Pancreatic Cancer

Pancreatic cancer makes up 2.6% of all cancer diagnoses globally, but it is the sixth leading cause of cancer death in the world and one of the most deadly.

The global burden of pancreatic cancer has more than doubled in recent decades, with an estimated 510,000 new cases and 467,000 deaths in 2022. Projections indicate a 95% increase in new cases by 2050, potentially reaching nearly 1 million cases per year.

More young women are being diagnosed, with rates increasing across 39 of 52 countries studied globally. Among adults under 55, the rise in incidence is occurring more quickly in women than in men.

Pancreatic cancer is often caught in later stages, once it has spread to nearby organs, because it poses few symptoms early on. For this reason, it remains one of the hardest cancers to treat.

What is pancreatic cancer?

The pancreas is about six inches long and located deep in the lower abdomen, between the stomach and intestines. Its main job is to create enzymes that help break down food. It also creates hormones that control blood sugar. 

The pancreas has several sections: the wide area is called the head; the two middle sections are the neck and the body; the skinny left area is called the tail. Three main blood vessels run behind the pancreas. 

Pancreatic cancer can form in the exocrine glands that break down food or in the endocrine glands that regulate hormones.

Types of pancreatic cancer

The majority of pancreatic cancers (over 90%) are pancreatic ductal adenocarcinoma, also called pancreatic exocrine cancer. This cancer begins in the exocrine cells. 

Adenocarcinomas begin in glands that line internal organs and make mucus and other fluids. 

Around 8% of pancreatic cancer is caused by neuroendocrine tumors, also called pancreatic endocrine cancer or ​​islet cell tumors. These form in the endocrine cells and are slower growing compared to adenocarcinomas.

Rare types of pancreatic cancer

There are many types of tumors that can grow in the pancreas. A few other very rare types of pancreatic cancer include acinar cell carcinoma, intraductal papillary-mucinous neoplasm (IPMN), and mucinous cystic neoplasm.  

Staging pancreatic cancer

Staging helps you understand the size of your tumor, where the cancer is now, and the best treatment plan for your unique situation. 

Pancreatic adenocarcinomas are staged on a scale from 0-4 (researchers use roman numerals 0-IV) based on the TNM staging system. In general:

• Stage 0 (carcinoma in situ): Abnormal cells are present but have not grown into surrounding tissue or spread anywhere else.
  Stage 1: The tumor is confined to the pancreas. Stage 1A is 2 cm or smaller; Stage 1B is larger than 2 cm but no larger than 4 cm.
  Stage 2: The tumor is larger than 4 cm and still confined to the pancreas, or has spread to 1–3 nearby lymph nodes but not to distant organs.
  Stage 3: The tumor has spread to 4 or more nearby lymph nodes, or has grown into major blood vessels near the pancreas. Surgery may still be considered in some cases but is often not possible.
  Stage 4 (also called "metastatic"): Cancer has spread to distant organs such as the liver, lungs, or abdomen. It may or may not be in lymph nodes. Cannot be removed by surgery.

Pancreatic cancer resectability

In pancreatic cancer, the resectability is also an important factor that will influence treatment. You'll be categozied as resectable, borderline resectable, and locally advanced (unresectable). Resectable pancreatic cancer can be removed by surgery because it has not grown into major blood vessels; borderline resectable cancer has grown into a major blood vessel or nearby tissue with a high risk that all cancer cells will not be removed; locally advanced cancer has vascular involvement that precludes surgery.

What causes pancreatic cancer?

Risk factors put you at a higher risk of getting cancer. Some risk factors can be controlled with lifestyle changes, and others cannot. Older age, smoking, and obesity increase your risk of many cancers.

Just because you have a risk factor, that doesn’t mean you will get cancer. 

These are scenarios researchers have found that can increase your risk: 

• Pancreatitis
• Diabetes
• Certain inherited syndromes like Lynch syndrome, FAP, Peutz-Jeghers syndrome, familial atypical multiple mole melanoma (FAMMM) syndrome and cystic fibrosis; and certain inherited mutations in genes like BRCA, ATM, and PALB2.
• Family history of pancreatic cancer
• Exposure to certain chemicals
• Gum disease and tooth loss
• Pancreatic cysts
• Polycystic ovary syndrome (PCOS)

Preventing pancreatic cancer

There are not any known ways to prevent pancreatic cancer nor are there any approved screening or early detection tests.

Because 10% of pancreatic cancers are caused by inherited conditions, it’s important to know your family’s health history and if pancreatic cancer runs in your family. Your risk increases with the more cases in the family.

As with every cancer, there are steps you can take to adopt a healthy lifestyle and reduce your overall cancer risk, such as maintaining a healthy weight, not smoking, and limiting or eliminating alcohol. 

Learn more about cancer prevention from the American Institute for Cancer Research.

What are some pancreatic cancer statistics? 

According to GLOBOCAN 2022:

• An estimated 510,566 people were diagnosed with pancreatic cancer globally in 2022, and 467,005 died from the disease. The number of deaths is nearly equal to the number of new cases.
• Pancreatic cancer is slightly more common in men than women globally.

According to the World Cancer Research Fund and JOGN/GCO:

• China, the United States, and Japan had the highest total number of pancreatic cancer cases in 2022.
• Northern America and Europe bear the highest burden by incidence rate, though Asia faces the greatest projected absolute growth through 2050.
• By 2050, new pancreatic cancer cases in adults over 50 are projected to rise by 85–88% globally
• Africa is projected to experience the fastest mortality growth at 159%
• Incidence in young women is rising in 39 of 52 countries studied globally

According to data in the World Journal of Gastroenterology:

• The average age at diagnosis globally is 70 years, with incidence most prevalent in those aged 65–75.
• In European studies, patient ages at diagnosis range from 57 to 74 years.
  

What are my odds of surviving it?

Doctors use what’s called “survival statistics” to understand the likelihood of a patient beating the disease.

According to the National Cancer Institute, 13% of patients are alive five years after a pancreatic cancer diagnosis.

Detailed survival statistics are based on where the cancer is located and if it has spread:

Localized

The cancer hasn’t spread

• 15.4% of cases
• 43.6% alive five years after diagnosis 

Regional

The cancer spread to nearby structures or lymph nodes

• 28% of cases
• 16.7% alive five years after diagnosis 

Distant

The cancer has spread to other organs

• 51% of cases
• 3.2% alive five years after diagnosis 
  

What types of tests should I expect to undergo?

Doctors will likely use these tests to diagnose pancreatic cancer:

• Blood tests checking bilirubin, liver enzymes, and tumor markers
• CT
• MRI
• Biopsy
• Endoscopic ultrasound
  

Other specialized tests and procedures may also be used to identify and diagnose pancreatic cancer.

Ask your doctor about these additional tests—ideally before you begin treatment.

• Biomarker testing
• Genetic testing

I’m facing a diagnosis: What are my next steps?

If you’re facing a diagnosis, the GI Cancers Alliance is here for you. 

If you’re newly diagnosed, work with your doctor to create a treatment plan. It’s important to find an expert who specializes in pancreatic cancer and visit a major cancer center if possible. If surgery is an option, find a surgeon who performs a high volume of pancreatic surgeries each year. The Whipple procedure (pancreaticoduodenectomy) is one of the most complex abdominal surgeries to receive, and outcomes are significantly better at centers performing high volumes.

Pancreatic cancer treatment plans may include a combination of:

• Surgery (whipple is most common procedure)
• Chemotherapy 
• Radiation 
• Targeted therapy
• Immunotherapy

ctDNA

A liquid biopsy is a blood test that detects fragments of tumor DNA circulating in the bloodstream, called circulating tumor DNA (ctDNA). In pancreatic cancer, liquid biopsy is increasingly being used in several important ways.

First, for patients who undergo surgery, a positive ctDNA result after the operation can indicate that cancer cells remain in the body even when scans appear clear. This may help guide a doctor's decision to recommend chemotherapy after surgery, or to intensify the treatment approach.

Second, during and after treatment, ctDNA can be monitored over time to assess how well the cancer is responding or to detect early signs of recurrence — sometimes months before a tumor would be visible on imaging.

Third, because pancreatic cancer is so often diagnosed at a late stage, ctDNA is being actively studied as an early detection tool in people at high risk, including those with inherited mutations in BRCA1, BRCA2, PALB2, or ATM, or a strong family history of the disease. Several large clinical trials are currently evaluating whether regular ctDNA testing in high-risk individuals can catch pancreatic cancer earlier, when treatment is more likely to be effective.

Liquid biopsy is not yet a universal standard of care in pancreatic cancer and is still being studied, but it is increasingly available at major cancer centers. Ask your care team whether ctDNA testing is appropriate for your situation.

We strongly encourage you to get a second opinion from another trusted doctor so you feel confident moving forward.