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Your personal team of experts, which includes oncologists, surgeons, radiologists, gastroenterologists and a specially trained support staff, communicates closely about your pancreatic cancer treatment. As an important part of the care team, you are involved in every decision.
As one of the nation's largest cancer centers, we are able to offer a variety of innovative treatments, including proton therapy and targeted therapies that help your body fight this illness.
We have pioneered several advances in pancreatic cancer, including:
- Neoadjuvant chemotherapy (given before surgery) to shrink the tumor and allow it to be removed surgically with less damage to normal tissue
- Gemcitabine, which now is standard treatment around the world
- Discovery of the genetic causes of pancreatic cancer
MD Anderson is leading research into ways to treat and prevent pancreatic cancer. This means we are able to offer a wide range of clinical trials for new treatment.
And at MD Anderson you're surrounded by the strength of one of the nation's largest and most experienced comprehensive cancer centers, which has all the support and wellness services needed to treat the whole person – not just the disease.
Get up, show up and never, ever give up.
Pancreatic cancer accounts for only 2% of cancers diagnosed in the United States each year; however, it is the fifth leading cause of cancer death in this country. According to the American Cancer Society's most recent estimates for pancreatic cancer in the United States, more than:
- 42,000 cases are diagnosed each year
- 35,000 people die because of the disease
The lifetime risk of having pancreatic cancer is about 1 in 72. It is about the same for men and women. The risk increases with age, and most cases are diagnosed between 60 and 80 years old. Pancreatic cancer usually has few, if any, signs or symptoms in the early stages when it would be most treatable.
The pancreas is a spongy, oblong organ about 6 inches long and 2 inches wide. It is located behind the lower part of the stomach, between the stomach and the spine. The pancreas is important because it makes insulin and other hormones that help the body absorb sugar and control blood sugar, and produces juices that aid in digestion.
Pancreatic Cancer Types
The pancreas contains two main types of cells:
- Exocrine cells, which make digestive juices
- Endocrine cells, which produce hormones
Almost all pancreatic cancers start in exocrine cells. These cells line the pancreatic duct (duct cells), through which pancreatic juices with digestive enzymes flow.
Adenocarcinoma is cancer of the exocrine cells. It accounts for 95% of pancreatic cancers.
Islet cell carcinoma involves endocrine cells. Most islet cell tumors are malignant, but some are benign, such as insulin-producing islet cell tumors. Tumors can be:
- Functional and produce abnormally high amounts of hormones
- Non-functional and produce no hormones
Pancreaticoblastoma is very rare. This type of pancreatic cancer is found mostly in young children.
Isolated sarcomas and lymphomas can occur in the pancreas. These are very rare.
Pseudopapillary neoplasms occur mostly in young women in their teens and 20s.
Ampullary cancer: This rare type of exocrine tumor begins where the bile duct (from the liver) and the pancreatic duct join with the small intestine. Since it causes yellowing of the skin and eyes, it may be found earlier than other types of pancreatic cancer.
Anything that increases your chance of getting pancreatic cancer is a risk factor. While the precise causes of pancreatic cancer have not been determined, MD Anderson is researching risk factors and has made several landmark discoveries. Risk factors for pancreatic cancer include:
Age: The risk of pancreatic cancer increases sharply after 50 years old. At the time of diagnosis, almost 90% of patients are older than 55.
Race: African-Americans are more likely to have pancreatic cancer than other ethnic groups.
Smoking and tobacco use: People who smoke are two to three times more likely to develop pancreatic cancer. Smokeless tobacco also increases risk. Read more about MD Anderson’s smoking cessation clinical trials
Family history: Pancreatic cancer seems to run in some families, and some research shows that about 10% are caused by hereditary gene changes. The exact genes have not been fully identified, but changes in DNA that increase a person's risk for other types of cancer may increase the risk of pancreatic cancer. Gene mutations that seem to increase risk for pancreatic cancer include:
- K-ras, found in most cases of pancreatic ductal adenocarcinomas
- BRCA2, often found in families with high rates of breast, ovarian and prostate cancers. BRCA2 seems to be more common in people with Ashkenazi Jewish or Eastern European heritage
- Peutz-Jeghers syndrome and other rare genetic syndromes
Other hereditary conditions that might mean higher risk of pancreatic cancer include:
- Hereditary pancreatitis
- Multiple endocrine neoplasia type 1 syndrome
- Hereditary nonpolyposis colon cancer (HNPCC, also called Lynch syndrome)
- Von Hippel-Lindau syndrome
- Familial atypical multiple mole melanoma syndrome (FAMMM)
- Obesity: People who are very overweight and have a body mass index (BMI) more than 30 are more likely to develop pancreatic cancer. It is also is found more often in people who do not exercise regularly.
Sudden onset diabetes: Diabetes can be both a risk factor and an early symptom of pancreatic cancer. The exact relationship between diabetes and pancreatic cancer is being studied, but it may be caused by high concentrations of insulin or other hormones. In diabetics, sudden changes in blood sugar control may also be a risk factor
Environmental exposure to certain pesticides, dyes, and chemicals
Not everyone with risk factors gets pancreatic cancer. However, if you have risk factors, you should discuss them with your doctor.
Pancreatic Cancer Prevention
The number one way to prevent pancreatic cancer is to stop smoking. Read more about MD Anderson’s smoking cessation clinical trials. Other lifestyle choices may lower your chances of getting pancreatic cancer, including:
- Eating a healthy diet
- Maintaining a healthy weight
- Getting regular exercise
Behavioral and lifestyle changes can help prevent pancreatic cancer. Visit our prevention and screening section to learn how to manage your risk.
Some cases of pancreatic cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
Did You Know?
Pancreatic cancer often does not cause symptoms in the early stages. When it does have symptoms, they usually are caused by the relationship of the pancreas to other organs of the digestive system.
Symptoms of pancreatic cancer include:
- Jaundice or yellowing of the skin or eyes
- Change of color in urine and stool: Urine may turn orange or the color of iced tea. Stool may turn yellow or reddish, or become grey or chalky-white.
- Pain in the abdomen or middle of the back
- Bloating or feeling of fullness
- Nausea, vomiting or indigestion
- Lack of appetite or unexplained weight loss
- Sudden-onset diabetes or sudden change in blood-sugar control in diabetics
- Swollen gallbladder
- Blood clots
These symptoms do not always mean you have pancreatic cancer. However, it is important to discuss any of these symptoms with your doctor, since they may signal other health problems.
MD Anderson has the most advanced and accurate technology available to diagnose pancreatic cancer, including endoscopic ultrasound. Our highly skilled pathologists, diagnostic radiologists and specially trained technicians are able to pinpoint the exact extent of the disease, improving your chances for successful treatment of pancreatic cancer.
Pancreatic cancer often can be challenging to diagnose. Symptoms of pancreatic cancer usually do not appear in the early stages, and if they do they may be mistaken for signs of another condition. Also, the pancreas is deep inside the body, behind several other organs. This makes it difficult to feel or see without proper equipment. Several medical tests usually are required to find and stage (determine extent of disease) pancreatic cancer. Accurate diagnosis and staging are important because they help your doctors choose the best type of treatment.
Pancreatic Cancer Diagnostic Tests
If you have pancreatic cancer symptoms, your doctor examine you and ask you questions about your health; your lifestyle, including smoking habits; and your family medical history. One or more of the following tests may be used to test for pancreatic cancer. These tests also may be used to find out if the cancer has spread and if treatment is working.
Imaging tests, which may include:
- CT or CAT (computed axial tomography) scans: This is the primary test used to determine the stage of pancreatic cancer
- PET (positron emission tomography) scans
- MRI (magnetic resonance imaging) scans
- Angiography: A type of X-ray that looks at blood vessels
Endoscopic ultrasound (EUS): A special endoscope with an ultrasound probe and a small needle at the end is placed through the mouth and esophagus and into the first part of the small intestine. The doctor views the pancreas on a video screen. Surgical instruments, called biopsy forceps or brushes, may be inserted through the endoscope to remove tissue to examine under a microscope.
Endoscopic retrograde cholangiopancreatography (ERCP): This test for pancreatic cancer X-rays the ducts that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. An endoscope is put 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, and an X-ray is taken. If the ducts are blocked by a tumor, a fine tube (stent) may be inserted into the duct to unblock it. The stent may be left in place to keep the duct open.
Blood tests: No single blood test can diagnose pancreatic cancer. Some blood tests, known as tumor markers, measure the levels of proteins made by cancer cells. Known tumor markers for pancreatic cancer include carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA). Blood tests also can evaluate the function of the liver and other organs that may be affected by a pancreatic tumor.
Biopsy: This is the removal of a small piece of tissue to view under a microscope. The ways to do a biopsy for pancreatic cancer include the following.
CT-guided Fine Needle Aspiration (FNA): A CT scan helps the doctor find the tumor and guide a small needle through the skin and abdomen into the pancreas.
Laparoscopy: This test for pancreatic cancer is done in the operating room under general anesthesia. An endoscope is guided through a very small cut in the abdomen. This lets the surgeon view the pancreas and find out if the cancer has spread. Tissue samples also can be taken.
Laparoscopy is not used to diagnose pancreatic cancer. It may be used to find out if the cancer has spread to other organs, such as the intestines, liver, lymph nodes and stomach.
Pancreatic Cancer Staging
If you are diagnosed with pancreatic cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer. Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.
(source: National Cancer Institute)
Stage 0: Cancer is found only in the lining of the pancreas. Stage 0 also is called carcinoma in situ.
Stage 1: Cancer has formed and is in the pancreas only.
- Stage IA: The tumor is 2 centimeters or smaller
- Stage IB: The tumor is larger than 2 centimeters
Stage 2: Cancer may have spread to nearby tissue and organs, and lymph nodes near the pancreas.
- Stage IIA: Cancer has spread to nearby tissue and organs but has not spread to nearby lymph nodes
- Stage IIB: Cancer has spread to nearby lymph nodes and may have spread to nearby tissue and organs
Stage 3: Cancer has spread to the major blood vessels near the pancreas and may have spread to nearby lymph nodes.
Stage 4: Cancer may be of any size and has spread to distant organs, such as the liver, lung and peritoneal cavity. It also may have spread to organs and tissues near the pancreas or to lymph nodes.
Doctors also may use the following terms to talk about how far pancreatic cancer has spread:
Resectable: Cancer is in the pancreas and can be removed surgically.
Locally advanced (unresectable): Pancreatic cancer has spread to tissue and blood vessels around the pancreas but not to other parts of the body. It cannot be removed entirely by surgery. Surgery may be done to help symptoms or other problems.
Metastatic: Pancreatic cancer has spread to other parts of the body. Surgery is done only to relieve symptoms or other problems.
MD Anderson has the expertise and experience to fight pancreatic cancer on all fronts. Using the latest most advanced therapies, we personalize your care to ensure the most advanced treatment with the least impact on your body. We offer the latest innovative pancreatic cancer treatments — many available at only a few cancer centers in the nation — including targeted therapies.
Frequently, treatment for pancreatic cancer requires more than one type of therapy. We are recognized as a leader in customizing care for pancreatic cancer, which often translates into better pancreatic cancer survival rates that might not be possible elsewhere.
Skilled Surgeons, Latest Techniques
The surgical techniques to treat pancreatic cancer are extremely complex. The surgeon must have a high degree of experience and skill to be successful.
Our surgeons are among the most experienced and skilled in the nation — and this is an important factor in the success of your pancreatic cancer surgery. The highest chances for successful treatment are when 100% of the tumor is removed. This requires expertise as well as powerful microscopes to be sure the entire tumor has been removed.
If surgery is possible, our approach to pancreatic cancer usually is to complete chemotherapy and radiation before surgery. This method increases chances the tumor can be removed completely, helps chemotherapy and radiation be more effective, and makes for better recovery.
Pancreatic Cancer Treatments
If you are diagnosed with pancreatic cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health.
Your treatment for pancreatic cancer will be customized to your needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
Surgery for pancreatic cancer may be used to help treat the cancer or to help relieve symptoms such as blocked bile ducts or intestine.
Only about 10% of pancreatic cancers are contained entirely within the pancreas at the time of diagnosis. Attempts to remove the entire cancer may be successful in some patients. But even when the cancer seems to have not spread, cancer cells too few to detect may have spread to other parts of the body.
The main types of surgery for pancreatic cancer are:
- Curative: Attempt to treat cancer by removing it
- Palliative: Attempt to relieve symptoms and make you more comfortable
Pancreaticoduodenectomy is the most common surgery to attempt to remove a pancreatic tumor. Also known as the Whipple procedure, this operation removes:
- Head of the pancreas
- Body of the pancreas (in some patients)
- Part of the stomach
- Duodenum (first part of the small intestine)
- A small portion of the jejunum (second part of the small intestine)
- Lymph nodes near the pancreas
- Part of the common bile duct
This major operation carries a high risk of complications, even when it is performed by experienced surgeons. About 30% to 50% of patients suffer complications, including leakage from surgical connections, infections and bleeding.
The surgery takes from six to 12 hours and requires a seven- to 10-day stay in the hospital. You may need nutritional support with a feeding tube or through a vein. Recovery will take about a month. It will be three months before your digestive system works well again.
Studies have shown this pancreatic cancer procedure is more successful and has less risk when it is performed at a major cancer center by doctors with extensive experience in the procedures.
Distal pancreatectomy removes only the tail of the pancreas, or the tail and a part of the body of the pancreas. The spleen usually is removed as well. This operation is used more often with islet cell tumors.
Total pancreatectomy, which removes the entire pancreas and the spleen, was once used for tumors in the body or head of the pancreas. However, when the entire pancreas is removed, patients are left without islet cells, which produce insulin. They develop hard-to-manage diabetes and become dependent on injected insulin. Studies have not shown any advantage to removing the whole pancreas.
Surgical techniques to help relieve symptoms of pancreatic cancer include:
Stent placement: Metal tubes that help keep the bile duct open are inserted, avoiding blockage. This procedure is used more often than biliary bypass. Stents may be placed with an endoscope.
Biliary bypass: The surgeon makes a cut in the gallbladder or bile duct and then sews it to the small intestine. This helps when a tumor is blocking the small intestine and causing bile to build up in the gallbladder. This surgery also may help relieve pain.
Gastric bypass: When pancreatic cancer blocks the stomach, the stomach may be sewn to the small intestine, allowing you to eat normally.
These may be used to help treat exocrine pancreatic cancer when a few tumors have spread. They include:
- Radiofrequency ablation (RFA) heats and destroys tissue with radio waves
- Microwave thermotherapy uses microwaves to heat and destroy cancer
- Cryosurgery or cryoablation freezes tissue to destroy it
Embolization or chemoembolization delivers substances, such as radiation therapy or chemotherapy, to the blood vessels around the tumor, cutting off the blood supply to the pancreatic cancer.
Chemotherapy: MD Anderson offers the most up-to-date and advanced chemotherapy options for pancreatic cancer.
Radiation therapy: New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target pancreatic cancer tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.
MD Anderson is among just a few cancer centers in the nation that offer targeted therapies for some types of pancreatic cancer. These innovative new drugs stop the growth of cancer cells by interfering with certain proteins and receptors or blood vessels that supply the tumor with what it needs to grow.
Nutrition and Pancreatic Cancer
If you have pancreatic cancer you may not feel like eating, especially when you are uncomfortable or tired. In addition, side effects of treatment, such as difficulty swallowing, nausea and vomiting, can make eating difficult.
At MD Anderson, dietitians are a part of your care team. They help establish diet plans and address specific nutritional needs.
Some pancreatic cancer patients who have problems swallowing may require a feeding (enteral) tube. Tube feeding may be temporary to treat acute conditions or long term in the case of chronic illness. A specially trained dietitian teaches patients and caregivers how to use and manage the tube and provides information about nutritional supplements.
Our Pancreatic Cancer Clinical Trials
At MD Anderson, you benefit from one of the most active pancreatic cancer research programs in the United States. This means we are able to offer a wide range of clinical trials (research studies) of new treatments for every type and stage of disease.
MD Anderson is studying ways to make treatment for pancreatic cancer more effective. We’re working to understand pancreatic cancer at the molecular level. Our numerous clinical trials include gene therapy, including tumor suppressor genes, targeted therapies and drugs that target epidermal growth factor.
As one of the world's largest and most experienced comprehensive cancer centers, MD Anderson’s research experts are leading the effort to better treat pancreatic cancer, as well as design more sensitive screening procedures to detect this disease at earlier stages. Our patients benefit from the most advanced pancreatic cancer research, translated into clinical practice as quickly as possible.
Due to the location of the pancreas, detection of tumors at a time early enough to be eligible for surgical removal is rare. Our researchers are working to change that by creating a blood test that signals the presence of cancer. In collaboration with the McCombs Institute for Early Detection of Cancer and its Director Sam Hanash, M.D., Ph.D., we're focusing on subsets of patients that are at high risk for pancreatic cancer, including those with pancreatic “cysts” or new-onset diabetes above the age of 50 years. When developed, this highly sensitive and specific test will detect abnormal molecules that are shed from tumors before the appearance of pancreatic cancer symptoms.
To complement this strategy, we’re also investigating new imaging techniques to visualize pre-cancerous pancreatic lesions called PanINs (pancreatic intraepithelial neoplasias) to detect early precursors of pancreatic cancer. The long term goal of these efforts is to improve the survival rate of pancreatic cancer patients by intercepting pancreatic cancer before it becomes deadly.
We’re also investigating new treatment options for patients with pancreatic cancer. Through preclinical studies, our researchers have identified a tumor-promoting pathway that, when inhibited, reduces the rate of resistance to validated targeted therapy drugs. In collaboration with the Institute for Applied Cancer Science Moon Shot™ platform, we’re developing a drug targeting this pathway that will soon enter Phase I trials. We’re also exploring ways to use new and personalized immunotherapy approaches to enhance a patient’s own immune cells to better fight their pancreatic cancer.
Our commitment to pancreatic cancer research is echoed through:
The Pancreatic Cancer Moon Shot™, which is aimed at rapidly improving pancreatic cancer patient outcomes by collaborating with internal experts and institutes to develop new treatment options and detection technologies.
Through this program and other cutting edge pancreatic cancer research, MD Anderson has:
- Initiated the first pancreatic cancer high-risk clinic, where family members and those at higher risk for pancreatic cancer (such as adults with new onset diabetes) can be screened and advised.
- Pioneered the advance of using chemotherapy before surgery (so-called “neoadjuvant therapy”) to enhance the effectiveness of pancreatic tumor resection. Patients who complete their neoadjuvant therapy and successfully undergo surgery have, on average, significantly longer survival than those who receive upfront surgery.
- Developed a long-term, personalized program to monitor pancreatic cancer patients using serial blood draws (“liquid biopsies”). This program allows us to map their tumor’s response to therapies and predict recurrent disease before it appears
Pancreatic Cancer Moon Shot
MD Anderson’s Pancreatic Cancer Moon Shot™ aims to rapidly and dramatically improve the disease’s survival rates and reduce suffering through prevention, early detection, research and new treatments.Learn more about the Pancreatic Cancer Moon Shot
BY Diego Zamora
Sometimes I forget that I have pancreatic cancer because I just don’t believe it’s going to kill me.
In fact, I’ve never felt healthier, thanks to an exercise program I’m participating in through a clinical trial at MD Anderson.
My pancreatic cancer diagnosis
Last summer, I noticed I was drinking a lot of water and urinating frequently. I also developed severe jaundice. At first, my doctor in Albuquerque, New Mexico thought I’d developed diabetes. But eventually, an ultrasound and MRI revealed a mass on my pancreas. I was shocked, but I’d battled through a cocaine addiction many years ago and knew I had it in me to fight, struggle and overcome again. What I learned from the addiction was that I can survive and I can make it.
Before I could start my pancreatic cancer treatment, my gastroenterologist needed to insert a stent in my pancreas so it could start processing fats again. He tried to place the stent three times, but the tumor kept getting in the way.
My pancreatic cancer treatment at MD Anderson
My wife and friends urged me to seek a second opinion with Dr. David Fogelman at MD Anderson. So, on Oct. 27, 2016, I flew to Houston and met with him. He told me that his colleague, Jeffrey Lee, M.D., could likely do the procedure. If Dr. Lee couldn’t get that stent in, no one in the world could, he told me. I realized then that I was in the best place in the world for pancreatic cancer treatment.
The next day, Dr. Lee successfully inserted a stent where the bile and pancreatic ducts meet. About a month later, I started three weeks of radiation therapy and chemotherapy simultaneously. After that, I’d undergo a Whipple procedure, a surgery that would remove part of my pancreas, stomach and small intestine, as well as my gallbladder.
I also enrolled in a clinical trial that looked at whether exercising before the Whipple procedure helped with recovery. Through the program, I learned how to perform different stretches and exercises using weights and resistance bands. I exercised for five hours a week and walked at least 2 miles every day.
My Whipple procedure
If the clinical trial hadn’t pushed me to exercise, I don’t think I would’ve been strong enough to survive my Whipple procedure on January 10.
The surgery was supposed to take eight hours, but it took Dr. Matthew Katz more than 11. He ended up having to dissect and resect a main portal vein because my tumor had wrapped around its sheath.
How the exercise clinical trial helped me recover
The initial recovery was brutal. I lost nearly 20 pounds while on a liquid diet.
And, for the first week or so, I wasn’t able to pee so they had to insert catheters. I also couldn’t have bowel movements for the first few days, which triggered abdominal pain. But I couldn’t take strong painkillers because of my addiction history, and the hydrocodone they prescribed made me feel too sick.
Despite all that, I still mustered the strength to get out of bed and walk 20 laps around the nurses unit. I even motivated another patient to join me.
The clinical trial didn’t just play a big part in my surgery and recovery; it’s also helped me turn my health around. I now exercise regularly with my wife, and that’s given me the energy to enjoy golfing and camping. It’s also helped me embrace a healthier diet. I’ve cut back on all red meats and started eating more fruits and vegetables.
I’ve never felt better
Cancer is hard, but I can tell you from first-hand experience that recovering from addiction is harder. The difference is in the support you receive. At MD Anderson, I feel safe; I feel comfortable; I feel loved and cared for. The love and the reaching out that happens between people during a cancer journey is unimaginable. It’s an amazing feeling.
Emotionally, spiritually and physically, I’ve never felt better. I’m planning to beat this cancer, so I enjoy every day without worrying about the next.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.