The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side. The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail. The pancreas lies between the stomach and the spine.
The pancreas has two main jobs in the body:
- To make juices that help digest (break down) food.
- To make hormones, such as insulin and glucagon, that help control blood sugar levels. Both of these hormones help the body use and store the energy it gets from food.
The digestive juices are made by exocrine pancreas cells and the hormones are made by endocrine pancreas cells. About 95% of pancreatic cancers begin in exocrine cells. This page is about exocrine pancreatic cancer. Find information about pancreatic neuroendocrine tumors from the National Cancer Institute.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk.
Risk factors for pancreatic cancer include the following:
- Being very overweight.
- Having a personal history of diabetes or chronic pancreatitis.
- Having a family history of pancreatic cancer or pancreatitis.
- Having certain hereditary conditions, such as:
- Multiple endocrine neoplasia type 1 (MEN1) syndrome.
- Hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome).
- von Hippel-Lindau syndrome.
- Peutz-Jeghers syndrome.
- Hereditary breast and ovarian cancer syndrome.
- Familial atypical multiple mole melanoma (FAMMM) syndrome.
For more information about hereditary conditions that increase canceer risk, visit the Family Cancer Assessment Clinic.
These and other symptoms may be caused by pancreatic cancer. In the early stages of pancreatic cancer, there may not be any symptoms, or other conditions may cause the same symptoms. Check with your doctor if you have any of the following problems:
- Jaundice (yellowing of the skin and whites of the eyes)
- Light-colored stools
- Dark urine
- Pain in the upper or middle abdomen and back
- Weight loss for no known reason
- Loss of appetite
- Feeling very tired
Pancreatic cancer is difficult to detect and diagnose for the following reasons:
- There aren’t any noticeable signs or symptoms in the early stages of pancreatic cancer.
- The signs of pancreatic cancer, when present, are like the signs of many other illnesses.
- The pancreas is hidden behind other organs such as the stomach, small intestine, liver, gallbladder, spleen, and bile ducts.
Tests that examine the pancreas are used to detect (find), diagnose, and stage pancreatic cancer.
Pancreatic cancer is usually diagnosed with tests and procedures that make pictures of the pancreas and the area around it. The process used to find out if cancer cells have spread within and around the pancreas is called staging. Tests and procedures to detect, diagnose, and stage pancreatic cancer are usually done at the same time. In order to plan treatment, it is important to know the stage of the disease and whether or not the pancreatic cancer can be removed by surgery.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as bilirubin, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
- Tumor marker test: A procedure in which a sample of blood, urine, or tissue is checked to measure the amounts of certain substances, such as CA 19-9, and carcinoembryonic antigen (CEA), made by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the body. These are called tumor markers.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A spiral or helical CT scan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.
- PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A PET scan and CT scan may be done at the same time. This is called a PET-CT.
- Abdominal ultrasound: An ultrasound exam used to make pictures of the inside of the abdomen. The ultrasound transducer is pressed against the skin of the abdomen and directs high-energy sound waves (ultrasound) into the abdomen. The sound waves bounce off the internal tissues and organs and make echoes. The transducer receives the echoes and sends them to a computer, which uses the echoes to make pictures called sonograms. The picture can be printed to be looked at later.
- Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.
- Endoscopic retrograde cholangiopancreatography (ERCP): A procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreatic 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 pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. 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): A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body. This test is done only if ERCP cannot be done.
- Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. The laparoscope may have an ultrasound probe at the end in order to bounce high-energy sound waves off internal organs, such as the pancreas. This is called laparoscopic ultrasound. Other instruments may be inserted through the same or other incisions to perform procedures such as taking tissue samples from the pancreas or a sample of fluid from the abdomen to check for cancer.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. There are several ways to do a biopsy for pancreatic cancer. A fine needle or a core needle may be inserted into the pancreas during an x-ray or ultrasound to remove cells. Tissue may also be removed during a laparoscopy.
Tests and procedures to stage pancreatic cancer are usually done at the same time as diagnosis. The process used to find out if cancer has spread within the pancreas or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage of the disease in order to plan treatment. The results of some of the tests used to diagnose pancreatic cancer are often also used to stage the disease.
There are three ways that cancer spreads in the body:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for pancreatic cancer:
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the lining of the pancreas. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
In stage I, cancer has formed and is found in the pancreas only. Stage I is divided into stage IA and stage IB, based on the size of the tumor.
- Stage IA: The tumor is 2 centimeters or smaller.
- Stage IB: The tumor is larger than 2 centimeters.
In stage II, cancer may have spread to nearby tissue and organs, and may have spread to lymph nodes near the pancreas. Stage II is divided into stage IIA and stage IIB, based on where the cancer has spread.
- Stage IIA: Cancer has spread to nearby tissue and organs but has not spread to nearby lymph nodes.
- Stage IIB: Cancer has spread to nearby lymph nodes and may have spread to nearby tissue and organs.
In stage III, cancer has spread to the major blood vessels near the pancreas and may have spread to nearby lymph nodes.
In stage IV, cancer may be of any size and has spread to distant organs, such as the liver, lung, and peritoneal cavity. It may have also spread to organs and tissues near the pancreas or to lymph nodes.
At Huntsman Cancer Institute, pancreatic cancer is treated by a team of specialists, including gastroenterologists (doctors who specialize in diseases of the digestive system), surgeons, medical oncologists, radiation oncologists, nurses, social workers, dietitians, and other professionals.
Different types of treatment are available for patients with pancreatic cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Five types of standard treatment are used:
New treatments are being tested in clinical trials.
One of the following types of surgery may be used to take out the tumor:
- Whipple procedure: A surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to produce digestive juices and insulin.
- Total pancreatectomy: This operation removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes.
- Distal pancreatectomy: The body and the tail of the pancreas and usually the spleen are removed.
If the cancer has spread and cannot be removed, the following types of palliative surgery may be done to relieve symptoms and improve quality of life:
- Surgical biliary bypass: If cancer is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine to create a new pathway around the blocked area.
- Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.
- Gastric bypass: If the tumor is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive
substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional
chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated. Learn more about this treatment in our Introduction to Chemotherapy video:
Chemoradiation therapy combines chemotherapy and radiation therapy to increase the effects of both.
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Tyrosine kinase inhibitors (TKIs) are targeted therapy drugs that block signals needed for tumors to grow. Erlotinib is a type of TKI used to treat pancreatic cancer.
This section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. For more information, visit HCI's clinical trials website.
- Biologic therapy: This treatment uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
There are treatments for pain caused by pancreatic cancer. Pain can occur when the tumor presses on nerves or other organs near the pancreas. When pain medicine is not enough, there are treatments that act on nerves in the abdomen to relieve the pain. The doctor may inject medicine into the area around affected nerves or may cut the nerves to block the feeling of pain. Radiation therapy with or without chemotherapy can also help relieve pain by shrinking the tumor. Visit HCI's Supportive Oncology and Survivorship clinic for more information about pain management.
Patients with pancreatic cancer have special nutritional needs. Surgery to remove the pancreas may affect its ability to make pancreatic enzymes that help to digest food. As a result, patients may have problems digesting food and absorbing nutrients into the body. To prevent malnutrition, the doctor may prescribe medicines that replace these enzymes. Visit HCI's Nutrition Care Services for more information.
When you or someone you love is diagnosed with cancer, concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, employment, or how to continue normal daily activities.
Here's where you can go for support:
- Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
- The G. Mitchell Morris Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist.
- Our Patient and Family Support Services professionals offer HCI patients and their families emotional support and resources for coping with cancer and its impact on daily life.
- The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers support groups, classes, and activities aimed to increase the quality of life and well-being of HCI patients and their families.
Adapted from the National Cancer Institute's Physician Data Query (PDQ®) Cancer Information Summaries
This information last updated on HCI website January 2014
*If you are interested in a trial that is currently marked *Not Open, please contact the Patient Education team at 1-888-424-2100 or email@example.com for other trial options. Enrollment is updated daily.
Forte Research Systems in partnership with Huntsman Cancer Institute
Douglas G. Adler, M.D.Locations
|Huntsman Cancer Institute||(801) 213-9797|
|Redwood Health Center||(801) 213-9797|
|University Hospital||(801) 213-9797|
|University Hospital||(801) 213-9797|
Specialties: Biliary Cancer, Endoscopic Retrograde Cholangiopancreatography (ERCP), Endoscopic Ultrasound, Endoscopy, Esophageal Diseases, Gastroenterology, Pancreatic Cancer, Therapeutic Endoscopy
Ignacio Garrido-Laguna, M.D., Ph.D.Locations
|Huntsman Cancer Hospital||(801) 213-4266|
|Huntsman Cancer Hospital||(801) 585-0193|
Specialties: Biliary Cancer, Colon Cancer, Medical Oncology, Oncology, Pancreatic Cancer
Sean J. Mulvihill, M.D.Locations
|Huntsman Cancer Institute||(801) 581-7167|
Specialties: Biliary Cancer, Hepatopancreatobiliary (Liver/Pancreas/Biliary) Surgery, Laparoscopy, Liver Cancer, Pancreatic Cancer, Surgery, General
N. Jewel Samadder, M.Sc., M.D.Locations
|Huntsman Cancer Hospital||(801) 213-9797|
|South Jordan Health Center||(801) 213-9797|
Specialties: Clinical Genetics, Colon Cancer, Gastroenterology, Gastrointestinal Cancers, Pancreatic Cancer
Courtney L. Scaife, M.D.Locations
|Huntsman Cancer Institute||(801) 585-6911|
Specialties: Colorectal Surgery, Esophageal Surgery, Gastric/Esophageal Surgery, Gastrointestinal Stromal Tumors, Hepatopancreatobiliary (Liver/Pancreas/Biliary) Surgery, Minimally Invasive Gastrointestinal Surgery, Oncology Surgery, Pancreatic Cancer, Sarcoma, Soft Tissue Sarcoma Surgery, Surgery, General, Upper Gastrointestinal Tract Surgery
Sunil Sharma, M.B.A., M.D., FACPLocations
|Huntsman Cancer Hospital||(801) 213-4266|
Specialties: Clinical Scientist, Colon Cancer, Liver Cancer, Oncology, Pancreatic Cancer
John R. Weis, M.D.Locations
|Huntsman Cancer Institute||(801) 585-0262|
Specialties: Colon Cancer, Oncology, Pancreatic Cancer
Diseases and Conditions
- Am I At Risk for Pancreatic Cancer?
- Anatomy of the Pancreas
- Can I Survive Pancreatic Cancer? What Is My Prognosis?
- Do What You Can to Ease Side Effects of Treatment for Pancreatic Cancer
- Goal of Radiation Therapy for Pancreatic Cancer
- How Pancreatic Cancer Spreads
- How Your Doctor Takes a Biopsy to Diagnose Pancreatic Cancer
- I’ve Just Been Told I Have Pancreatic Cancer
- Overview of Your Treatment Choices for Pancreatic Cancer
- Questions to Ask About Treatment for Pancreatic Cancer
- Recovering From Surgery for Pancreatic Cancer
- Statistics About Pancreatic Cancer
- Tell Your Healthcare Team How You Feel During Treatment for Pancreatic Cancer
- Tests You May Need to Evaluate Pancreatic Cancer
- Types of Surgery for Pancreatic Cancer
- Understanding Your Stage of Pancreatic Cancer
- What Are the Symptoms of Pancreatic Cancer?
- What Can I Do if I’m At Risk for Pancreatic Cancer?
- What Happens During Chemotherapy for Pancreatic Cancer
- What Happens During External Beam Radiation Treatment for Pancreatic Cancer
- What Tests Help My Doctor Find Pancreatic Cancer?
- What to Expect After Chemotherapy for Pancreatic Cancer
- What to Know About Combination Therapy for Pancreatic Cancer
- What to Know About Radiation Treatment for Pancreatic Cancer
- Abraxane Approved for Late-Stage Pancreatic Cancer
- Bile Protein May Help Detect Pancreatic Cancer
- Blood Test for Pancreatic Cancer Shows Promise in Early Trial
- Blood Test Might Help Spot Pancreatic Cancer Early