What is pancreatic cancer?
Cancer can start any place in the body. Pancreatic (PAN-kree-A-tik) cancer begins when cells in the pancreas (PAN-kree-us) start to grow out of control and crowd out normal cells. This makes it hard for the body to work the way it should.
Cancer cells can spread to other parts of the body. Cancer cells in the pancreas can sometimes travel to the liver and grow there. When cancer cells do this, it’s called metastasis (pronounced meh-TAS-tuh-sis). To doctors, the cancer cells in the new place look just like the ones from the pancreas.
Cancer is always named for the place where it starts. So when pancreatic cancer spreads to the liver (or any other place), it’s still called pancreatic cancer. It’s not called liver cancer unless it starts in the liver.
Ask your doctor to use this picture to show you where your cancer is located.
The pancreas is a body part that lies behind the stomach and has 2 kinds of cells that have special jobs. The exocrine cells make a substance that helps digest (break down food). The endocrine cells make hormones that help control sugar levels in the blood.
Are there different kinds of pancreatic cancer?
Each type of cell can lead to a different type of pancreatic cancer. Treatment depends on the type of pancreatic cancer. Your doctor can tell you more about the type you have.
Cancers that start in the exocrine cells are the most common kind of pancreatic cancer. These are called exocrine pancreatic cancers.
Tumors of the endocrine pancreas are much less common. They are known as pancreatic endocrine tumors, neuroendocrine tumors (NETs), or islet cell tumors.
This rest of the information here is about only exocrine cancer.
Questions to ask the doctor
- Why do you think I have cancer?
- Is there a chance I don’t have cancer?
- Would you please write down the kind of cancer you think I might have?
- What will happen next?
How does the doctor know I have pancreatic cancer?
It is hard to find pancreatic cancer early. Because the pancreas is deep inside the body, the doctor can’t see or feel something not normal in the pancreas during a standard physical exam. Most of the time, early pancreatic cancers don’t cause any signs or symptoms. These cancers are often not found until they cause problems that make a person seek help from a doctor.
The doctor will ask questions about your health and perform a physical exam. If signs are pointing to pancreatic cancer, more tests will be done. Here are some of the tests you may need:
Tests that may be done
Biopsy (BY-op-see): The doctor takes out a little bit of tissue or some cells to check for cancer. A biopsy is the only way to tell for sure if you have cancer. Biopsies can be done in more than one way. Ask your doctor which type of biopsy you will have.
CT or CAT scan: Uses x-rays to make pictures of your insides. This can show clear pictures of the pancreas and the area around it to see if the cancer has spread.
MRI scan: Uses radio waves and strong magnets instead of x-rays to make clear pictures of the inside of the body. This test may be used to learn more about the cancer’s size and spread. Special types of MRI scans can also be used to look at ducts and blood vessels in and around the pancreas.
Endoscopic ultrasound or EUS for short (en-DAHS-kuh-picUL-truh-sound): This test uses sound waves to make pictures of the inside of the body. To do this test, a small probe is placed on the tip of a thin tube that is passed down the throat into the stomach and then into the first part of the small intestine. The probe can be pointed at the pancreas. It can also be used to take out a little bit of tissue that can be checked for cancer.
Endoscopic retrograde cholangiopancreatography or ERCP for short (en-doh-SKAH-pik REH-troh-grayd koh-LAN-jee-oh-PAN-kree-uh-TAH-gruh-fee): A small probe is placed on the tip of a thin tube that is passed down the throat into the stomach and into the first part of the small intestine. This test can check if the ducts are blocked due to pancreatic cancer. It can also be used to help open a blocked duct or take out some cells.
Liver function tests: Blood tests to see how well the liver is working.
Tumor markers: Some pancreatic cancer cells can make certain proteins that show up in the blood. This test is never used alone. Other tests that make pictures and a biopsy help your doctor find out the kind of pancreatic cancer that you have.
Other blood tests: Can help find out if you have any other health problems (such as how well your kidney and bone marrow are working).
Grading Pancreatic Cancer
The cancer cells in the biopsy sample will be graded. This helps doctors tell how fast the cancer is likely to grow and spread. Cancer cells are graded based on how much they look like normal cells. In pancreatic cancer, grade is sometimes listed from G1 to G3 (or G4). The lower the number, the more the cancer cells look like normal cells, with G1 cancers looking the most like normal cells. Ask the doctor to explain the grade of your cancer. The grade helps the doctor decide which treatment is best for you.
Questions to ask the doctor
- What tests will I need to have?
- Who will do these tests?
- Where will they be done?
- Who can explain them to me?
- How and when will I get the results?
- Who will explain the results to me?
- What do I need to do next?
How serious is my cancer?
If you have pancreatic cancer, the doctor will want to find out how far it has spread. This is called staging. You may have heard other people say that their cancer was “stage 1” or “stage 2.” Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.
Your cancer can be staged 1, 2 ,3 or 4. The lower the number, the less the cancer has spread.
Questions to ask the doctor
- Do you know the stage of the cancer?
- If not, how and when will you find out the stage of the cancer?
- Would you explain to me what the stage means in my case?
- Based on the stage of the cancer, how long do you think I’ll live?
- What will happen next?
What kind of treatment will I need?
Most people with pancreatic cancer find out that it is a higher stage and hard to treat. Treatment in most cases helps make symptoms better and slows down the cancer but does not cure it. Talk with your doctor to find out your options. The main ways to treat pancreatic cancer are surgery (SUR-jur-ee), chemotherapy (KEY-mo-THAIR-uh-pee), other drugs and radiation (RAY-dee-A-shun) therapy. Ask your doctor what treatments can help you.
The treatment plan that’s best for you will depend on:
- The stage and grade of the cancer
- The chance that a type of treatment will cure the cancer or help in some way
- Your age
- Other health problems you have
- Your feelings about the treatment and the side effects that come with it
Surgery for pancreatic cancer
Surgery is used to try to take out all of the cancer if it’s small and has not spread. If your cancer is too bad, surgery may not be possible. There is more than one way to do surgery in the pancreas. Getting better after surgery depends on how much of the pancreas and other parts of the body were taken out. Ask your doctor what kind of surgery you will have.
Side effects of surgery
Surgery for pancreatic cancer is a very big operation and can have risks and side effects. Be sure to ask the doctor what you can expect. If you have problems, let your doctors know. Even in the best cases you can have problems from surgery. They are:
- Leaking inside the body
- Trouble eating (may need to take medicine to help)
- Weight loss
- Changes in bathroom habits
Chemo (KEY-mo) is the short word for chemotherapy, the use of drugs to fight cancer. These drugs spread through the body. They kill cells that are fast-growing cancer cells and good cells, like blood cells and hair. Chemo is given in cycles or rounds. Each round of treatment is followed by a break to allow your body to get better from the side effects. There is more than one chemo drug from which your doctor can pick. In some cases of higher stage cancer, treatment may include a chemo drug along with a targeted therapy. Targeted therapies are newer treatments that are being studied for cancer.
Side effects of chemo
Chemo can make you feel very tired, sick to your stomach, and cause your hair to fall out.
There are ways to treat most chemo side effects. If you have side effects, be sure to talk to your cancer care team so they can help.
Radiation uses high energy x-rays to kill cancer cells. Radiation (along with chemotherapy) can also be used when the cancer is too far along to be taken out by surgery. It can also be used to help make symptoms better – such as pain in people with higher stage cancers.
Side effects of radiation treatments
If your doctor suggests radiation treatment, talk about what side effects might happen. The most common side effects of radiation are:
- Skin changes where the radiation is given
- Feeling very tired
- Feeling sick to your stomach
- Losing weight
Talk to your cancer care team about what you can expect.
Pain is a common problem with pancreatic cancer. You should not be afraid to use the pain medicines offered. Pain medicines work best when they are taken at set times, not just when the pain gets bad. Ask your doctor which ones you will get and what to expect.
Clinical trials are research studies that test new drugs or other treatments in people. They compare standard treatments with others that may be better.
If you would like to be in a clinical trial, start by asking your doctor if your clinic or hospital takes part in clinical trials. You can also call our clinical trials matching service at 1-800-303-5691 or go online at www.cancer.org/clinicaltrials to find studies near you.
Clinical trials are one way to get the newest cancer treatment. They are the best way for doctors to find better ways to treat cancer. If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part. And if you do sign up for a clinical trial, you can always stop at any time.
What about other treatments that I hear about?
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.
Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else.
Questions to ask the doctor
- What treatment do you think is best for me?
- What’s the goal of this treatment? Do you think it could cure the cancer?
- Will treatment include surgery? If so, who will do the surgery?
- What will the surgery be like?
- Will I need other types of treatment, too?
- What’s the goal of these treatments?
- What side effects could I have from these treatments?
- What can I do about side effects that I might have?
- Is there a clinical trial that might be right for me?
- What about special vitamins or diets that friends tell me about? How will I know if they are safe?
- How soon do I need to start treatment?
- What should I do to be ready for treatment?
- Is there anything I can do to help the treatment work better?
- What’s the next step?
What will happen after treatment?
With pancreatic cancer, treatments may not cure your cancer. You many need to keep getting treatment and care. From time to time tests will be done to see how your treatment is working, and at other times tests will be done to see if your cancer has come back. Ask your doctor what to expect. No matter what, your doctors will still want to watch you closely. Be sure to go to all of these follow-up visits. During these visits, your doctors will ask about symptoms, do physical exams, and may order blood tests or tests that take pictures, such as CT scans.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.
You can’t change the fact that you have cancer. What you can change is how you live the rest of your life.
Adenocarcinoma (AD-no-KAR-suh-NO-muh): Cancer that starts in the glandular cells that line certain organs and make and release substances into the body, such as mucus, digestive juices, or other fluids.
Angiography (AN-jee-AH-gruh-fee): This is an x-ray test that looks at blood vessels. A small amount of dye is injected into an artery to outline the blood vessels, and then x-rays are taken. This test can be useful in finding out if a pancreatic cancer has grown through the walls of certain blood vessels.
Endocrine cells (EN-doh-krin): Cells in the pancreas that produce hormones (such as insulin) that help control sugar in the blood.
Exocrine cells (EK-soh-krin): Cells in the pancreas that make special juices that help your body digest food after you eat.
Pancreatic Enzymes: The proteins made by the pancreas that help in the digestion of food. Together these enzymes are commonly referred to as pancreatic juice.
Targeted therapy: These drugs affect mainly cancer cells and not normal cells in the body. These drugs often have milder side effects than chemo.
Last Medical Review: April 21, 2016 Last Revised: April 21, 2016