Pancreatic Cancer

What is pancreatic cancer?

The pancreas is a gland, about the size and shape of your hand, tucked behind your stomach. It sits deep in your abdomen, which is why it’s often difficult to detect early. It plays a crucial role in digestion and regulating blood sugar.

Pancreatic cancer occurs when abnormal cells in the pancreas grow uncontrollably, forming a tumor. There are several different types, and the specific type and location of the tumor significantly influence the treatment approach and prognosis.

Pancreas cancer is the third leading cause of cancer death in the United States and is expected to be the second leading cause by 2030. Since pancreatic cancer doesn’t often show symptoms early on, the majority of patients are diagnosed at an advanced stage. The AHN Pancreas Cancer Center of Excellence and the skilled cancer specialists who serve patients are here to help and support you through your diagnosis. 

Each week, the multidisciplinary team meets to discuss our patients at a roundtable with an array of top experts. This high level of collaboration allows us to develop a personalized therapy plan for each patient. We are with you every step of the way, from your initial evaluation through treatment and recovery.

Specialists involved in your pancreatic cancer care may include:

This variety of specialties and areas of focus can help in ensuring your care is personalized and tailored to your cancer treatment needs. 

AHN Pancreas Cancer Center of Excellence

The Pancreas Cancer Center of Excellence at AHN Cancer Institute provides personalized, multidisciplinary care to our patients in a supportive and innovative care setting. We diagnose our patients with highly sophisticated and safe techniques using innovative technology. Learn more about our Pancreas Cancer Center of Excellence.

Pancreatic cancer care at AHN: Why choose us?

At the Cancer Institute, we collaborate to determine the right treatment plan for you. Our physicians, surgeons, oncologists, and researchers are paving the way for new and seminal pancreatic cancer treatments to help you continue to lead a full life. We offer:

• Advanced technology: We use innovative treatment techniques to deliver the most comprehensive care to our patients.
• Collaborative team: Our tumor board reviews all patients with pancreatic cancer every week. This board includes gastroenterologists, surgeons, medical oncologists, radiation oncologists, radiologists, and researchers. They evaluate every aspect of the cancer to help you get the best results.
• Compassionate care: A Navigation Team helps you manage all the details of treatment, from arranging appointments to coordinating transportation or answering questions about treatment options. This way you can focus on your health instead of the details of managing appointments. And our robust support services — including support groups, palliative care, and cancer genetics — provide care options that support your mental, emotional, and physical well-being.
• Research-driven treatment: Several clinical trials are available to our patient population. When a new treatment is upcoming, we review its efficacy to determine if it is a fit for patients. Research-driven treatment is incredibly important to move care options forward.

Quick guide to pancreas cancer

Pancreatic cancer symptoms and signs

Pancreatic cancer screening and diagnosis

Types and stages of pancreatic cancer

Pancreatic cancer treatment

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Pancreatic cancer symptoms and signs

Pancreatic cancer symptoms are often vague and don’t appear until the cancer is advanced. This makes early detection difficult. Having regular preventive visits, maintaining a good relationship with your personal doctor, and staying on top of any changes to your health can help in detecting pancreatic cancer.

Signs of pancreatic cancer can include:

Causes and risk factors

The exact causes are not fully understood, but risk factors include:

Learn more about high-risk pancreatic cancer risk factors by visiting AHN’s High-Risk Pancreas Cancer page.

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Pancreatic cancer screening and diagnosis

There is currently no routine screening test for pancreatic cancer that is recommended for the general population.

At the Cancer Institute, we use a team approach to diagnosis. Specialists, including medical oncologists, surgeons, radiation oncologists, and gastroenterologists, carefully review your results to arrive at a diagnosis. We get the most precise diagnosis so we can tailor an effective, comprehensive treatment plan for you.

First, we ask you about your symptoms and conduct a physical exam. Then, we use diagnostic tests to detect cancer and to pinpoint its stage. Our sophisticated diagnostic tests can include one or more different types, depending on your care plan.

Radiology

Pancreatic cancer often hides itself, without causing noticeable symptoms until it’s quite advanced. That’s where radiology comes in — it provides an in-depth look into the hard-to-view area where the pancreas lives.

Radiology uses different imaging techniques to create detailed pictures of the inside of your body, without needing to have surgery. The most common techniques used to look at the pancreas are:

• Pancreatic protocol CT (computed tomography) scan: A technician takes multiple, precise images of your pancreas to pinpoint the location of a tumor.
• Magnetic resonance imaging (MRI): Powerful magnets and radio waves give technicians a detailed picture of the pancreas.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure combines endoscopy and X-ray imaging to diagnose and treat problems in the bile and pancreatic ducts. The procedure goes “backward” — against the normal flow of fluids. Dye is injected into the ducts against their natural flow. X-rays are used to visualize the biliary (bile) and pancreatic ducts after a contrast dye is injected. This allows doctors to see the structure and function of these ducts.
• Endoscopic ultrasound (EUS): A gastroenterologist inserts a probe (endoscope) into the pancreas. We then use an ultrasound to obtain images of areas within the body, including your abdomen, other organs, and blood vessels. This information helps us evaluate your condition and plan treatment.
• Abdominal or pancreatic ultrasound (US): This is a noninvasive imaging technique that uses high-frequency sound waves to create images of the internal organs, including the pancreas.

Biopsy

A biopsy is when the physician collects cells from the suspicious area. This biopsy of the pancreas mass may be performed by a gastroenterologist during an endoscopic ultrasound, a radiologist during an ultrasound or CT-guided biopsy, or by a surgeon. This is then reviewed by the pathologist to make a diagnosis.

Other diagnosis tools

Blood tests and tumor markers are also used to diagnose pancreatic cancer and monitor prognosis. Tumor markers are substances produced by cancer cells or by the body in response to cancer. They can be found in the blood, urine, or body tissues. The tumor markers for pancreatic cancer are carbohydrate antigen (CA) 19-9 and Carcinoembryonic Antigen (CEA). While tumor markers can be helpful in cancer diagnosis and management, they don’t definitively diagnose cancer on their own.

What happens next?

Your case will be discussed at the weekly Multidisciplinary Pancreas Cancer Conference where leading experts in medical oncology, radiation oncology, surgery, gastroenterology, radiology, pathology, nutrition, genetics, and exercise will formulate a personalized and innovative treatment plan for you.

These experts will continue to provide their expert opinions throughout your cancer journey at various stages of treatment. A nurse navigator helps you coordinate your appointments with various specialists

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Types and stages of pancreatic cancer

Pancreatic cancer isn’t a single disease; it’s a group of cancers that arise from different cells within the pancreas. Understanding the specific type of pancreatic cancer is crucial because it significantly impacts the treatment approach and your overall prognosis. When your care team knows the type, the treatment strategy can be better managed and executed.

Pancreas Exocrine tumors

Pancreatic exocrine tumors originate from the exocrine cells of the pancreas, which are responsible for producing digestive enzymes. These enzymes are essential for breaking down food in the small intestine. The vast majority of pancreatic cancers are exocrine tumors, with adenocarcinomas representing the most prevalent subtype.

• Pancreatic adenocarcinoma: This is the most common type of pancreatic cancer. It starts in the tubes (ducts) that carry digestive enzymes. The cancer acts like a clog in the duct, limiting the function.
• Squamous cell carcinoma, acinar cell carcinoma, adenosquamous carcinoma, and undifferentiated carcinoma: These are all very rare types of pancreatic cancer. They start from different, less common cell types within the pancreas. They are so uncommon that doctors often treat them differently than the more common adenocarcinomas.
• Ampullary carcinoma: This cancer doesn’t start in the pancreas itself, but in a small area where the pancreatic duct and bile duct meet (the ampulla of Vater). It’s near the pancreas, so it’s often treated by the same doctors, but its origin and behavior are distinct.

Benign and precancerous lesions

Benign pancreatic lesions are noncancerous growths or abnormalities within the pancreas. Precancerous lesions, also called pancreatic intraepithelial neoplasia (PanIN), are abnormal cell changes that increase the risk of developing pancreatic cancer but aren't cancerous themselves. Regular monitoring and sometimes removal of precancerous lesions can help prevent cancer development.

• Intraductal papillary mucinous neoplasm (IPMN): This is a tumor that can grow from the main pancreatic duct or side branches of the duct. It may be benign but can change into cancer.
• Mucinous cystic neoplasm: This is a rare type of cystic (fluid-filled) tumor that typically occurs in the pancreas. It’s characterized by a cyst lined with mucus-producing cells. While some are benign (noncancerous), others can become cancerous. They’re most commonly found in women and often present as a single cyst. Because of their potential to become cancerous, they typically require careful monitoring and often surgical removal depending on their characteristics and features seen on imaging.
• Cystic neoplasms: Cystic neoplasms of the pancreas are fluid-filled growths or masses within the pancreas. They can be benign or cancerous, and range in size and type. Diagnosis usually involves imaging studies like CT scans or MRIs, often followed by further investigation, like endoscopic ultrasound (EUS) and sometimes biopsy, to determine the exact nature and risk of malignancy.
• Solid pseudopapillary neoplasms: Solid pseudopapillary neoplasms (SPNs) are uncommon, slow-growing tumors of the pancreas that often appear solid on imaging but have a pseudopapillary (falsely papillary) microscopic structure. They are usually benign but can rarely behave in a more aggressive manner. Treatment typically involves surgical removal, especially if there are concerns about the tumor’s growth or location.

Pancreas neuroendocrine tumors (PanNETs)

Pancreatic neuroendocrine tumors (PanNETs) are rare tumors that arise from the hormone-producing cells (neuroendocrine cells) within the pancreas. Unlike the more common pancreatic adenocarcinomas, they often grow more slowly and may not cause symptoms until they’re quite large. Treatment depends on the size, location, and whether the tumor has spread, ranging from close monitoring to surgery, chemotherapy, or targeted therapy. Learn more about pancreas neuroendocrine tumors.

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Pancreatic cancer treatment

Pancreatic cancer is a serious and often aggressive disease, known for its late diagnosis and poor prognosis. This is primarily because it often doesn’t cause noticeable symptoms until it has spread significantly, making early detection extremely difficult. Even with treatment, the survival rates are relatively low.

Depending on your tumor type and stage, you could be offered innovative therapies such as chemotherapy, immunotherapy, targeted therapy depending on the unique makeup of your tumor and tailored specifically to you, surgery, or radiation therapy.

You will receive supportive care services from our compassionate nurses, social workers, nutritionists, and complementary medicine physician.

The Cancer Institute offers several groundbreaking, unique treatment options for pancreatic cancer. Many of them were pioneered right here.

Nutrition support

Some pancreatic cancer treatments can cause gastrointestinal issues for patients. AHN uses a collaborative team approach that includes nutrition support via AHN Dietitians. These dietitians can work with patients who may be experiencing issues like exocrine pancreatic insufficiency that make it challenging to get the nutrients the body needs. If you are experiencing side effects of your pancreatic cancer treatment, AHN is here to support you and find solutions.

Whipple procedure

This surgery is also known as a pancreaticoduodenectomy. A surgeon removes the head of the pancreas, the gallbladder, the uppermost part of the small intestine, a small part of the stomach, and nearby lymph nodes. Then we reconnect the pancreas to the remaining digestive organs so that stomach contents flow right into the small intestine. This method allows you to have normal digestion after the procedure. Learn more about the Whipple procedure.

Intensity-modulated radiation therapy (IMRT)

Sophisticated computer technology maps the precise shape and density of cancerous tumors. We mold the radiation beam to match the shape of the tumor exactly. This process allows us to use a high dose of radiation to destroy the cancer cells without harming surrounding healthy tissue.

Stereotactic body radiotherapy (SBRT)

This precise technique delivers high doses of radiation in fewer than five treatments. This technique was pioneered at the Cancer Institute and has dramatically improved our ability to control tumors.

Clinical trials: We offer a thriving clinical trials program, keeping you at the forefront of the latest treatment options as they develop.

MR-Linac

Radiation treatments are already delivered with pinpoint accuracy, but the new MR-Linac takes precision to the next level. We are the only cancer center in the region and one of only six in the United States that tested this new innovative technology. The MR-Linac combines a magnetic resonance imaging (MRI) machine with the radiation delivery machine — known as a linear accelerator — into one treatment device. The MRI provides high-quality images of a tumor in realtime, and then the linear accelerator emits radiation beams to the exact location of the cancer.

Inhaling and exhaling causes organs, tissues, and the actual tumor to move. This technology allows us to see images of a patient’s body as breaths are taken, so we can directly target the tumor with radiation. If a tumor moves out of the determined radiation area as a patient inhales, the radiation automatically turns off. When the patient exhales and the tumor returns to its original position, the high-energy beams resume.

This type of delivery limits healthy tissue and organs from being radiated while providing a powerful dose of radiation to the cancer.

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Contact us

Call the AHN Cancer Help Line anytime at (412) NURSE-4-U (412) 687-7348 to schedule a cancer-related appointment or to just talk with our nurses about diagnoses, treatments, and side effects.  

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