What is pancreatic cancer?

Pancreatic cancer occurs when abnormal cells grow uncontrollably in the pancreas, an organ located behind the stomach. The pancreas produces enzymes for digestion and hormones for blood glucose regulation. 

These abnormal cells in the pancreas can grow to form a cancer, which can spread to other parts of the body. 

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

Enzymes

Molecules (mainly proteins) produced by cells that can drive specific chemical reactions.

Glucose

A simple sugar found in many foods (such as fruit) that functions as a major energy source for the body.

Hormones

A chemical substance secreted in one part of an organism and transported to another part of that organism, where it has a specific effect.

Causes

The cause of pancreatic cancer, as with other cancers, is due to damage to cellular DNA. This damage results in uncontrolled growth of damaged cells, which leads to formation of a cancer. A cancer can grow into nearby tissue, or cells can break off and spread throughout the body via the bloodstream or lymphatic system. The exact causes of this cellular damage in the pancreas are not known.

Pancreas and digestive system.The pancreas and digestive system. 

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

DNA

The genetic material of all living cells and some viruses. The full name is deoxyribonucleic acid.

Lymphatic system

A network of vessels, lymph nodes, the spleen and other organs that transport lymph fluid between tissues and bloodstream.

Risk factors

Risk factors that increase the chances of developing pancreatic cancer include:

  • Smoking - it is associated with a two-to-threefold increase in the risk of developing pancreatic cancer;
  • Age - people between 60-80 years of age account for more than 80% of cases;
  • Chronic pancreatitis - inflammation of the pancreas is associated with cancer when it occurs over the long-term. The exact reason for this is unclear, but it is possible that prolonged inflammation causes damage to cellular DNA
  • Stomach surgery - the surgical removal of part of the stomach, due to a stomach ulcer or a cancer, is associated with an increased risk of developing pancreatic cancer, and;
  • Diets high in meat, cholesterol and food preservatives. 

DNA

The genetic material of all living cells and some viruses. The full name is deoxyribonucleic acid.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

Ulcer

An open sore in the skin or mucous membranes such as those of the stomach lining, intestine or mouth.

Types

Exocrine tumours

Exocrine tumours are the most common type of pancreatic cancer. They are cancers of the exocrine pancreas, which is where the exocrine glands are located. These glands produce the pancreatic enzymes that are released into the intestine.

Adenocarcinomas

Adenocarcinoma cancers form in the exocrine glands and account for about 95% of all exocrine pancreatic cancers.

Less common types of pancreatic cancers

There are several other types of exocrine cancers that form in areas around the exocrine glands rather than in the glands themselves.

Endocrine tumours

Endocrine tumours arise from the endocrine glands, originating in the cells that produce hormones. They are also called neuroendocrine tumours and are an uncommon type of pancreatic cancer. Endocrine tumours are defined as functional if they secrete hormones and non-functional if they do not.

Some types of endocrine tumours include:

  • Insulinomas - originate in cells that produce insulin, the hormone that reduces blood glucose levels;
  • Gastrinomas - originate in cells that make gastrin, a hormone that stimulates production of stomach acid;
  • Glucagonomas - originate in alpha cells that produce glucagon, a hormone that raises blood glucose levels;
  • Somatostatinomas - originate in cells that make somatostatin, a hormone involved in the regulation of other hormones;
  • VIPomas - originate in cells that make vasoactive intestinal peptide, a neurotransmitter that has several regulatory functions, and;
  • PPomas - originate in cells that produce pancreatic polypeptide, a hormone released in response to food ingestion.

Micro anatomy of the pancreas.A cross-section of the pancreas showing the exocrine and endocrine glands. 

Adenocarcinoma

Cancer that develops in glandular tissue.

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

Endocrine

Of or relating to the body's endocrine glands, which secrete hormones into the bloodstream and surrounding tissues. This includes the pineal gland, pituitary gland, pancreas, ovaries, testes, thyroid, hypothalamus and adrenal glands.

Enzymes

Molecules (mainly proteins) produced by cells that can drive specific chemical reactions.

Exocrine

Refers to the secretion of hormones and other substances out of a structure by way of a duct.

Glucose

A simple sugar found in many foods (such as fruit) that functions as a major energy source for the body.

Hormones

A chemical substance secreted in one part of an organism and transported to another part of that organism, where it has a specific effect.

Insulin

A hormone secreted by the pancreas in order to regulate glucose levels in the body's cells, which is used for energy.

Intestine

The part of the digestive system from the stomach to the anus.

Neurotransmitter

Chemicals that communicate signals from one nerve cell to another, or from nerve cells to other tissues.

Tumours

A growth caused by an abnormal and uncontrolled reproduction of cells.

Stages of pancreatic cancer

Treatment outcomes can vary greatly, depending on the stage of cancer. Cancer is staged according to its size and location, and whether it has spread to nearby or distant lymph nodes or organs throughout the body.

Stage I

The cancer is located in the pancreas and has not spread.

Stage II

The cancer has spread to nearby lymph nodes or structures near the pancreas, but has not spread to other organs.

Stage III

The cancer has spread to nearby major arteries, with or without the lymph node being affected.

Stage IV

The cancer has spread to other organs such as the lungs or liver.

Lymph nodes

A small organ of the lymphatic system containing many immune cells. Lymph nodes, also known as lymph glands, are the sites where many interactions between immune cells and foreign materials occur.

Signs and symptoms

Pancreatic cancer is uncommon and many of the following symptoms may also be due to other causes.

Jaundice and pale stools

If there is a blockage in a bile duct, it can cause jaundice, the symptoms of which include yellowing of the eyes and skin. It can also cause pale stools, if insufficient bile is present in the intestines to give stool its colour.

Abdominal pain

Abdominal pain can occur when the pancreatic cancer irritates or invades surrounding nerves. Very rarely, it can be due to the cancer causing a bowel obstruction.

Nausea and vomiting

A blockage of the pancreatic or bile ducts can cause inflammation of the pancreas and put pressure on surrounding organs, which can lead to nausea and vomiting.

Loss of appetite and weight loss

Loss of appetite can be associated with nausea and vomiting. Weight loss can result from the cancer blocking the enzymes needed to digest food.

Unexpected onset of diabetes

Diabetes might develop if the cancer is disrupting the normal function of the pancreas. The pancreas produces insulin, a vital enzyme involved in sugar metabolism.

Bile

A fluid made in the liver and stored in the gall bladder.

Diabetes

A metabolic disorder that is caused by problems with insulin secretion and regulation and which is characterised by high blood sugar levels. Also known as diabetes mellitus.

Enzymes

Molecules (mainly proteins) produced by cells that can drive specific chemical reactions.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

Insulin

A hormone secreted by the pancreas in order to regulate glucose levels in the body's cells, which is used for energy.

Intestines

The part of the digestive system from the stomach to the anus.

Nerves

One or more fibres that transmit signals of sensation and motion between the brain or spinal cord and other parts of the body.

Abdominal

Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.

Bowel

The part of the digestive tract that comprises the small and large intestines.

Methods for diagnosis

Scans

Scans used in the diagnosis of pancreatic cancer include:

Laboratory tests

CA19.9 is a protein associated with pancreatic cancer, but its presence does not necessarily mean you have pancreatic cancer and it is not elevated in all forms of pancreatic cancer. It is mainly used to track the progress of treatment rather than to diagnose a tumour.

Pancreatic cancer can affect the function of the liver and kidneys, so tests are performed to check their functionality.

Procedures

Procedures performed to diagnose pancreatic cancer include:

  • Endoscopy - involves the insertion of a long and narrow telescopic camera down the throat into the digestive system. This may be used to assess blocked pancreatic or bile ducts and reopen them with stents if possible;
  • Laparoscopy - involves making a small incision in the abdomen so a camera can be inserted to see the internal organs. This may be done to determine the extent of the spread of pancreatic cancer and to do a biopsy, and;
  • Tissue biopsy - involves removing a sample of pancreatic tissue for examination by a pathologist.

Abdomen

The part of the body that lies between the chest and the pelvis.

Bile

A fluid made in the liver and stored in the gall bladder.

Biopsy

The removal of a tissue sample for microscopic laboratory examination. It is used to determine the presence, cause and type of the disease.

Computerised tomography

A scan that uses X-rays to create a 3D image of the body. This can detect abnormalities more effectively than a simple X-ray can.

Magnetic resonance imaging

A type of imaging that uses a magnetic field and low-energy radio waves, instead of X-rays, to obtain images of organs.

Pathologist

A doctor specialising in the microcopic study of disease, such as examining a tissue sample taken in a biopsy.

Positron emission tomography

During positron emission tomography (PET) scan, an injection with a radioactive label is administered and then combined with a computerised tomography (CT) scan to produce functional images.

Stents

Small mesh tubes made of metal or plastic, which are inserted into passageways that are blocked or obstructed.

Tumour

A growth caused by an abnormal and uncontrolled reproduction of cells.

Types of treatment

Surgery

Surgery is used to remove a cancer that has not spread. If you have pancreatic cancer and are fit for major surgery, your doctor will perform a procedure called Whipple's resection. This is where a portion of the gall bladder, bile ducts and sometimes stomach are removed.

Another type of procedure, called a distal pancreatectomy, involves removing the cancer and surrounding tissue from the tail end of the pancreas. If the cancer cannot be removed, other forms of surgery can be used as a means of relieving symptoms. For example, stents can be inserted into the bile and pancreatic ducts to keep them open.

Additional therapy

Other therapies can be used in addition to surgical treatments to further improve treatment outcomes. They may be given before surgery (neoadjuvant therapy) and/or after surgery (adjuvant therapy). When given before surgery, they aim to reduce the size, and therefore stage, of the cancer. When given after surgery, they aim to help prevent the cancer returning. These non-surgical treatments include chemotherapy, radiotherapy, hormone therapy or a combination of these. 

Occasionally, these therapies may be used if individuals are not suitable for surgical treatment. Often, in these situations, the aim of treatment is to control symptoms, and are not necessarily for cure. The treatment options and aims can differ, based upon the individual, the stage and type of cancer. Your doctor can help explain this information in more detail.

Chemotherapy

Chemotherapy works by damaging cancer cells and stopping their reproduction. Various medications can be used, which can be administered intravenously or orally. They are often given in cycles, with intervening rest periods, to help reduce toxic side effects.

Side effects occur because chemotherapy can also affect healthy cells. Your doctor will monitor your dosage carefully to achieve the best therapeutic effect.

Radiotherapy

Radiotherapy focuses X-rays on the area where the cancer is located. Radiotherapy can be used alone, or in addition to surgery and/or chemotherapy.

Hormone therapy

Hormone therapy is sometimes used to treat advanced pancreatic cancer, if the cancer cells are found to carry a particular hormone receptor. For example, some pancreatic cancers have oestrogen receptors and tamoxifen is a medication that can be used to block that receptor, potentially slowing the growth of the tumour.

Other therapies

Some people diagnosed with cancer seek out complementary and alternative therapies. None of these therapies are proven to cure cancer, but some can help people feel better when used together with conventional medical treatment. It is important to discuss any additional treatments with your doctor before starting them.

Bile

A fluid made in the liver and stored in the gall bladder.

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

Gall bladder

A small organ attached to the liver that stores bile until it is released into the small intestine, to aid the digestion of food.

Hormone

A chemical substance secreted in one part of an organism and transported to another part of that organism, where it has a specific effect.

Intravenously

Within a vein.

Stents

Small mesh tubes made of metal or plastic, which are inserted into passageways that are blocked or obstructed.

Tumour

A growth caused by an abnormal and uncontrolled reproduction of cells.

X-rays

A scan that uses ionising radiation beams to create an image of the body’s internal structures.

Potential complications

Treatment side effects

Side effects of treatment for pancreatic cancer can include:

  • Nausea, vomiting and fatigue;
  • Altered bowel habits, such as constipation or diarrhoea;
  • Joint and muscle pain;
  • Temporary hair loss from the head and body, and;
  • Tingling in the hands and feet - some chemotherapeutic agents can affect the nerves. It is important to tell your doctor if you develop these symptoms. 

Advanced pancreatic cancer

Metastasis is when the cancer spreads to other parts of the body through the bloodstream and lymphatic system. The metastasised cancer damages the function of an affected organ or body part.

Bowel obstruction

If the pancreatic cancer grows and puts pressure on the small intestine, it can cause a bowel obstruction or blockage, which reduces the flow of food from the stomach to the intestines.

Intestine

The part of the digestive system from the stomach to the anus.

Joint

A connecting surface or tissue between two bones.

Lymphatic system

A network of vessels, lymph nodes, the spleen and other organs that transport lymph fluid between tissues and bloodstream.

Nerves

One or more fibres that transmit signals of sensation and motion between the brain or spinal cord and other parts of the body.

Bowel

The part of the digestive tract that comprises the small and large intestines.

Prognosis

The outlook for pancreatic cancer depends on the type and stage of cancer, however the overall survival rates are usually low, as it is most often diagnosed at an advanced stage. Pancreatic cancer is the fifth-most common cause of cancer death and, in Australia, the five-year survival rate is 6.7%. [1]  

It is important to remember survival rates are only an indication, and are based upon the averages of previously treated patients. It is not an absolute prognosis for an individual. It is often difficult to accurately predict an individual's cure or survival rate. Constant advances in treatment are continually improving these statistics. 

As pancreatic cancer progresses, the aim of treatment shifts from extending life to minimising pain, with palliative care available for terminal patients.

Palliative care

The comprehensive care of unwell and terminally-ill patients that is aimed at making them as comfortable as possible, rather than prolonging their life. It includes pain management, counselling, education and support for their family/carers.

1. SEER stat fact sheets: pancreas cancer. Surveillance epidemiology and end results program (SEER). Accessed 14 July 2014 from

External link

Prevention

Maintaining a healthy weight, quitting smoking and avoiding alcohol overuse are the best means of reducing your risk of pancreatic cancer.

1. SEER stat fact sheets: pancreas cancer. Surveillance epidemiology and end results program (SEER). Accessed 14 July 2014 from

External link