Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body. See What Is Cancer? to learn more about how cancers start and spread.

Pancreatic cancer starts when cells in the pancreas start to grow out of control. The pancreas is an organ that sits behind the stomach. It's shaped a bit like a fish with a wide head, a tapering body, and a narrow, pointed tail. In adults it's about 6 inches long but less than 2 inches wide. The head of the pancreas is on the right side of the abdomen (belly), behind where the stomach meets the duodenum (the first part of the small intestine). The body of the pancreas is behind the stomach, and the tail of the pancreas is on the left side of the abdomen next to the spleen.

Survival rates tell you what portion of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed. They can’t tell you how long you will live, but they may help give you a better understanding about how likely it is that your treatment will be successful. Some people will want to know the survival rates for their cancer, and some people won’t. If you don’t want to know, you don’t have to.

What is a 5-year survival rate?

Statistics on the outlook for a certain type and stage of cancer are often given as 5-year survival rates, but many people live longer – often much longer – than 5 years. The 5-year survival rate is the percentage of people who live at least 5 years after being diagnosed with cancer. For example, a 5-year survival rate of 70% means that an estimated 70 out of 100 people who have that cancer are still alive 5 years after being diagnosed. Keep in mind, however, that many of these people live much longer than 5 years after diagnosis.

But remember, the 5-year relative survival rates are estimates – your outlook can vary based on a number of factors specific to you.

Cancer survival rates don’t tell the whole story

Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they can’t predict what will happen in any particular person’s case. There are a number of limitations to remember:

• The numbers below are among the most current available. But to get 5-year survival rates, doctors have to look at people who were treated at least 5 years ago. As treatments are improving over time, people who are now being diagnosed with pancreatic cancer may have a better outlook than these statistics show.
• These statistics are based on the stage of the cancer when it was first diagnosed. They do not apply to cancers that later come back or spread, for example.
• The outlook for people with pancreatic cancer varies by the stage (extent) of the cancer – in general, the survival rates are higher for people with earlier stage cancers. But many other factors can affect a person’s outlook, such as age and overall health, and how well the cancer responds to treatment. The outlook for each person is specific to their circumstances.

Your doctor can tell you how these numbers may apply to you, as he or she is familiar with your particular situation.

Survival rates for exocrine pancreatic cancer

The numbers below come from the National Cancer Data Base and are based on people diagnosed with exocrine pancreatic cancer between 1992 and 1998. In general, people who can be treated with surgery tend to live longer than those not treated with surgery.

• The 5-year survival rate for people with stage IA pancreatic cancer is about 14%. For stage IB cancer, the 5-year survival rate is about 12%.
• For stage IIA pancreatic cancer, the 5-year survival rate is about 7%. For stage IIB cancer, the 5-year survival rate is about 5%.
• The 5-year survival rate for stage III pancreatic cancer is about 3%.
• Stage IV pancreatic cancer has a 5-year survival rate of about 1%. Still, there are often treatment options available for people with this stage of cancer.

Remember, these survival rates are only estimates – they can’t predict what will happen to any individual person. We understand that these statistics can be confusing and may lead you to have more questions. Talk to your doctor to better understand your specific situation.

Survival rates for neuroendocrine pancreatic tumors (treated with surgery)

For pancreatic neuroendocrine tumors (NETs), survival statistics by stage are only available for patients treated with surgery. These numbers come from the National Cancer Data Base and are based on patients diagnosed between 1985 and 2004.

• The 5-year survival rate for people with stage I pancreatic NETs is about 61%.
• For stage II pancreatic NETs, the 5-year survival rate is about 52%.
• The 5-year relative survival rate for stage III pancreatic NETs is about 41%.
• Stage IV pancreatic NETs have a 5-year survival rate of about 16%. Still, there are often treatment options available for people with these cancers.

In this database, the overall 5-year survival rate for people who did not have their tumors removed by surgery was 16%.

Research into the causes, diagnosis, and treatment of pancreatic cancer is under way in many medical centers throughout the world.

Genetics and early detection

Scientists are learning more about some of the gene changes in pancreas cells that cause them to become cancer. Inherited changes in genes such as BRCA2, p16, and the genes responsible for Lynch syndrome can increase a person’s risk of developing pancreatic cancer.

Researchers are now looking at how these and other genes may be altered in pancreatic cancers that are not inherited. Pancreatic cancer actually develops over many years in a series of steps known as pancreatic intraepithelial neoplasia or PanIN. In the early steps, such as PanIN 1, there are changes in a small number of genes, and the duct cells of the pancreas do not look very abnormal. In later steps such as PanIN 2 and PanIN 3, there are changes in several genes and the duct cells look more abnormal.

Researchers are using this information to develop tests for detecting acquired (not inherited) gene changes in pancreatic pre-cancerous conditions. One of the most common DNA changes in these conditions affects the KRAS oncogene, which affects regulation of cell growth. New diagnostic tests are often able to recognize this change in samples of pancreatic juice collected during an ERCP (endoscopic retrograde cholangiopancreatography).

For now, imaging tests like endoscopic ultrasound (EUS), ERCP, and genetic tests for changes in certain genes (such as KRAS) are options for people with a strong family history of pancreatic cancer. But these tests are not recommended for widespread testing of people at average risk who do not have any symptoms.

Other tests are looking to see if groups of proteins found in the blood might be used to find pancreatic cancer early, when it is likely to be easier to treat. Some early results with this approach have been promising, but more research is needed to confirm its usefulness.

Treatment

A lot of research is focused on finding better treatments for pancreatic cancer. Improving surgery and radiation therapy are major goals, as is determining the best combination of treatments for people with certain stages of cancer.

Surgery

Surgery to remove pancreatic cancer (most often a Whipple procedure) is a long and complex operation that can be hard both for the surgeon and the patient. It often requires a long hospital stay, at least in part because of the long incision (cut) made in the belly.

A newer approach now used at some major medical centers is to do the operation laparoscopically. For this approach, the surgeon makes several small incisions in the belly instead of one large one. Long, thin surgical tools and a tiny video camera are then inserted through these cuts to do the operation. One advantage of this surgery is that people often recover from it more quickly. But this is still a difficult operation. Surgeons are looking to see how it compares to the standard operation and which patients might be helped the most by it.

Radiation therapy

Some studies are looking at different ways to give radiation to treat pancreatic cancer. These include intraoperative radiation therapy (in which a single large dose of radiation is given to the area of the cancer in the operating room at the time of surgery) and proton beam radiation (which uses a special type of radiation that might do less damage to nearby normal cells).

Chemotherapy

Many clinical trials are testing new combinations of chemotherapy drugs for pancreatic cancer. Many studies are seeing if combining gemcitabine with other drugs can help people live longer. Other newer chemo drugs are also being tested, as are combinations of chemo drugs with newer types of drugs.

Targeted therapies

Targeted drugs work differently from standard chemo drugs in that they attack only specific targets on cancer cells (or nearby cells). Targeted therapies may prove to be useful along with, or instead of, current treatments. In general, they seem to have fewer side effects than traditional chemo drugs. Looking for new targets to attack is an active area of cancer research.

Growth factor inhibitors: Many types of cancer cells, including pancreatic cancer cells, have certain proteins on their surface that help them grow. These proteins are called growth factor receptors. One example is epidermal growth factor receptor (EGFR). Several drugs that target EGFR are now being studied. One, known as erlotinib (Tarceva), is already approved for use along with gemcitabine.

Anti-angiogenesis factors: All cancers depend on new blood vessels to nourish their growth. To block the growth of these vessels and thereby starve the tumor, scientists have developed anti-angiogenesis drugs. These are being studied in clinical trials for patients with pancreatic cancer.

Drugs that target the tumor stroma (supporting tissue): Chemotherapy is not always helpful for pancreatic cancer. This is partly because of the cancer cells themselves. But another reason might be that the dense supportive tissue (stroma) in the tumor seems to form a barrier that helps protect the cancer cells from the chemo drugs. Researchers are now testing drugs such as PEGPH20, which attack the stroma directly to help break it down. This might allow chemo or other drugs to be more effective. This and similar drugs are now in clinical trials.

Drugs that target cancer stem cells: One theory as to why pancreatic cancer is difficult to treat is based on the idea that not all of the cancer cells in a tumor are the same. There might be a small group of cancer cells, called stem cells, that drive tumor growth and are resistant to chemo, so even if the other cells are killed, the cancer will continue to grow. Drugs that are thought to target such stem cells, such as BBI-608 and demcizumab, are now being tested along with chemotherapy, and some early results from these studies have been promising.

Other targeted therapies: Many drugs targeting other aspects of cancer cells are now being studied for use in pancreatic cancer.

Immune therapy

Immune therapies attempt to boost a person’s immune system or give them ready-made components of an immune system to attack cancer cells. Some studies of these treatments have shown promising results.

Monoclonal antibodies: One form of immune therapy uses injections of man-made monoclonal antibodies. These immune system proteins are made to home in on a specific molecule, such as carcinoembryonic antigen (CEA), which is sometimes found on the surface of pancreatic cancer cells. Toxins or radioactive atoms can be attached to these antibodies, which bring them directly to the tumor cells. The hope is that they will affect cancer cells while leaving normal cells alone. For use in pancreatic cancer, these types of treatments are available only in clinical trials at this time.

Cancer vaccines: Several types of vaccines for boosting the body’s immune response to pancreatic cancer cells are being tested in clinical trials. Unlike vaccines against infections like measles or mumps, these vaccines are designed to help treat, not prevent, pancreatic cancer. One possible advantage of these types of treatments is that they tend to have very limited side effects. At this time, vaccines are available only in clinical trials.

Drugs that target immune system checkpoints: The immune system normally keeps itself from attacking other normal cells in the body by using “checkpoints” – molecules on immune cells that need to be activated (or inactivated) to start an immune response. Cancer cells sometimes find ways to use these checkpoints to avoid being attacked by the immune system. Newer drugs that target these checkpoints have shown a lot of promise in treating some types of cancer. Some of these are now being studied for use in pancreatic cancer.

Individualization of therapy

Some drugs seem to work better if certain types of mutations can be found in the patient’s tumor. For example, erlotinib may work better in patients whose tumors have a particular change in the EGFR gene. This concept is an area of intense study. There might also be some gene alterations that affect how well gemcitabine will work in a particular patient. Identifying markers that can predict how well a drug will work before it is given is an important area of research in many types of cancer.

Advances for pancreatic neuroendocrine tumors (NETs)

Many pancreatic NETs have receptors for somatostatin on their cells. This allows these tumors to be detected with imaging tests such as somatostatin receptor scintigraphy (OctreoScan), as well as to be treated with octreotide and other drugs like it.

Newer forms of octreotide have shown even more promise in detecting and treating NETs. For example:

• Gallium-68 (Ga-68) DOTATATE is a slightly radioactive drug that can be used as part of a PET/CT scan to detect NETs. Some research has found that it might be better at this than the OctreoScan.
• Lutetium-177 (Lu-177) DOTATATE is a different radioactive form of this drug that can be used to treat some NETs. It is injected into a vein, and the octreotide portion of the drug brings the radiation directly to the tumor. This type of treatment, known as peptide receptor radionuclide therapy (PRRT), has been shown to shrink some tumors and keep others from growing in early studies.

If a person has signs and symptoms that might be caused by pancreatic cancer, certain exams and tests will be done to find the cause. If cancer is found, more tests will be done to help determine the extent (stage) of the cancer.

Medical history and physical exam

Your doctor will ask about your medical history to learn more about your symptoms. The doctor might also ask about possible risk factors, including your family history.

Your doctor will also examine you to look for signs of pancreatic cancer or other health problems. The exam will probably focus mostly on your belly. Pancreatic cancers can sometimes cause the liver or gallbladder to swell, which the doctor might be able to feel during the exam. Your skin and the whites of your eyes will also be checked for jaundice (yellowing).

If the results of the exam are abnormal, your doctor will probably order tests to help find the problem. You might also be referred to a gastroenterologist (a doctor who treats digestive system diseases) for further tests and treatment.

Imaging tests

Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests might be done for a number of reasons both before and after a diagnosis of pancreatic cancer, including:

• To look for suspicious areas that might be cancer
• To learn if and how far cancer has spread
• To help determine if treatment is working
• To look for signs of cancer coming back after treatment

Computed tomography (CT) scan

The CT scan makes detailed cross-sectional images of your body. CT scans are often used to diagnose pancreatic cancer because they can show the pancreas fairly clearly. They can also help show if cancer has spread to organs near the pancreas, as well as to lymph nodes and distant organs. A CT scan can help determine if surgery might be a good treatment option.

If your doctor thinks you might have pancreatic cancer, you might get a special type of CT known as a multiphase CT scan or a pancreatic protocol CT scan. During this test, different sets of CT scans are taken over several minutes after you get an injection of an intravenous (IV) contrast.

CT-guided needle biopsy: CT scans can also be used to guide a biopsy needle into a suspected pancreatic tumor. But if a needle biopsy is needed, most doctors prefer to use endoscopic ultrasound (described below) to guide the needle into place.

Magnetic resonance imaging (MRI)

MRI scans use radio waves and strong magnets instead of x-rays to create detailed images of parts of your body. Most doctors prefer to look at the pancreas with CT scans, but an MRI might also be done.

Special types of MRI scans can also be used in people who might have pancreatic cancer:

• MR cholangiopancreatography (MRCP), which can be used to look at the pancreatic and bile ducts, is described below in the section on cholangiopancreatography.
• MR angiography (MRA), which looks at blood vessels, is mentioned below in the section on angiography.

Ultrasound

Ultrasound tests use sound waves to create images of organs such as the pancreas.

Abdominal ultrasound: For this test, a wand-shaped probe is moved over the skin of the abdomen. It gives off sound waves and detects the echoes as they bounce off organs. If it’s not clear what might be causing a person’s abdominal symptoms, this might be the first test done because it is easy to do and it doesn’t expose a person to radiation. But if signs and symptoms are more likely to be caused by pancreatic cancer, a CT scan is often more useful.

Endoscopic ultrasound (EUS): This test is more accurate than abdominal ultrasound and can be very helpful in diagnosing pancreatic cancer. This test is done with a small ultrasound probe on the tip of an endoscope, which is a thin, flexible tube that doctors use to look inside the digestive tract.

For this test, you will first be sedated (given medicine to make you sleepy). The scope is then passed through your mouth or nose, down through the stomach, and into the first part of the small intestine. It is then pointed toward the pancreas, which is next to the small intestine. The probe on the tip of the endoscope can get very close to the pancreas, so this is a very good way to look at the pancreas. If a tumor is seen, a small, hollow needle can be passed down the endoscope to get biopsy samples of it.

Cholangiopancreatography

This is an imaging test that looks at the pancreatic ducts and bile ducts to see if they are blocked, narrowed, or dilated. These tests can help show if someone might have a pancreatic tumor that is blocking a duct. They can also be used to help plan surgery. The test can be done in different ways, each of which has pros and cons.

Endoscopic retrograde cholangiopancreatography (ERCP): For this test, an endoscope (a thin, flexible tube with a tiny video camera on the end) is passed down the throat, through the esophagus and stomach, and into the first part of the small intestine. This is usually done while you are sedated (given medicine to make you sleepy).

The doctor can see through the endoscope to find the ampulla of Vater (where the common bile duct empties into the small intestine). The doctor guides a catheter (a very small tube) through the tip of the endoscope and into the common bile duct. A small amount of dye (contrast material) is then injected into the common bile duct, and x-rays are taken. This dye outlines the bile and pancreatic ducts. The x-rays can show narrowing or blockage in these ducts that might be due to pancreatic cancer. The doctor doing this test can also put a small brush through the tube to remove cells for a biopsy (see below).

ERCP can also be used to place a stent (small tube) into a bile or pancreatic duct to keep it open if a nearby tumor is pressing on it. This is described in more detail in the section on palliative surgery in Surgery for pancreatic cancer.

Magnetic resonance cholangiopancreatography (MRCP): This is a non-invasive way to look at the pancreatic and bile ducts using the same type of machine used for standard MRI scans. Unlike ERCP, it does not require an infusion of a contrast dye. Because this test is non-invasive, doctors often use MRCP if the purpose is just to look at the pancreatic and bile ducts. But this test can’t be used to get biopsy samples of tumors or to place stents in ducts.

Percutaneous transhepatic cholangiography (PTC): In this procedure, the doctor puts a thin, hollow needle through the skin of the belly and into a bile duct within the liver. A contrast dye is then injected through the needle, and x-rays are taken as it passes through the bile and pancreatic ducts. As with ERCP, this approach can also be used to take fluid or tissue samples or to place a stent into a duct to help keep it open. Because it is more invasive (and might cause more pain), PTC is not usually used unless ERCP has already been tried or can’t be done for some reason.

Somatostatin receptor scintigraphy (SRS)

This test, also known as OctreoScan, can be very helpful in finding pancreatic neuroendocrine tumors (NETs). A hormone-like substance called octreotide that is bound to a radioactive substance is injected into a vein. Octreotide travels through the blood and attaches to the tumor cells of many types of NETs (although it is less helpful for insulinomas).

Several hours after the injection, a special camera can be used to show where the radioactivity is in the body. More scans may be done on the following few days as well.

This scan can also help decide on treatment. NETs that show up on SRS scans will often stop growing if treated with octreotide.

Positron emission tomography (PET) scan

For a PET scan, you are injected with a slightly radioactive form of sugar, which collects mainly in cancer cells. A special camera is then used to create a picture of areas of radioactivity in the body.

This test is sometimes used to look for spread from exocrine pancreatic cancers, but because NETs grow slowly, they do not show up well on PET scans.

PET/CT scan: Special machines can do both a PET and CT scan at the same time. This lets the doctor compare areas of higher radioactivity on the PET scan with the more detailed appearance of that area on the CT scan. This test can help determine the stage (extent) of the cancer. It might be especially useful for spotting cancer that has spread beyond the pancreas and wouldn’t be treatable by surgery.

Angiography

This is an x-ray test that looks at blood vessels. A small amount of contrast dye is injected into an artery to outline the blood vessels, and then x-rays are taken.

An angiogram can show if blood flow in a particular area is blocked or compressed by a tumor. It can also show abnormal blood vessels (feeding the cancer) in the area. This test can be useful in finding out if a pancreatic cancer has grown through the walls of certain blood vessels. Mainly, it helps surgeons decide if the cancer can be removed completely without damaging vital blood vessels, and it can also help them plan the operation.

Angiography can also be used to look for pancreatic NETs that are too small to be seen on other imaging tests. These tumors cause the body to make more blood vessels to “feed” the tumor, which can often be seen on angiography.

X-ray angiography can be uncomfortable because the doctor has to put a small catheter into the artery leading to the pancreas. Usually the catheter is put into an artery in your inner thigh and threaded up to the pancreas. A local anesthetic is often used to numb the area before inserting the catheter. Once the catheter is in place, the dye is injected to outline all the vessels while the x-rays are being taken.

Angiography can also be done with a CT scanner (CT angiography) or an MRI scanner (MR angiography). These techniques are now used more often because they can give the same information without the need for a catheter in the artery. You might still need an IV line so that a contrast dye can be injected into the bloodstream during the imaging.

Blood tests

Several types of blood tests can be used to help diagnose pancreatic cancer or to help determine treatment options if it is found.

Blood tests for exocrine pancreatic cancers

Liver function tests: Jaundice (yellowing of the skin and eyes) is often one of the first signs of pancreatic cancer, but it can have many causes other than cancer. Doctors often get blood tests to assess liver function in people with jaundice to help determine its cause.

For example, blood tests that look at levels of different kinds of bilirubin (a chemical made by the liver) can help tell whether a patient’s jaundice is caused by disease in the liver itself or by a blockage of bile flow (from a gallstone, a tumor, or other disease).

Tumor markers: Tumor markers are substances that can sometimes be found in the blood when a person has cancer. Two tumor markers may be helpful in pancreatic cancer:

• CA 19-9
• Carcinoembryonic antigen (CEA), which is not used as often as CA 19-9

Neither of these tumor marker tests is accurate enough to tell for sure if someone has pancreatic cancer. Levels of these tumor markers are not high in all people with pancreatic cancer, and some people who don’t have pancreatic cancer might have high levels of these markers for other reasons. Still, these tests can sometimes be helpful, along with other tests, in figuring out if someone has cancer.

In people already known to have pancreatic cancer and who have high CA19-9 or CEA levels, these levels can be measured over time to help tell how well treatment is working. If all of the cancer has been removed, these tests can also be done to look for the cancer coming back.

Other blood tests: Other tests can help evaluate a person’s general health (such as kidney and bone marrow function). These tests can help determine if they’ll be able to withstand the stress of a major operation.

Blood tests for pancreatic neuroendocrine tumors

Blood tests looking at the levels of certain pancreatic hormones can often help diagnose pancreatic neuroendocrine tumors (NETs). Tests might be done to check blood levels of:

• Hormones made by different types of NET cells, such as insulin, gastrin, glucagon, somatostatin, pancreatic polypeptide, and VIP (vasoactive intestinal peptide)
• Chromogranin A (CgA)
• Glucose and C-peptide (for insulinomas)

Carcinoid tumors: For carcinoids, a blood test may be done to look for serotonin, which is made by many of these tumors. The urine might also be tested for serotonin and for related chemicals such as 5-HIAA and 5-HTP.

Other common tests to look for carcinoids include blood tests for chromogranin A (CgA), neuron-specific enolase (NSE), substance P, and gastrin.

Depending on where the tumor might be located and the patient’s symptoms, doctors might do other blood tests as well.

Biopsy

A person’s medical history, physical exam, and imaging test results may strongly suggest pancreatic cancer, but usually the only way to be sure is to remove a small sample of tumor and look at it under the microscope. This procedure is called a biopsy. Biopsies can be done in different ways.

Percutaneous (through the skin) biopsy: For this test, a doctor inserts a thin, hollow needle through the skin over the abdomen and into the pancreas to remove a small piece of a tumor. This is known as a fine needle aspiration (FNA). The doctor guides the needle into place using images from ultrasound or CT scans.

Endoscopic biopsy: Doctors can also biopsy a tumor during an endoscopy. The doctor passes an endoscope (a thin, flexible, tube with a small video camera on the end) down the throat and into the small intestine near the pancreas. At this point, the doctor can either use endoscopic ultrasound (EUS) to pass a needle into the tumor or endoscopic retrograde cholangiopancreatography (ERCP) to remove cells from the bile or pancreatic ducts. These tests are described in more detail above. You will be sedated (made sleepy) for these tests, but general anesthesia (being put into a deep sleep) is not usually needed. Major side effects from these types of biopsies are rare.

Surgical biopsy: Surgical biopsies are now done less often than in the past. They can be useful if the surgeon is concerned the cancer has spread beyond the pancreas and wants to look at (and possibly biopsy) other organs in the abdomen.

The most common way to do a surgical biopsy is to use laparoscopy (sometimes called keyhole surgery). You will be sedated or asleep for this procedure. The surgeon makes several small incisions (cuts) in the abdomen and inserts long, thin instruments. One of these has a small video camera on the end to let the surgeon see inside the abdomen. The surgeon can look at the pancreas and other organs for tumors and take biopsy samples of abnormal areas.

In the past, surgeons often used a laparotomy (a large incision through the skin into the wall of the abdomen) to examine internal organs and take biopsies. But this type of surgery requires a longer recovery and is now rarely used.

Some people might not need a biopsy

Rarely, the doctor might not do a biopsy on someone who has a tumor in the pancreas if imaging tests show the tumor is very likely to be cancer and if it looks like surgery can remove all of it. Instead, the doctor will proceed with surgery, at which time the tumor cells can be looked at to confirm the diagnosis. During surgery, if the doctor finds that the cancer has spread too far to be removed completely, only a sample of the cancer may be removed to confirm the diagnosis, and the rest of the planned operation will be stopped.

If treatment (such as chemotherapy or radiation) is planned before surgery, a biopsy is needed first to be sure of the diagnosis.

See Testing Biopsy and Cytology Specimens for Cancer to learn more about different types of biopsies, how the biopsy samples are tested in the lab, and what the results will tell you.

The symptoms of exocrine pancreatic cancers and pancreatic neuroendocrine tumors (NETs) are often different, so they are described separately.

Having one or more of the symptoms below does not mean you have pancreatic cancer. In fact, many of these symptoms are more likely to be caused by other conditions. Still, if you have any of these symptoms, it’s important to have them checked by a doctor so that the cause can be found and treated, if needed.

Signs and symptoms of exocrine pancreatic cancer

Early pancreatic cancers often do not cause any signs or symptoms. By the time they do cause symptoms, they have often already spread outside the pancreas.

Jaundice and related symptoms

Jaundice is yellowing of the eyes and skin. Most people with pancreatic cancer (and nearly all people with ampullary cancer) will have jaundice as one of their first symptoms.

Jaundice is caused by the buildup of bilirubin, a dark yellow-brown substance made in the liver. Normally, the liver excretes bilirubin as part of a liquid called bile. Bile goes through the common bile duct into the intestines, where it helps break down fats. It eventually leaves the body in the stool. When the common bile duct becomes blocked, bile can’t reach the intestines, and the level of bilirubin in the body builds up.

Cancers that start in the head of the pancreas are near the common bile duct. These cancers can press on the duct and cause jaundice while they are still fairly small, which can sometimes lead to these tumors being found at an early stage. But cancers that start in the body or tail of the pancreas don’t press on the duct until they have spread through the pancreas. By this time, the cancer has often spread beyond the pancreas as well.

When pancreatic cancer spreads, it often goes to the liver. This can also lead to jaundice.

Dark urine: Sometimes, the first sign of jaundice is darker urine. As bilirubin levels in the blood increase, the urine becomes brown in color.

Light-colored or greasy stools: Bilirubin normally helps give stools their brown color. If the bile duct is blocked, stools might be pale or gray. Also, if bile and pancreatic enzymes can’t get through to the intestines to help break down fats, the stools can become greasy and might float in the toilet.

Itchy skin: When bilirubin builds up in the skin, it can start to itch as well as turning yellow.

Pancreatic cancer is not the most common cause of jaundice. Other causes, such as gallstones, hepatitis, and other liver and bile duct diseases, are much more common.

Belly or back pain

Pain in the abdomen (belly) or back is common in pancreatic cancer. Cancers that start in the body or tail of the pancreas can grow fairly large and start to press on other nearby organs, causing pain. The cancer may also spread to the nerves surrounding the pancreas, which often causes back pain. Of course, pain in the abdomen or back is fairly common and is most often caused by something other than pancreatic cancer.

Weight loss and poor appetite

Unintended weight loss is very common in people with pancreatic cancer. These people often have little or no appetite.

Nausea and vomiting

If the cancer presses on the far end of the stomach it can partly block it, making it hard for food to get through. This can cause nausea, vomiting, and pain that tend to be worse after eating.

Gallbladder or liver enlargement

If the cancer blocks the bile duct, bile can build up in the gallbladder, making it larger. Sometimes a doctor can feel this (as a large lump under the right side of the ribcage) during a physical exam. It can also be seen on imaging tests.

Pancreatic cancer can also sometimes enlarge the liver, especially if the cancer has spread to the liver. The doctor might be able to feel this below the right ribcage as well on an exam, or it might be seen on imaging tests.

Blood clots

Sometimes, the first clue that someone has pancreatic cancer is a blood clot in a large vein, often in the leg. This is called a deep vein thrombosis or DVT. Symptoms can include pain, swelling, redness, and warmth in the affected leg. Sometimes a piece of the clot can break off and travel to the lungs, which might make it hard to breathe or cause chest pain. A blood clot in the lungs is called a pulmonary embolism or PE.

Still, having a blood clot does not usually mean that you have cancer. Most blood clots are caused by other things.

Fatty tissue abnormalities

Some people with pancreatic cancer develop an uneven texture of the fatty tissue underneath the skin. This is caused by the release of the pancreatic enzymes that digest fat.

Diabetes

Rarely, pancreatic cancers cause diabetes (high blood sugar) because they destroy the insulin-making cells. Symptoms can include feeling thirsty and hungry, and having to urinate often. More often, cancer can lead to small changes in blood sugar levels that don’t cause symptoms of diabetes but can still be detected with blood tests.

Signs and symptoms of pancreatic neuroendocrine tumors

Pancreatic neuroendocrine tumors (NETs) often release excess hormones into the bloodstream. Different types of tumors make different hormones, which can lead to different symptoms.

Gastrinomas

These tumors make gastrin, a hormone that tells the stomach to make more acid. Too much gastrin causes a condition known as Zollinger-Ellison syndrome, in which the stomach makes too much acid. This leads to stomach ulcers, which can cause pain, nausea, and loss of appetite. Severe ulcers can start bleeding. If the bleeding is mild, it can lead to anemia (too few red blood cells), which can cause symptoms like feeling tired and being short of breath. If the bleeding is more severe, it can make stool black and tarry. Severe bleeding can itself be life-threatening.

If the stomach acid reaches the small intestine, it can damage the cells of the intestinal lining and break down digestive enzymes before they have a chance to digest food. This can cause diarrhea and weight loss.

Glucagonomas

These tumors make glucagon, a hormone that increases glucose (sugar) levels in the blood. Most of the symptoms that can be caused by a glucagonoma are mild and are more often caused by something else.

Excess glucagon can raise blood sugar, sometimes leading to diabetes. This can cause symptoms such as feeling thirsty and hungry, and having to urinate often.

People with these tumors can also have problems with diarrhea, weight loss, and malnutrition. The nutrition problems can lead to symptoms like irritation of the tongue and the corners of the mouth.

The symptom that brings most people with glucagonomas to their doctor is a rash called necrolytic migratory erythema. This is a red rash with swelling and blisters that often travels from place to place on the skin.

Insulinomas

These tumors make insulin, which lowers blood glucose levels. Too much insulin leads to low blood sugar, which can cause symptoms like weakness, confusion, sweating, and rapid heartbeat. When blood sugar gets very low, it can lead to a person passing out or even going into a coma and having seizures.

Somatostatinomas

These tumors make somatostatin, which helps regulate other hormones. Symptoms of this type of tumor can include belly pain, nausea, poor appetite, weight loss, diarrhea, symptoms of diabetes (feeling thirsty and hungry, and having to urinate often), and jaundice (yellowing of the skin and eyes).

The early symptoms of a somatostatinoma tend to be mild and are more often caused by other things, so these tumors tend to be diagnosed at an advanced stage. Often, they are not found until they spread to the liver, when they cause problems like jaundice and pain.

VIPomas

These tumors make a substance called vasoactive intestinal peptide (VIP). Too much VIP can lead to problems with diarrhea. This may be mild at first, but gets worse over time. By the time they are diagnosed, most people have severe, watery diarrhea.

Other symptoms can include nausea, vomiting, muscle cramps, feeling weak or tired, and flushing (redness and warmth in the face or neck).

People with these tumors also tend to have low levels of acid in their stomachs, which can lead to problems digesting food.

PPomas

These tumors make pancreatic polypeptide (PP), which helps regulate both the exocrine and endocrine pancreas. They can cause problems such as belly pain and an enlarged liver. Some people also get watery diarrhea.

Carcinoid tumors

These tumors often make serotonin or its precursor, 5-HTP. When a pancreatic tumor makes these substances, they first travel to the liver. The liver breaks these substances down before they can reach the rest of the body and cause problems. Because of this, carcinoid tumors often don’t cause symptoms until they spread outside the pancreas.

When these tumors do spread, it is most often to the liver. There, the cancer cells can release hormones directly into the blood leaving the liver. This can cause the carcinoid syndrome, with symptoms including flushing (redness and warmth in the face or neck), diarrhea, wheezing, and a rapid heart rate. These symptoms often occur in episodes, between which the person may feel fine.

Over a long time, the hormone-like substances released by these tumors can damage heart valves, causing shortness of breath, weakness, and a heart murmur (an abnormal heart sound).

Non-functioning neuroendocrine tumors

These tumors don’t make excess hormones, so they don’t cause symptoms in early stages and often grow quite large before they are found. Most of these are cancers and start to cause problems as they get larger or spread outside the pancreas. Symptoms can be like those from exocrine pancreas cancers, including jaundice (yellowing of the eyes and skin), belly pain, and weight loss.

Symptoms caused by the cancer spreading

When pancreatic NETs spread, most often they go to the liver. This can enlarge the liver, which can cause pain and loss of appetite. It can also affect liver function, sometimes leading to jaundice (yellowing of the skin and eyes) and abnormal blood tests.

These cancers can also spread to other organs and tissues. The symptoms depend on where the cancer is growing. For example, cancer spread to the lungs can cause shortness of breath or a cough. Spread to bones can cause pain in those bones.

How common is pancreatic cancer?

The American Cancer Society’s estimates for pancreatic cancer in the United States for 2018 are:

• About 55,440 people (29,200 men and 26,240 women) will be diagnosed with pancreatic cancer.
• About 44,330 people (23,020 men and 21,310 women) will die of pancreatic cancer.

Pancreatic cancer accounts for about 3% of all cancers in the US and about 7% of all cancer deaths.

Lifetime risk of pancreatic cancer

The average lifetime risk of pancreatic cancer for men is about 1 in 63. For women, the lifetime risk is about 1 in 65. But each person’s chances of getting this cancer can be affected by certain risk factors.

For statistics related to survival, see Pancreatic Cancer Survival Rates by Stage.

Visit our Cancer Statistics Center for more key statistics.

A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a person’s age or family history, can’t be changed.

But having a risk factor, or even many risk factors, does not mean that you will get the disease. And many people who get the disease may have few or no known risk factors.

Several factors can affect a person’s chance of getting cancer of the pancreas. Most of these are risk factors for exocrine pancreatic cancer.

Risk factors that can be changed

Tobacco use

Smoking is one of the most important risk factors for pancreatic cancer. The risk of getting pancreatic cancer is about twice as high among smokers compared to those who have never smoked. About 20% to 30% of pancreatic cancers are thought to be caused by cigarette smoking. Cigar and pipe smoking also increase risk, as does the use of smokeless tobacco products.

Overweight and obesity

Being overweight is a risk factor for pancreatic cancer. Very overweight (obese) people are about 20% more likely to develop pancreatic cancer.

Carrying extra weight around the waistline may be a risk factor even in people who are not very overweight.

Workplace exposure to certain chemicals

Heavy exposure at work to certain chemicals used in the dry cleaning and metal working industries may raise a person’s risk of pancreatic cancer.

Risk factors that can’t be changed

Age

The risk of developing pancreatic cancer goes up as people age. Almost all patients are older than 45. About two-thirds are at least 65 years old. The average age at the time of diagnosis is 71.

Gender

Men are slightly more likely to develop pancreatic cancer than women. This may be due, at least in part, to higher tobacco use in men, which raises pancreatic cancer risk (see above). The difference in pancreatic cancer risk was larger in the past (when tobacco use was much more common among men than women), but the gap has closed in recent years.

Race

African Americans are slightly more likely to develop pancreatic cancer than whites. The reasons for this aren’t clear, but it may be due in part to having higher rates of some other risk factors for pancreatic cancer, such as diabetes, smoking in men, and being overweight in women.

Family history

Pancreatic cancer seems to run in some families. In some of these families, the high risk is due to an inherited syndrome (explained below). In other families, the gene causing the increased risk is not known. Although family history is a risk factor, most people who get pancreatic cancer do not have a family history of it.

Inherited genetic syndromes

Inherited gene changes (mutations) can be passed from parent to child. These gene changes may cause as many as 10% of pancreatic cancers. Sometimes these changes result in syndromes that include increased risks of other cancers (or other health problems). Examples of genetic syndromes that can cause exocrine pancreatic cancer include:

• Hereditary breast and ovarian cancer syndrome, caused by mutations in the BRCA1 or BRCA2 genes
• Familial atypical multiple mole melanoma (FAMMM) syndrome, caused by mutations in the p16/CDKN2A gene
• Familial pancreatitis, usually caused by mutations in the PRSS1 gene
• Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC), most often caused by a defect in the MLH1 or MSH2 genes.
• Peutz-Jeghers syndrome, caused by defects in the STK11 gene. This syndrome is also linked with polyps in the digestive tract and several other cancers.
• Von Hippel-Lindau syndrome, caused by mutations in the VHL gene. It can lead to an increased risk of pancreatic cancer and carcinoma of the ampulla of Vater.

Pancreatic neuroendocrine tumors and cancers can also be caused by genetic syndromes, such as:

• Neurofibromatosis, type 1, which is caused by mutations in the NF1 gene. This syndrome leads to an increased risk of many tumors, including somatostatinomas.
• Multiple endocrine neoplasia, type I (MEN1), caused by mutations in the MEN1 gene. This syndrome leads to an increased risk of tumors of the parathyroid gland, the pituitary gland, and the islet cells of the pancreas.

Changes in the genes that cause some of these syndromes can be found by genetic testing. For more information on genetic testing, see Can Pancreatic Cancer Be Found Early?

Diabetes

Pancreatic cancer is more common in people with diabetes. The reason for this is not known. Most of the risk is found in people with type 2 diabetes. This type of diabetes most often starts in adulthood and is often related to being overweight or obese. It’s not clear if people with type 1 (juvenile) diabetes have a higher risk.

Chronic pancreatitis

Chronic pancreatitis, a long-term inflammation of the pancreas, is linked with an increased risk of pancreatic cancer (especially in smokers), but most people with pancreatitis never develop pancreatic cancer.

Chronic pancreatitis is sometimes due to an inherited gene mutation. People with this inherited (familial) form of pancreatitis have a high lifetime risk of pancreatic cancer.

Cirrhosis of the liver

Cirrhosis is a scarring of the liver. It develops in people with liver damage from things like hepatitis and heavy alcohol use. People with cirrhosis seem to have an increased risk of pancreatic cancer.

Stomach problems

Infection of the stomach with the ulcer-causing bacteria Helicobacter pylori (H. pylori) may increase the risk of getting pancreatic cancer. Some research has suggested that excess stomach acid might also increase the risk.

Factors with unclear effect on risk

Diet

Some studies have linked pancreatic cancer to diets that are high in red and processed meats (such as sausage and bacon) and low in fruits and vegetables. But not all studies have found such links, and this is still being studied.

Physical inactivity

Some research has suggested that lack of physical activity might increase pancreatic cancer risk. But not all studies have found this.

Coffee

Some older studies have suggested that drinking coffee might increase the risk of pancreatic cancer, but more recent studies have not confirmed this.

Alcohol

Some studies have shown a link between heavy alcohol use and pancreatic cancer. This link is still not certain, but heavy alcohol use can lead to conditions such as chronic pancreatitis and cirrhosis, which are known to increase pancreatic cancer risk.

Scientists don’t know exactly what causes most pancreatic cancers, but they have found several risk factors that can make a person more likely to get this disease. Some of these risk factors affect the DNA of cells in the pancreas, which can result in abnormal cell growth and may cause tumors to form.

DNA is the chemical in our cells that carries our genes, which control how our cells function. We look like our parents because they are the source of our DNA. But DNA affects more than just how we look.

Some genes control when our cells grow, divide into new cells, and die:

• Genes that help cells grow, divide, and stay alive are called oncogenes.
• Genes that help keep cell division under control, repair mistakes in DNA, or cause cells to die at the right time are called tumor suppressor genes.

Cancers can be caused by DNA changes (gene mutations) that turn on oncogenes or turn off tumor suppressor genes.

Inherited gene mutations

Some people inherit gene changes from their parents that raise their risk of pancreatic cancer. Sometimes these gene changes are part of syndromes that include increased risks of other health problems as well. These syndromes, which cause a small portion of all pancreatic cancers, are discussed in Risk Factors for Pancreatic Cancer.

Acquired gene mutations

Most gene mutations related to cancers of the pancreas occur after a person is born, rather than having been inherited. These acquired gene mutations sometimes result from exposure to cancer-causing chemicals (like those found in tobacco smoke). But often what causes these changes is not known. Many gene changes are probably just random events that sometimes happen inside a cell, without having an outside cause.

Some of the DNA changes often seen in sporadic (non-inherited) cases of pancreatic cancer are the same as those seen in inherited cases, while others are different. For example, many sporadic cases of exocrine pancreatic cancer have changes in the p16 and TP53 genes, which can also be seen in some genetic syndromes. But many pancreatic cancers also have changes in genes such as KRAS, BRAF, and DPC4 (SMAD4), which are not part of inherited syndromes. Other gene changes can also be found in pancreatic cancers, although often it’s not clear what has caused these changes.

There is no sure way to prevent pancreatic cancer. Some risk factors such as age, gender, race, and family history can’t be controlled. But there are things you can do that might lower your risk.

Don’t smoke

Smoking is the most important avoidable risk factor for pancreatic cancer. Quitting smoking helps lower risk. If you smoke and want help quitting, please talk to your health care provider or call us at 1-800-227-2345.

Stay at a healthy weight

Getting to and staying at a healthy weight might also help lower your risk. While the effects of getting physical activity and eating well on pancreatic cancer risk are not as clear, both of these can help you stay at a healthy weight.

The American Cancer Society recommends choosing foods and beverages in amounts that help you get to and stay at a healthy weight. Eat a healthy diet, with an emphasis on plant foods. This includes at least 2½ cups of vegetables and fruits every day. Choose whole-grain breads, pastas, and cereals instead of refined grains, and eat fish, poultry, or beans instead of processed meat and red meat. For more, see the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention.

Limit alcohol use

Heavy alcohol use has been tied to pancreatic cancer in some studies but not in others. This link is still not certain, but heavy alcohol use can lead to conditions such as chronic pancreatitis and cirrhosis, which are known to increase pancreatic cancer risk.

Limit exposure to certain chemicals in the workplace

Avoiding workplace exposure to certain chemicals may reduce your risk for pancreatic cancer.

Pancreatic cancer is hard to find early. The pancreas is deep inside the body, so early tumors can’t be seen or felt by health care providers during routine physical exams. People usually have no symptoms until the cancer has already spread to other organs.

Screening tests or exams are used to look for a disease in people who have no symptoms (and who have not had that disease before). At this time, no major professional groups recommend routine screening for pancreatic cancer in people who are at average risk. This is because no screening test has been shown to lower the risk of dying from this cancer.

Sometimes when a person has pancreatic cancer, the levels of certain proteins in the blood go up. These proteins, called tumor markers, can be detected with blood tests. The tumor markers CA 19-9 and carcinoembryonic antigen (CEA) are the ones most closely tied to pancreatic cancer. But these proteins don’t always go up when a person has pancreatic cancer, and even if they do, the cancer is often already advanced by the time this happens. Sometimes levels of these tumor markers can go up even when a person doesn’t have pancreatic cancer. For these reasons, blood tests aren’t used to screen for pancreatic cancer, although a doctor might still order these tests if a person has symptoms that might be from pancreatic cancer. These tests are more often used in people already diagnosed with pancreatic cancer to help tell if treatment is working or if the cancer is progressing.

Genetic testing for people who might be at increased risk

Some people might be at increased risk of pancreatic cancer because of a family history of the disease (or a family history of certain other cancers). Sometimes this increased risk is due to a specific genetic syndrome.

Some of the gene changes that increase pancreatic cancer risk can be tested for. Knowing if you are at increased risk can help you and your doctor decide if you should have tests to look for pancreatic cancer early, when it might be easier to treat. But determining whether you might be at increased risk is not simple. Talking to someone with experience in hereditary cancer syndromes such as a genetic counselor, geneticist, or an oncologist (doctor who treats people with cancer) is often helpful.

The American Cancer Society strongly recommends that anyone thinking about genetic testing talk with a genetic counselor, nurse, or doctor qualified to interpret and explain the test results before they proceed with testing. It’s important to understand what the tests can − and can’t − tell you, and what any results might mean, before deciding to be tested.

Genetic tests look for mutations in your genes that cause inherited conditions. The tests are used to look for these inherited conditions, not pancreatic cancer itself. Your risk may be increased if you have one of these conditions, but it doesn’t mean that you have (or definitely will get) pancreatic cancer. 

Testing for pancreatic cancer in people at high risk

For people in families at high risk of pancreatic cancer, newer tests for detecting early pancreatic cancer may help. One of these is called endoscopic ultrasound. (See Tests for Pancreatic Cancer.) This test is not used to screen the general public, but it might be used for someone with a strong family history of pancreatic cancer or with a known genetic syndrome that increases their risk. Doctors have been able to find early, treatable pancreatic cancers in some members of high-risk families with this test.

Doctors are also studying other new tests to try to find pancreatic cancer early. Interested families at high risk may wish to take part in studies of these new screening tests

It’s important to have honest, open discussions with your cancer care team. You should feel free to ask any question, no matter how minor it might seem. For instance, consider these questions:

When you’re told you have pancreatic cancer

• What kind of pancreatic cancer do I have?
• Has my cancer spread beyond where it started?
• What is the stage of my cancer? Is it resectable (removable by surgery)?
• Do I need any other tests before we can decide on treatment?
• Will I need to see other doctors?
• If I’m concerned about the costs and insurance coverage for my diagnosis and treatment, who can help me?

When deciding on a treatment plan

• How much experience do you have treating this type of cancer?
• What are my treatment choices?
• What do you recommend and why?
• What is the goal of each treatment?
• Should I get a second opinion? How do I do that? Can you recommend a doctor or cancer center?
• How is treatment likely to help me?
• What risks or side effects might I expect? How long are they likely to last?
• Should I think about taking part in a clinical trial?
• How soon do I need to start treatment?
• What should I do to be ready for treatment?
• How long will treatment last? What will it be like? Where will it be done?
• What risks or side effects should I expect? How long are they likely to last?
• Will treatment affect how I eat?
• Will treatment affect my daily activities?
• What would my options be if the treatment doesn’t work or if the cancer comes back?

During treatment

Once treatment begins, you’ll need to know what to expect and what to look for. Not all of these questions may apply to you, but getting answers to the ones that do may be helpful.

• How will we know if the treatment is working?
• Is there anything I can do to help manage side effects?
• What symptoms or side effects should I tell you about right away?
• How can I reach you on nights, holidays, or weekends?
• Do I need to change what I eat during treatment?
• Are there any limits on what I can do?
• Should I exercise? What should I do, and how often?
• Can you suggest a mental health professional I can see if I start to feel overwhelmed, depressed, or distressed?

After treatment

• Are there any limits on what I can do?
• What symptoms should I watch for?
• What kind of exercise should I do now?
• What type of follow-up will I need after treatment?
• How often will I need to have follow-up exams and tests?
• How will we know if the cancer has come back? What should I watch for?
• What will my options be if the cancer comes back?

Along with these sample questions, be sure to write down some of your own. Keep in mind that doctors aren’t the only ones who can give you information. Other health care professionals, such as nurses and social workers, can answer some of your questions. To find out more about speaking with your health care team, see The Doctor-Patient Relationship.

For some people with pancreatic cancer, treatment can remove or destroy the cancer. Completing treatment can be both stressful and exciting. You may be relieved to finish treatment, but find it hard not to worry about cancer coming back. This is very common if you’ve had cancer.

For most people with pancreatic exocrine cancer (and some people with pancreatic neuroendocrine tumors), the cancer might never go away completely, or it might come back in another part of the body. These people may get regular treatments with chemotherapy, radiation therapy, or other therapies to help keep the cancer under control for as long as possible. Learning to live with cancer that does not go away can be difficult and very stressful.

Follow-up care

If you have completed treatment, your doctors will still want to watch you closely. It’s very important to go to all of your follow-up appointments. During these visits, your doctors will ask questions about any problems you are having and may do exams and lab or imaging tests to look for signs of cancer or treatment side effects.

Some treatment side effects might last a long time or might not even show up until years after you have finished treatment. Your doctor visits are a good time to ask questions and talk about any changes or problems you notice or concerns you have.

Doctor visits and tests

Your schedule of doctor visits, exams, and tests will depend on the original extent of your cancer, how it was treated, and other factors. Tests might include blood tests for tumor markers (such as CA 19-9) or imaging tests (such as CT scans). Be sure to follow your doctor’s advice about follow-up tests.

Ask your doctor for a survivorship care plan

Talk with your doctor about developing a survivorship care plan for you. This plan might include:

• A suggested schedule for follow-up exams and tests
• A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
• A schedule for other tests you might need, such as tests to look for long-term health effects from your cancer or its treatment
• Diet and physical activity suggestions

Keeping health insurance and copies of your medical records

Even if you’ve finished treatment, it’s very important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.

At some point after your cancer treatment, you might find yourself seeing a new doctor who doesn’t know about your medical history. It’s important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment. Learn more in Keeping Copies of Important Medical Records.

Help with nutrition and pain

Pancreatic cancer often causes weight loss and weakness from poor nutrition. These symptoms might be caused by treatment or by the cancer itself. A team of doctors and nutritionists can work with you to provide nutritional supplements and information about your individual nutritional needs. This can help you keep up your weight and nutritional intake. Many patients need to take pancreatic enzymes in pill form to help digest food so that it can be absorbed. For serious nutrition problems, the doctor might need to put a feeding tube into the stomach to improve nutrition and energy levels. This is usually temporary. For more information and nutrition tips for during and after cancer treatment, see Nutrition for the Person With Cancer During Treatment.

There are many ways to control pain caused by pancreatic cancer. If you have pain, tell your cancer care team right away, so they can give you prompt and effective pain management. For more information, see the Cancer Pain section of our website.

Can I lower the risk of my cancer progressing or coming back?

If you have (or have had) pancreatic cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements. Unfortunately, it’s not yet clear if there are things you can do that will help.

Tobacco use has clearly been linked to pancreas cancer, so not smoking may help reduce your risk. We don’t know for certain if this will help, but we do know that it can help improve your appetite and overall health. It can also reduce the chance of developing other types of cancer. If you want to quit smoking and need help, call your American Cancer Society at 1-800-227-2345.

Other healthy behaviors such as eating well, getting regular physical activity, and staying at a healthy weight might help as well, but no one knows for sure. However, we do know that these types of changes can have positive effects on your health that can extend beyond your risk of cancer.

About dietary supplements

So far, no dietary supplements (including vitamins, minerals, and herbal products) have been shown to clearly help lower the risk of pancreatic cancer progressing or coming back. This doesn’t mean that no supplements will help, but it’s important to know that none have been proven to do so.

Dietary supplements are not regulated like medicines in the United States – they do not have to be proven effective (or even safe) before being sold, although there are limits on what they’re allowed to claim they can do. If you’re thinking about taking any type of nutritional supplement, talk to your health care team. They can help you decide which ones you can use safely while avoiding those that might be harmful.

If the cancer comes back

If your cancer does come back at some point, your treatment options will depend on the where the cancer is, what treatments you’ve had before, and your current health and preferences. Treatment options might include surgery, radiation therapy, chemotherapy, or some combination of these. For more on how recurrent cancer is treated, see Treatment of Pancreatic Cancer, Based on Extent of the Cancer.

For more general information on dealing with a recurrence, you might also want to see Understanding Recurrence.

Getting emotional support

Some amount of feeling depressed, anxious, or worried is normal when pancreatic cancer is a part of your life. Some people are affected more than others. But everyone can benefit from help and support from other people, whether friends and family, religious groups, support groups, professional counselors, or others. Learn more in Coping With Cancer.