Pancreatic cancer is the fourth most common cause of cancer death in the United States.

One reason for the often poor outcome of pancreatic cancer is the location of the pancreas deep inside the body. Pancreatic tumors can’t be seen or felt by doctors during routine physical exams, and patients usually have no symptoms until the cancer has spread to other organs.

At the John Wayne Cancer Institute at Providence Saint John’s Health Center our gastrointestinal cancer surgeons diagnose and treat pancreas cancer with the most advanced therapies available. We provide focused, personalized care via a team that consists of surgeons, medical and radiation oncologists, radiologists, gastroenterologists, pathologists and specially trained support staff, all to help you make the most informed decision about your care.

As a center for treatment of advanced cancer, we offer innovative treatments, including immunotherapy, against pancreatic cancer.

Learn More About The Pancreas

Pancreas
Diagnosis

Diagnosis

We take a complete medical history and do a physical exam prior to beginning any diagnostic procedures for pancreatic cancer.

If pancreatic cancer is suspected, we might perform any of the following tests in order to make a definitive diagnosis.

  • Screening
  • Ultrasound
  • Computed tomography scan (CT or CAT scan)
  • Magnetic resonance imaging (MRI)
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Percutaneous transhepatic cholangiography (PTC)
  • Pancreas biopsy
  • Positron emission tomography (PET)
Doctor looking at information
Risk Factors

Risk Factors for Pancreatic Cancer Include:

Gender

More men than women are diagnosed with pancreatic cancer.

Age

Although pancreas cancer can occur in younger patients most occur in people over the age of 60.

Chronic pancreatitis

Long-term inflammation of the pancreas, often caused by excessive alcohol abuse, has been linked to an increased risk for pancreatic cancer.

Smoking

Heavy cigarette smokers are two or three times more likely than nonsmokers to develop pancreatic cancer.

Obesity

Pancreatic cancer is more common in overweight, inactive people.

Diabetes

Pancreatic cancer occurs more often in diabetic patients.

Race

African-Americans are more likely than whites to be diagnosed with pancreatic cancer and present with more advanced disease.

Workplace exposures

Exposure to certain occupational carcinogens like pesticides and chemicals used in the metal industry may increase the risk of pancreatic cancer.

Genetic factors

Most pancreatic cancer is not hereditary. A small percentage of patients have a familial type which can be associated with genetic mutations that are associated with melanoma or breast cancer.

Mutations in the genes BRCA1 and BRCA2, which increase the risk of breast, prostate, and certain gynecologic cancers, have been found in some families with a history of pancreatic cancer.

Family history

The risk for developing pancreatic cancer is higher if a person’s mother, father, or a sibling had the disease. An estimated 5 to 10 percent of people with pancreatic cancer have one or more family members who have had the disease. According to the National Cancer Institute, people with a strong family history of pancreatic cancer are nine times more likely to develop pancreatic cancer than others.

Types

The Pancreas Contains Two Main Types of Cells:

1. Exocrine cells that produce digestive juices

2. Endocrine cells that produce hormones

Adenocarcinoma

  • Starts in exocrine cells and accounts for 95 percent of pancreatic cancers. It occurs in the lining of the pancreatic ducts.

Islet cell carcinoma

  • Originates in the endocrine cells which make hormones such as insulin and glucagon. Most islet cell carcinomas are malignant, but insulin-producing islet cell tumors are often benign (non-cancerous). Islet cell tumors can be:
  • Functional (produce high levels of hormones causing symptoms)
  • Non-functional (produce no hormones) and symptoms are less obvious.

Pancreaticoblastoma

  • Is very rare. This type of pancreatic cancer is found mostly in young children. Isolated sarcomas and lymphomas can also occur in the pancreas. These are very rare.

Pseudopapillary neoplasms

  • Are mostly found in women in their teens and 20s. Patients can present with pain, jaundice (yellowing), weight loss or a mass. These cancers mainly originate in the head of the pancreas.  Resection of the tumor is often curative.

Ampullary cancer

  • Is a rare type of exocrine tumor that begins where the bile duct from the liver and the pancreatic duct join with the small intestine. Since it causes jaundice, yellowing of the skin and eyes, it may be found earlier than other types of pancreatic cancer and therefore has a better outcome.

Rare types of pancreatic cancer

  • Adenosquamous carcinoma
  • Squamous cell carcinoma
  • Benign or malignant tumors

  • Insulinoma: Is a rare pancreatic tumor that secretes insulin, the hormone that lowers glucose levels in the blood.
  • Gastrinoma: Is a tumor that secretes above-average levels of gastrin, a hormone that stimulates the stomach to secrete acids and enzymes. Gastrinoma can also cause stomach ulcers and can spread to the liver.
  • Glucagonoma: Is a tumor that secretes glucagon, a hormone that raises levels of glucose in the blood, often leading to a characteristic rash.
  • Benign and pre-cancerous pancreatic lesions

  • Advances in imaging technology have dramatically increased the number of small abnormalities that are found in the pancreas. Most of these abnormalities are identified during imaging for another condition. Many of them are benign, fluid-filled cysts and are unlikely to cause symptoms or shorten a person’s life. Others are pre-cancerous and have the ability to turn into pancreatic cancer.
  • Symptoms

    Symptoms

    Symptoms are often not obvious until the cancer is more advanced.

    Non-specific symptoms include

    • Unexplained loss of appetite and weight loss
    • Pain in the upper abdomen (belly) or upper back
    • Jaundice (yellow skin and eyes, and dark urine)
    • Indigestion, Nausea and Vomiting
    • Extreme fatigue
    • Pale stools and dark urine
    Stages

    Stages

    Staging is a way of describing where the cancer is located, whether it has spread, and whether it is affecting the functions of other organs in the body.

    Diagnostic tests including pathology are used to determine stage which is important to select the most appropriate treatment.

    Stage 0

    • Refers to cancer in situ, in which the cancer has not yet invaded outside the duct (or tube) in which it started (Tis, N0, M0).

    Stage 1A

    • The tumor is 2 cm or smaller in the pancreas. It has not spread to lymph nodes or other parts of the body (T1, N0, M0).

    Stage 1B

    • A tumor larger than 2 cm is in the pancreas. It has not spread to lymph nodes or other parts of the body (T2, N0, M0).

    Stage 2A

    • A tumor extends beyond the pancreas, but the tumor has not spread to nearby arteries or veins. It has not spread to any lymph nodes or other parts of the body (T3, N0, M0).

    Stage 2B

    • A tumor of any size has not spread to nearby arteries or veins. It has spread to lymph nodes but not to other parts of the body (T1, T2, or T3; N1; M0).

    Stage 3

    • A tumor has spread to nearby arteries, veins, and/or lymph nodes but has not spread to other parts of the body (T4, N1, M0).

    Stage 4

    • Any tumor that has spread to other parts of the body (any T, any N, M1).

    Recurrent

    • Recurrent cancer is cancer that comes back after treatment. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.
    Treatment

    Treatment

    Depending on the type and stage, pancreas cancer may be treated in a variety of ways.

    Learn About Our Treatment Options
    Doctor in surgery