Pancreatic Cancer

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Understanding the Pancreas

The pancreas is an organ located in the upper abdomen behind the stomach and colon, next to the spleen. It has two main jobs: regulating blood sugar through hormones like insulin, and producing digestive enzymes that break down fat, protein, and sugars. Anatomically it is divided into the head, neck, body, tail, and uncinate process, and is in close proximity to several major blood vessels supplying the liver, spleen, and intestines.

Exocrine Function

The exocrine pancreas produces digestive enzymes (lipase, amylase, and proteases) that are released through the pancreatic duct into the small intestine to break down fats, carbohydrates, and proteins. This function accounts for the vast majority of the organ by volume.

Endocrine Function

Scattered throughout the pancreas are clusters of cells called the islets of Langerhans, which produce hormones released directly into the bloodstream. The most important of these are insulin, which lowers blood sugar after meals, and glucagon, which raises it when levels fall, together maintaining stable blood sugar throughout the day.

Overview

What Is Pancreatic Cancer?

Pancreatic cancer is an abnormal, disorganized growth of cells that lose their normal function and replicate rapidly. It can invade neighboring organs and spread to other areas of the body. The most common type is adenocarcinoma; adenosquamous carcinoma and neuroendocrine tumors (PNET) are less common variants.

Diagnosis

How Pancreatic Cancer Is Diagnosed

Once there is a suspicion of pancreas cancer based on imaging or other tests, a diagnosis is often confirmed by obtaining biopsies and other imaging studies that will help determine how advanced the cancer is, and guide treatment decisions.

Imaging

CT Scan

The primary tool for evaluating pancreatic cancer. Determines tumor size and location, vascular involvement, extension beyond the pancreas, and whether the tumor can be surgically removed. Special pancreas protocols are often necessary so your doctor might repeat a CT scan even if you had an initial screening scan to obtain additional detail. The test often involves IV contrast and takes about 15 minutes to perform.

MRI & MRCP

A different kind of imaging study that uses magnets, not radiation. Particularly useful for evaluating the bile ducts, liver lesions, and cases where CT findings are unclear. It is also often performed with intravenous contrast and can take up to one hour to complete.

PET Scan

Specialized test that looks at how cells throughout the body use energy; typically, cancer cells use more and appear as bright spots. Used when CT or MRI results are unclear. Requires fasting; the process takes 2–3 hours total.

Tumor Markers

These are blood-based tests that are often elevated in the presence of malignancy. CA 19-9 is the primary blood test used to monitor pancreatic cancer; levels typically rise when cancer grows and fall when treatment is working. It is not diagnostic on its own, as it can be elevated in some non-malignant conditions and not every patient produces CA 19-9 so it can be normal even in the presence of confirmed cancer. CEA is a secondary marker used alongside CA 19-9, particularly in patients who do not produce CA 19-9.

Biopsy & Procedures

EUS-FNA

A thin flexible scope is passed through the mouth to image the pancreas up close and take a tissue sample with a fine needle. The sample is examined by a pathologist to confirm cancer type. Outpatient procedure; same-day discharge.

ERCP / Biliary Stent

Used when a tumor blocks the bile duct, causing jaundice. A small stent is placed to restore bile flow. Often done in the same session as EUS; the EUS confirms the tumor and takes a biopsy while ERCP relieves the obstruction.

Important

A biopsy is required before starting chemotherapy or radiation. Patients going directly to surgery generally do not need one beforehand. Your team will determine the right sequence.

Staging

How Is Pancreatic Cancer Staged?

The most important initial question in staging is whether the cancer has spread to other organs or the lining of the abdomen (peritoneum). If distant spread is present, treatment focuses on systemic therapy. If it has not spread (stages I through III), patients may be candidates for a combination of systemic and local therapies, including surgery.

Resectability

Resectability refers to a surgeon's ability to completely remove a pancreatic tumor. Because these cancers frequently involve the blood vessels that pass directly behind and through the pancreas (including the superior mesenteric artery and vein and the portal vein), careful preoperative assessment is required. In many cases, vascular involvement can be addressed through resection and reconstruction at the time of surgery. In others, the extent of arterial encasement or multi-vessel involvement carries a risk that outweighs the potential benefit of an operation. This determination is best made by a surgeon experienced in hepatobiliary and pancreatic surgery, reviewing high-quality cross-sectional imaging in the context of the patient's overall condition.

Resectable

The tumor does not involve major arteries or veins. Surgery may be performed upfront or after neoadjuvant chemotherapy, depending on tumor biology and multidisciplinary team assessment.

Borderline Resectable

The tumor contacts and may distort (deform) major blood vessels without encasing them. Systemic chemotherapy is given first to improve the chance of a complete resection, which may require resection of major blood vessels with complex reconstruction.

Locally Advanced

Complex vascular involvement that cannot be safely reconstructed and precludes resection. Initial treatment is based on systemic chemotherapy, with radiation added in selected cases. Patients who demonstrate a favorable response and tumor biology may later be considered for surgery at specialized centers. It is important to plan ahead for possible surgery, as this may affect treatment planning.

Metastatic Disease

Many patients present with metastatic disease at the time of diagnosis. This means that the tumor has spread from the primary tumor in the pancreas to other organs and implies stage IV disease. Most commonly this is seen in the form of liver metastases. In some cases there might be spread to the inner lining of the abdomen or the surface of abdominal organs; often this pattern of spread may not be detectable with radiographic studies and may require direct examination with laparoscopy (see staging laparoscopy); your team will discuss if this procedure is necessary in your case.

Treatment

Treatment Overview

Pancreatic cancer is treated with a combination of approaches tailored to each patient's stage, tumor location, and overall health. Treatment is planned by a multidisciplinary team and typically involves some combination of systemic therapy, surgery, and radiation.

Supportive Care

Supportive Care

Treating the cancer is only part of the journey. Supportive care addresses nutrition, emotional well-being, and comfort throughout diagnosis, treatment, and beyond.

FAQ

Frequently Asked Questions