Short walks and light activity can help. Rest when you need to, and let others help with chores.

Low blood counts and infection

Chemotherapy can lower your white blood cells. Wash your hands often and avoid sick people. Call right away for a fever.

Numbness and tingling

Oxaliplatin and nab-paclitaxel can affect nerves in the hands and feet. Oxaliplatin can also make cold things feel painful. Tell your team early so they can adjust treatment.

Living with and after pancreatic cancer

Ask to meet the palliative care team early. They help with pain, eating, sleep, mood, and planning. People who get this support often feel better and cope better.

After surgery and chemotherapy, you will have regular visits, scans, and blood tests. These look for any return of the cancer.

Life after a Whipple takes adjusting. Many people need enzyme capsules for good. Some need diabetes care. Small meals and a dietitian can help you regain strength.

With advanced cancer, treatment can often go on for many months. Your team will balance controlling the cancer with how you feel. It is okay to talk about what matters most to you.

If you have an inherited gene change, share the results with your blood relatives. They may be able to get testing, extra screening, or both.

It is normal to feel scared, sad, or overwhelmed. Caregivers feel this too. Social workers, counselors, and support groups can help you and your family.