Pancreatic Cancer

Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas. In this serious cancer, the two pancreatic glands — exocrine and endocrine cells — form different types of tumors:

  • Exocrine tumors: The most common (about 95% of cases), which usually begin in the ducts (tubular canals) of the pancreas, but sometimes form in the cells that make the pancreatic enzymes. Treatment depends on the stage, or extent of the cancer. Another form of exocrine tumor is called an ampullary cancer, which develops where the bile duct and pancreatic duct come together and empty into the duodenum. Read more about treatment and information on exocrine tumors.
  • Endocrine tumors: These are much less common, but often have a better prognosis. As a group, they are known as neuroendocrine tumors or islet cell tumors. These can arise in the cells that make insulin or glucagon, as well as cells that make the hormones gastrin and somatostatin, or in vasoactive intenstinal peptides.

Another type of cancer involving the pancreas is called an intraductal papillary mucinous neoplasm (IPMN), which can have a higher cure rate than the previously mentioned types of pancreatic cancer. Imaging studies can usually determine if you have IPMN.

Unfortunately, many cases of pancreatic cancer are not discovered until a late stage, due to the difficulty in imaging this nearly-hidden organ, and because symptoms rarely appear early. 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.

Our patients with pancreatic cancer are treated at the Pancreatic Cancer Unit. See Pancreatic Cancer Unit for more information.

You can also review the tabs at top of this page for information on pancreatic cancer symptoms and risks, diagnosis, and treatment.

Symptoms

Because it does not cause symptoms early on, and because routine pancreas screening is not plausible (due to the pancreas’ location behind other organs), the serious forms of pancreatic cancer may grow for some time before they show symptoms such as:

  • Jaundice, a yellowish appearance of the skin and whites of the eyes
  • Pain in the upper abdomen or back
  • Pressure in the abdomen
  • Nausea
  • Loss of appetite
  • Depression
  • Weakness

Risk factors

  • Smoking
  • Long-standing diabetes
  • Chronic pancreatitis
  • Cirrhosis
  • Certain hereditary conditions
  • Diet high in fat

Diagnosis

If you experience one or more of the symptoms linked to pancreatic cancer and wish to be seen by a UC San Diego physician, or if your doctor has referred you to Moores UCSD Cancer Center, your medical history will be taken, you will receive a thorough physical examination, and you’ll be scheduled for laboratory and imaging tests. A biopsy (the removal of a small sample of the tumor with a fine needle) may also be taken during one of the imaging exams.  If pancreatic cancer is diagnosed, the information gathered will pinpoint the location, size and stage of the cancer. This information will help your medical team design your specific treatment plan.

If you've already been diagnosed with pancreatic cancer, our physicians will take your medical history, examine you, evaluate the tests you’ve already received, and order additional tests as needed.

Advanced imaging techniques for pancreatic cancer

Pancreatic cancer is usually diagnosed with tests and procedures that produce pictures of the pancreas and the area around it.

Endoscopic Ultrasonography

In this procedure, you will receive intravenous sedation so that an endoscope (a thin, lighted tube) can be inserted into the abdominal area, next to the pancreas. The endoscope has a special miniaturized ultrasound built onto the tip, so that physicians can detect even the smallest of growths.  This procedure also differentiates between a tumor and a non-cancerous stone that might be blocking the bile duct.  If the physician sees a pancreatic mass, a needle can be inserted into the mass to take a biopsy, which is immediately evaluated by a pathologist who is right there, in the room with you. UCSD physicians are regional experts in Endoscopic Ultrasound.

CT (Computed Tomography) scan

During a CT scan, a series of detailed pictures are taken of areas inside the body, from different angles.  UCSD’s high-quality, multidetector CT scanners are able to obtain detailed images of the pancreas and adjacent organs and vessels.  You will receive an intravenous (IV) contrast injected into your vein, allowing radiologists to precisely determine the extent of the cancer and any involvement of adjacent organs.

MRI (Magnetic Resonance Imaging)

In selected patients, an MRI scan may be performed instead of, or in addition to the CT scan.  UCSD is a leader in MRI, with multiple scanners available to provide high resolution imaging of the pancreas.  An MRI provides detailed information about all parts of the pancreas, including areas that are hard to see on a CT scan, such as pancreatic ducts and channels that can be involved by cancer. As with a CT scan, you will receive an intravenous (IV) contrast injected into your vein.

Staging

In order to plan treatment, it is best to know the size, location and stage of the cancer.

The American Cancer Society recommends the American Joint Committee on Cancer (AJCC) TNM system of staging:

  • T describes the size of the primary tumor, measured in centimeters
  • N describes the spread to nearby lymph nodes
  • M indicates whether the cancer has metastasized (spread) to other organs.

The numbers and/or letters after TNM provide more detail about each of these factors. According to the National Cancer Institute, these numbers are:

  • Stage 0 – the cancer is found only in the lining of the pancreas
  • Stage I – the cancer is only in the pancreas, if IA the tumor is 2 centimeters or smaller, IB if larger than 2 centimeters
  • Stage II – in IIA, the cancer may have spread to nearby tissue and organs; in IIB, it has also spread to nearby lymph nodes
  • Stage III – the cancer has spread to major blood vessels near the pancreas and may have spread to nearby lymph nodes
  • State IV – the cancer may be of any size and has spread to distant organs, such as the liver, lung and peritoneal cavity

After your diagnosis, your physician will discuss your treatment options, which may include:

The treatment selected for you will be customized to your unique condition. In advanced cancers of the pancreas that have grown too far to be completely removed by surgery, the standard treatments are chemotherapy with the drug Gemcitabine and Erlotinib or the combination of radiation therapy and chemotherapy with Gemcitabine or 5-Fluorouracil (5-FU). In some cases of widespread, metastatic cancer of the pancreas, additional medications may be considered, as well.

If at all possible, your doctor will recommend surgery to remove the tumor. However, the location, size and stage of the cancer may not make surgery an option. Only about 20% of pancreatic cancers can be removed by surgery, due to the nature of the illness. Most cases of pancreatic cancer are diagnosed after the cancer has already spread. Because the pancreas is located behind the stomach, in the back of the body, early-growth tumors can’t be felt by the physician in a routine exam. In addition, pancreatic cancer does not cause symptoms early on. So, by the time it is diagnosed, pancreatic cancer has frequently spread and is inoperable. Following surgery, you may also receive chemotherapy and/or radiation therapy.

Other options

Another treatment option your physician may discuss with you is participation in one of our clinical trials. This is your access to the most promising new therapies being tested. The decision to enter a clinic trial is always up to you.

Palliative care, an important part of your treatment, is designed to relieve suffering and improve the quality of your life. It is care that treats physical and emotional symptoms caused by your cancer and/or your treatment. Palliative care is available to you at all stages of cancer and your specific treatment.