Most of the pancreas is made up of exocrine tissue which makes digestive enzymes. Enzymes help break down fats, proteins, and carbohydrates, allowing the body to absorb nutrients from food. The pancreas also releases a substance called bicarbonate, which neutralizes stomach acid so these enzymes can work properly in the digestive system.

The pancreas also plays a key role in regulating blood sugar by producing two important hormones:

• Insulin: lowers blood sugar after eating.
• Glucagon: raises blood sugar between meals or during fasting.

These hormones work together to keep blood sugar balanced, which is essential for energy and overall health.

These tumours develop from the exocrine cells that produce digestive enzymes. They make up about 95% of all pancreatic cancers and include several types:

Adenocarcinoma

Also called ductal carcinoma, adenocarcinoma is the most common type, representing over 90% of pancreatic cancers. It originates from the lining of the pancreatic ducts (small tubes that carry digestive enzymes to the intestine, where nutrients from food are absorbed).

Colloid Carcinoma‍

This is a rare subtype of adenocarcinoma that makes up one to three percent of exocrine pancreatic cancers. These tumours are surrounded by a jelly-like substance called mucin, making them less likely to spread and often easier to treat than other types.

Acinar Cell Carcinoma‍

This rare cancer develops from the enzyme-producing cells of the pancreas and accounts for one to two percent of exocrine tumours.

Squamous Cell Carcinoma‍

This extremely rare form of pancreatic cancer arises in the pancreatic ducts and consists entirely of squamous cells, which are not normally found in the pancreas.

Adenosquamous Carcinoma

This is a rare tumour making up one to four percent of exocrine pancreatic cancers. These tumours show features of both ductal adenocarcinoma and squamous cell carcinoma. These have poorer outcomes than adenocarcinoma.

Smoking cigarettes is the strongest and most well-established risk factor. Smoking is a major preventable risk factor for pancreatic cancer, and quitting reduces this risk over time. Cigar smoking is also strongly linked to an increased risk but studies on pipe smoking and smokeless tobacco, such as chewing tobacco and snuff, have mixed results. Although vaping has fewer, harmful chemicals than traditional tobacco products, it still has nicotine and other potentially harmful substances that may increase the risk of pancreatic cancer. More research is needed to understand the link between vaping and pancreatic cancer.

Obesity, especially belly fat, is a well-known risk factor for pancreatic cancer. Extra fat causes inflammation which can damage cells and lead to cancer. It also makes the body less sensitive to insulin, so the pancreas must make more, which can help cancer grow. Fat also changes hormones and can build up inside the pancreas, adding to the risk. Maintaining a healthy weight through diet and exercise is important to lower risk, especially since obesity is also linked to diabetes and chronic pancreatitis, both of which increase risk of this cancer.

Diabetes, particularly type 2, is associated with an increased risk of pancreatic cancer. This increased risk may be due to shared risk factors such as obesity, or because diabetes can sometimes be an early symptom of pancreatic cancer. While the association is well-documented, the exact relationship between diabetes and pancreatic cancer is not fully understood.

Chronic pancreatitis is long-term inflammation that damages the pancreas, causing scarring and reducing function. This can increase the chance of abnormal changes and cancer. Repeated episodes of acute pancreatitis (sudden, severe inflammation) may also increase risk.

Drinking large amounts of alcohol regularly can damage the pancreas and cause ongoing inflammation (chronic pancreatitis). Limiting alcohol can help reduce inflammation and the associated cancer risk, making it an important lifestyle change.

A family history of cancer, especially pancreatic or related types like breast, ovarian or colon cancer, can increase risk of developing the disease because of inherited genetic factors.

Jaundice occurs when a tumour blocks the bile duct preventing bile, a fluid that helps digest fats, from reaching the small intestine. This causes bilirubin, a yellow substance found in bile, to build up in the blood. Signs of jaundice include yellowing of the skin and whites of the eyes, itchiness (pruritus), dark urine and changes in stool. Stools may be pale or clay-coloured, greasy (steatorrhea) or oily, have a strong smell or float.

This pain may feel like a dull ache or pressure in the upper belly, back or between the shoulder blades. It can happen because the tumour presses on nearby nerves or organs, such as the stomach, spine, or intestines. The pain may worsen after eating or when lying down.

The pancreas produces substances, called enzymes, which help break down fats, sugars, and proteins. If a tumour blocks these enzymes, food is not digested properly. This can cause bloating, gas, heartburn, or discomfort after eating, especially rich or fatty foods. Individuals may also have diarrhea or constipation. Other digestive symptoms include:

You may lose your appetite or feel full quickly, even after eating a small amount of food. This can happen because the tumour slows or block parts of the digestive system, making it harder to digest food. This can cause nausea,bloating and vomiting, which can also lead to eating less.

Losing weight without trying, even if your appetite seems normal, is common. When enzymes are not working properly, the body cannot absorb nutrients well, leading to malnutrition, and muscle and weight loss. Pancreatic cancer can also increase the body's energy demands, contributing to further weight loss.

Cancer-related fatigue is an overwhelming tiredness that does not improve with rest or sleep. This can result from the body using extra energy to fight cancer, poor digestion, weight loss, emotional stress or discomfort and pain that interferes with sleep. Cancer triggers the release of special substances, called inflammatory chemicals, which can also cause weakness and exhaustion.

A medical professional will review symptoms, personal and family history of cancer, and risk factors. The physical exam may check for signs like jaundice, abdominal tenderness, or unexplained weight loss.

Blood tests are important to assess overall health and look for signs that may suggest the presence of cancer. This can guide decisions about next steps.

There are various imaging tools to help diagnose pancreatic cancer. These include computed tomography (CT) scans, magnetic resonance imaging (MRI) and endoscopic ultrasounds (EUS).

Abnormal cells are found but have not invaded deeper tissues.

Cancer is only in the pancreas. Stage I is divided into the following stages based on the size of the tumour:

Stage IA: The tumour is two centimeters or smaller.
Stage IB: The tumour is larger than two centimeters.

Cancer may have spread to nearby tissue, organs, or lymph nodes near the pancreas but not to distant organs. Stage II is divided into the following stages based on where the cancer has spread:

Stage IIA: The cancer is in the pancreas and has not spread to nearby tissue and organs or lymph nodes.
Stage IIB: The cancer has spread to nearby lymph nodes and may have also spread to nearby tissue and organs.

Cancer has spread to major blood vessels near the pancreas and possibly nearby lymph nodes. It has not spread to distant organs.

Surgery offers the best chance of cure but is only an option if the cancer is limited to the pancreas, with some exceptions, and has not spread. About twenty percent of patients are eligible for potentially curative surgery at the time of diagnosis.

This procedure is for tumours in the head of the pancreas. It involves removing the head of the pancreas, part of the small intestine (duodenum), bile duct, gallbladder, lymph nodes and occasionally part of the stomach. The remaining organs are reconnected to restore digestive tract function.

This procedure is for when the tumours is in the body and tail of the pancreas. The tail, parts of the body and spleen may be removed.

This procedure removes the entire pancreas, spleen, gallbladder, bile duct, and parts of the small intestine and stomach. After surgery, patients require lifelong insulin and enzyme replacement.

In some cases, the tumour involves major blood vessels near the pancreas. This is a more complex operation requiring the removal and reconnection of blood vessels. Only select centers with specialized expertise perform these operations.

When potentially curative surgery is not possible, surgery may be performed to relieve symptoms and improve quality of life. Palliative procedures can help manage things such as blocked bile ducts, which can cause jaundice, itching, nausea, and bowel problems.

Chemotherapy uses powerful drugs to kill the fast-growing cancer cells. Chemotherapy is a main treatment option and can be used at any stage of disease. Treatment is typically given in cycles with breaks to help the body recover. Chemotherapy can be given alone, or in combination with other treatments. The drugs can be administered intravenously (IV) or taken orally as pills.

Some chemotherapies commonly used include Gemcitabine, FOLFIRINOX (combination of four drugs: 5-Fluorouracil (5-FU), Irinotecan, Oxaliplatin, Leucovorin), Abraxane, Capecitabine (Xeloda), Cisplatin and Paclitaxel.

While chemotherapy is an aggressive cancer-fighting strategy, it can also attack healthy cells which can lead to side effects. Depending on the type of chemotherapy drug and dosage, type of drug administration, and the individual’s general health, side effects will vary. Some side effects are mild and manageable, while others can lead to more serious problems. Common side effects include fatigue, nausea, vomiting, neuropathy (nerve damage often affecting the hands and feet), hair thinning or loss, changes in appetite, anemia, and changes in bowel habits.

Radiation therapy uses high energy rays or particles to targets and kill cancer cells. Modern techniques focus the radiation on the tumour to protect healthy tissue. In some cases, radiation is given with an oral chemotherapy to help it work more effectively. Radiation can also be used to help ease symptoms, such as pain. Radiation treatment can cause similar side effects to chemotherapy; however, because it focuses on one area of the body, additional side effects include skin irritation, abdominal discomfort, and bowel irritation.

Chemotherapy and radiation can be given at various stages in the cancer treatment:

Neoadjuvant treatment is given before surgery, typically to shrink tumours to make surgery more possible. Adjuvant treatment is given after surgery to destroy cancer cells that may be circulating in the body and reduce risk of the cancer coming back. Palliative treatment is used when surgery is not an option. The goal is to relieve symptoms and slow cancer growth.

There are other innovative therapies including immunotherapy, which stimulates the immune system to recognize and attack cancer cells, targeted therapies, which focuses on specific changes in the cancer cells and others that are currently being tested.

Early detection of pancreatic cancer remains a significant challenge largely because there are no established screening guidelines for the general population. As a result, routine screening is not recommended for individuals at average risk. However, international guidelines recommend screening within research protocols for those at higher risk, such as individuals with a strong family history of cancer or certain genetic mutations (changes). These individuals may also benefit from genetic counseling to better understand their risk and guide medical decisions.

Most pancreatic cancers are sporadic, meaning they occur by chance without a known inherited cause. While all cancers involve genetic changes, not all are hereditary (passed down in families). About ten to twenty percent of pancreatic cancers result from inherited genetic factors. Identifying these hereditary cases is important because it can influence treatment options, help assess risk for family members and guide long-term surveillance strategies.

Certain clinical situations increase the likelihood that pancreatic cancer has a hereditary component. These include families with multiple members affected by pancreatic cancer, individuals diagnosed with pancreatic cancer along with another primary cancer, and those diagnosed at a younger age, typically before age 50. A personal or family history of cancers linked to hereditary syndromes, such as breast, ovarian, prostate, melanoma, or colorectal cancer, also suggests a possible inherited risk. People of certain ethnicities may have a higher prevalence of specific genetic mutations associated with pancreatic cancer.

Familial Pancreatic Cancer refers to families where two or more biologically related individuals have been diagnosed with pancreatic cancer, but no known hereditary cancer syndrome has been identified. FPC accounts for about ten percent of all new diagnoses of pancreatic cancer. Unlike some other hereditary cancers, there is no single gene identified as the clear cause of FPC.

While no single gene mutation currently explains all hereditary pancreatic cancers, several well-known hereditary cancer syndromes increase the risk of developing pancreatic cancer. These syndromes involve specific genetic changes and often raise the risk of other cancers as well.

‍Hereditary Breast and Ovarian Cancer Syndrome (HBOC) is commonly linked to breast, ovarian, prostate and pancreatic cancers.

Familial Atypical Multiple Mole Melanoma (FAMMM) increases the risk of both melanoma, a type of skin cancer, and pancreatic cancer.

Peutz–Jeghers Syndrome (PJS) is characterized by dark spots on the lips and digestive tract polyps, and increases the risk of several cancers including pancreatic, gastrointestinal, breast, and gynecologic cancers.

Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer, HNPCC) increases the risk of colon, endometrial, ovarian, stomach, and pancreatic cancers.

Hereditary Pancreatitis causes repeated inflammation of the pancreas, often beginning in childhood, and significantly raises the risk of developing pancreatic cancer over time due to chronic inflammation.

Familial Adenomatous Polyposis (FAP) leads to numerous colon and rectal polyps and carries a slightly increased risk of pancreatic cancer.

Multiple Endocrine Neoplasia Type 1 (MEN1) increases the risk of tumours in hormone-producing glands, including pancreatic neuroendocrine tumours.‍Hereditary Breast and Ovarian Cancer Syndrome (HBOC) is commonly linked to breast, ovarian, prostate and pancreatic cancers. is linked to a higher risk of pancreatic neuroendocrine tumours, as well as tumours in the kidneys, brain, spine, and adrenal glands.

Individuals with pancreatic cancer or a personal or family history suggestive of hereditary pancreatic cancer should be referred to a genetics clinic or genetic counselor. Genetic counsellors are healthcare professionals with advanced training in medical genetics and counselling, which enables them to assess risk, order genetic testing and interpret results. Genetic testing can help determine if you carry genetic changes, which could increase your risk. The decision to have genetic testing is a personal one and it is important to make an informed choice. It is always a good idea to keep your doctor informed about your family history of cancer. A doctor can provide a referral to a genetics clinic or counsellor.

The genetic counsellor will review your personal and family history of cancer and any other relevant medical information. If previous genetic testing has been performed in the family, sharing those results can be helpful.

There will be a discussion of hereditary cancer risk, inheritance patterns, available genetic tests, and how outcomes may impact you and/or your family. There may be information about screening for other cancers and prevention options. There will be an opportunity to ask questions and receive support to make an informed choice about testing.

Note: Genetic testing is voluntary. Genetic counselling is designed to provide information to support informed decision-making.

Genetic testing involves providing a blood or saliva sample. The specific genetic tests will depend on personal and family history and the clinical situation.

Test results can guide cancer risk management and treatment decisions, including eligibility for targeted therapies or clinical trials. If a mutation is found, family members may be offered testing. The genetic counsellor can then recommend appropriate screening, prevention strategies, or enrollment in research studies and high-risk surveillance programs. Ongoing health monitoring is essential, and any new or unusual symptoms should be evaluated by a healthcare professional.

Genetic testing may be covered by health insurance, particularly when ordered for individuals who meet clinical eligibility testing criteria. Out-of-pocket costs vary by country, insurance plans, and laboratories. Turnaround time for results also varies by testing facility and type of analysis.

Canada: Canadian Association of Genetic Counsellors (CAGC) ⯈

United States: National Society of Genetic Counselors (NSGC) ⯈

Other Countries: Ask your healthcare provider or local cancer center about available options.

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