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Table of Contents General Information About Pancreatic Cancer
Stages of Pancreatic Cancer
Recurrent Pancreatic Cancer
Treatment Option Overview
Treatment Options by Stage
Treatment Options for Recurrent Pancreatic Cancer
To Learn More About Pancreatic Cancer
Get More Information From NCI
Changes to This Summary (06/13/2008)
About PDQ
General Information About Pancreatic Cancer
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Pancreatic cancer is a disease in which malignant (cancer)
cells form in the tissues of the pancreas.
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 behind the stomach and in front of the spine.
The pancreas has two main jobs in the body:
- To produce juices that help digest (break down) food.
- To produce 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 produced by exocrine pancreas cells and
the hormones are produced by endocrine pancreas cells. About 95% of pancreatic
cancers begin in exocrine
cells.
This summary provides information on exocrine pancreatic cancer.
Refer to the PDQ summary on Islet Cell
Tumors (Endocrine Pancreas) Treatment for information on
endocrine pancreatic cancer.
Smoking and health history can affect the risk of developing
pancreatic cancer.
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. People who think they may be at risk should discuss this with their doctor. Risk
factors for pancreatic cancer include the following:
Possible signs of pancreatic cancer include jaundice, pain, and
weight loss.
These and other symptoms may be caused by pancreatic cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems
occur:
- Jaundice (yellowing of the skin and whites of the eyes).
- Pain in the upper or middle abdomen and back.
- Unexplained weight loss.
- Loss of appetite.
- Fatigue.
Pancreatic cancer is difficult to detect (find) and diagnose
early.
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 produce 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:
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- 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.
- 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.
- 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).
- 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.
- 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.
- 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. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy.
- 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.
- 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 may be inserted into the pancreas during an x-ray or ultrasound to remove cells. Tissue
may also be removed during a laparoscopy (a surgical incision made in the wall
of the abdomen).
Certain factors affect prognosis (chance
of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- Whether or not the tumor can be removed by surgery.
- The stage
of the cancer (the size of the tumor and whether the cancer has spread outside
the pancreas to nearby tissues or lymph
nodes or to other places in the body).
- The patient’s general
health.
- Whether the cancer has just been diagnosed or has recurred (come back).
Pancreatic cancer can be controlled only if it is found before it
has spread, when it can be removed by surgery. If the cancer has spread, palliative treatment can improve the patient's quality of life by controlling the
symptoms and complications of this disease.
 Back to Top Stages of Pancreatic Cancer
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Tests and procedures to stage pancreatic cancer are usually
done at the same time as diagnosis.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- 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.
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Stage I
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 II
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 III
In stage III, cancer has spread to the major blood vessels near the pancreas and may have spread to nearby lymph nodes.
Stage IV
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.
Back to Top Recurrent Pancreatic Cancer
Recurrent pancreatic
cancer is cancer that has recurred
(come back) after it has been treated. The cancer may come
back in the pancreas or in other
parts of the body.
Back to Top Treatment Option Overview
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There are different types of treatment for patients with
pancreatic cancer.
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.
Three types of standard treatment are used:
Surgery
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:
- 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
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
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 spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
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.
Patients with pancreatic cancer have special nutritional
needs.
Surgery to remove the pancreas may interfere with the production of 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.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web
site.
Biologic therapy
Biologic therapy is a treatment that 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.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.
Follow-up tests may be needed
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Back to Top Treatment Options by Stage
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Stages I and II Pancreatic Cancer
Treatment of stage I and stage II pancreatic cancer may include the
following:
- Surgery alone.
- Surgery with chemotherapy and radiation therapy.
- A clinical trial of surgery followed by radiation therapy with chemotherapy. Chemotherapy is
given before, during, and after the radiation therapy.
- A clinical trial of surgery followed by chemotherapy.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I pancreatic cancer.
Stage III Pancreatic Cancer
Treatment of stage III pancreatic
cancer may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III pancreatic cancer.
Stage IV Pancreatic Cancer
Treatment of stage IV pancreatic
cancer may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV pancreatic cancer.
Back to Top Treatment Options for Recurrent Pancreatic Cancer
Treatment of recurrent pancreatic cancer may include the
following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent pancreatic cancer.
Back to Top To Learn More About Pancreatic Cancer
For more information from the National Cancer Institute about pancreatic cancer, see the following:
For general cancer information and other resources from the National Cancer Institute, see the following:
Back to Top Get More Information From NCI
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
Chat online
The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
- NCI Public Inquiries Office
- Suite 3036A
- 6116 Executive Boulevard, MSC8322
- Bethesda, MD 20892-8322
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
Find Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
Back to Top Changes to This Summary (06/13/2008)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Changes were made to this summary to match those made to the health professional version.
Back to Top About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." 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.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
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