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Pancreatic cancer

Last updated: February 18, 2021

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Pancreatic cancer is the fourth leading cause of cancer deaths in the US and typically affects older individuals in the sixth to eighth decades of life. Underlying risk factors include smoking, obesity, heavy alcohol consumption, and chronic pancreatitis. Pancreatic carcinomas are mostly ductal adenocarcinomas and frequently located in the pancreatic head. The disease is commonly diagnosed at an advanced stage because of the late onset of clinical features (e.g., epigastric pain, painless jaundice, and weight loss). In many cases, the tumor has already spread to other organs (mainly the liver) when it is diagnosed. Treatment is often palliative as surgical resection is only possible in approx. 20% of cases. The most commonly used surgical technique is the pancreaticoduodenectomy (Whipple procedure). Five-year survival rates range from 3–40% depending on the extent, spread, and resectability of the tumor.

  • Age of onset: 60–80 years [1][2]
  • Incidence
    • ∼ 3% of all new cancers in the US
    • In 2020, 57,600 individuals in the US will be newly diagnosed with pancreatic cancer ( > )
  • Mortality: accounts for ∼ 8% of all cancer deaths in the US
  • High-risk groups [3][4]
    • African Americans
    • Individuals of Jewish ancestry

Epidemiological data refers to the US, unless otherwise specified.

Exogenous risk factors [5][6][7]

Endogenous risk factors [5][8]

In most cases, there are no early symptoms suggestive of pancreatic cancer. [9]

Constitutional symptoms

  • Poor appetite
  • Weight loss
  • Weakness

Gastrointestinal symptoms

Hypercoagulability

A thrombosis of unknown origin may be caused by an undiagnosed malignancy (especially pancreatic cancer, but also pulmonary, and prostatic carcinoma, the "3P's").

The symptoms of pancreatic cancer may be similar to those of chronic pancreatitis. Differential diagnosis is difficult since carcinoma may be accompanied by pancreatitis.

Blood

Imaging

Location [10]

Pancreatic exocrine tumors [11]

The majority of pancreatic malignancies are located in the head of the pancreas and originate from epithelial cells within the tubules.

Pancreatic endocrine tumors (neuroendocrine tumors/NET) [12]

Pancreatic cyst

  • Overview
  • Clinical features
  • Diagnostics
  • Treatment
    • Asymptomatic cyst: no surgical treatment
    • Symptomatic cyst: CT-guided, endoscopic, or surgical drainage

Other

The differential diagnoses listed here are not exhaustive.

As the only curative treatment option for pancreatic cancer is surgical resection, patients with operable tumors (∼ 20%) are always recommended for surgery. If surgical tumor resection is not possible or distant metastasis is present, a palliative approach is chosen.

Curative approach [13][14]

Surgery

Neoadjuvant or adjuvant chemoradiotherapy

Palliative approach [13][14]

Palliative chemotherapy

Pain management

Management of gastrointestinal complications

We list the most important complications. The selection is not exhaustive.

  • Very aggressive course [1]
  • Median survival for patients who undergo successful resection: ∼ 18 months (5-year survival rate: ∼ 20%) [15]
  1. Cancer Stat Facts: Pancreas Cancer. https://seer.cancer.gov/statfacts/html/pancreas.html. Updated: January 11, 2017. Accessed: January 11, 2017.
  2. Pancreatic cancer risk factors. http://www.cancer.org/cancer/pancreaticcancer/detailedguide/pancreatic-cancer-risk-factors. Updated: April 5, 2016. Accessed: January 11, 2017.
  3. Hamada T, Yuan C, Yurgelun MB, et al. Family history of cancer, Ashkenazi Jewish ancestry, and pancreatic cancer risk. Br J Cancer. 2019; 120 (8): p.848-854. doi: 10.1038/s41416-019-0426-5 . | Open in Read by QxMD
  4. Eldridge RC et al.. Jewish Ethnicity and Pancreatic Cancer Mortality in a Large U.S. Cohort. Cancer Epidemiol Biomarkers Prev. 2011; 20 (4): p.691-698. doi: 10.1158/1055-9965.epi-10-1196 . | Open in Read by QxMD
  5. Pancreatic Cancer Risk Factors. https://www.cancer.org/cancer/pancreatic-cancer/causes-risks-prevention/risk-factors.html. Updated: May 31, 2016. Accessed: September 3, 2017.
  6. Edderkaoui M, Thrower E. Smoking and pancreatic disease. J Cancer Ther. 2013; 4 (10A): p.34-40. doi: 10.4236/jct.2013.410A005 . | Open in Read by QxMD
  7. Alcohol Use and Cancer. https://www.cancer.org/cancer/cancer-causes/diet-physical-activity/alcohol-use-and-cancer.html. Updated: April 5, 2017. Accessed: September 3, 2017.
  8. Pancreatic Cancer Risk Factors. http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/pancreatic-cancer/risk-factors#heading-Seven. . Accessed: September 3, 2017.
  9. Signs and Symptoms of Pancreatic Cancer. https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/signs-and-symptoms.html. Updated: February 11, 2019. Accessed: November 10, 2020.
  10. Artinyan A, Soriano PA, Prendergast C, Low T, Ellenhorn JDI, Kim J. The anatomic location of pancreatic cancer is a prognostic factor for survival. HPB. 2008; 10 (5): p.371-376. doi: 10.1080/13651820802291233 . | Open in Read by QxMD
  11. What is pancreatic cancer?. http://www.cancer.org/cancer/pancreaticcancer/detailedguide/pancreatic-cancer-what-is-pancreatic-cancer. Updated: April 5, 2016. Accessed: January 11, 2017.
  12. What Is a Pancreatic Neuroendocrine Tumor?. https://www.cancer.org/cancer/pancreatic-neuroendocrine-tumor/about/what-is-pnet.html. Updated: January 21, 2020. Accessed: November 10, 2020.
  13. Ducreux M, Cuhna AS, Caramella C, et al. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015; 26 ( Suppl 5): p.v56-68. doi: 10.1093/annonc/mdv295 . | Open in Read by QxMD
  14. Hruban RH, Fukushima N. Pancreatic adenocarcinoma: update on the surgical pathology of carcinomas of ductal origin and PanINs. Mod Pathol. 2007; 20 (Suppl 1): p.S61-70. doi: 10.1038/modpathol.3800685 . | Open in Read by QxMD
  15. Chakraborty S, Singh S. Surgical resection improves survival in pancreatic cancer patients without vascular invasion- a population based study.. Annals of gastroenterology. 2013; 26 (4): p.346-352.