Pancreatic Cancer Awareness - Signs, Symptoms, Stages, & More

In light of the tragic passing of Aretha Franklin, the "Queen of Soul" - today we, at Mountainside Medical Equipment honor her memory and hope to bring awareness of the terrible disease that her, and so many others suffer from: pancreatic cancer. We salute and humbly respect those who fought and are still fighting this malicious disease. We know we can speak for many when we say that someday, we hope to see cancer as nothing more than a zodiac sign.

What is Pancreatic Cancer?

Cancer. That word alone sends shivers down anyone's spine. There are many definitions of the word; one could perhaps define it as the most vicious, cruel disease to affect a living being. Medically speaking however, cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancerous, and can quickly spread to other areas of the body if not detected and treated promptly.

Pancreatic cancer begins when cells in the pancreas start to grow at an abnormal rate. The pancreas is an organ that sits behind the stomach. Studies have shown that in adults, it is approximately six inches long, but less than two inches wide. The head of the pancreas is on the ride side of the abdomen, behind where the stomach meets 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.

The pancreas has two main types of cells called exocrine cells and endocrine cells.

Exocrine cells: Most of the cells in the pancreas form the exocrine glands and ducts. The exocrine glands make pancreatic enzymes that are released into the intestines to help digest food. The enzymes are first released into tiny tubes called ducts, which then merge to form larger ducts, leading them to empty into the pancreatic duct. The pancreatic duct merges with the duct that carries bile from the liver, and empties into the first part of the small intestine.

Endocrine cells: Make up a much smaller percentage of the cells in the pancreas. These cells are in small clusters called islets, which make important hormones, such as insulin and glucagon and release them directly into the blood.

Types of Pancreatic Cancer

The exocrine cells and endocrine cells of the pancreas form different types of tumors. It is very important to know if the cancer is an exocrine or endocrine cancer, as they have distinct risk factors, causes, different signs and symptoms, are diagnosed with different tests, are treated in different ways, and have different outcomes. 

Exocrine Pancreatic Cancers

Exocrine cancers are the most common type of pancreatic cancer. 

Pancreatic Adenocarcinoma: Approximately 95% of cancers of the exocrine pancreas are adenocarcinomas. These cancers usually start in the ducts of the pancreas. Less often, they develop from the cells that make the pancreatic enzymes, which are called acinar cell carcinomas.

Less common types of exocrine cancer include: adenosquarmous carcinomas, squamous cell carcinomas, signet ring cell carcinomas, undifferentiated carcinomas, and undifferentiated carcinomas with giant cells.

Ampullary Cancer: also known as carcinoma of the ampulla of Vater, this cancer begins where the bile duct and pancreatic duct come together and empty into the small intestine. Ampullary cancers aren't technically pancreatic cancers, but they are treated much the same. Ampullary cancers often block the bile duct while they are still small enough and haven't begun to spread. This blockage causes bile to build up in the body, which leads to jaundice. Due to this, these cancers are usually found earlier than most pancreatic cancers, and they usually have a better prognosis.

Pancreatic Endocrine Tumors (Neuroendocrine Tumors)

Tumors of the endocrine pancreas are uncommon, making up less than 5% of all pancreatic cancers. As a group, they are often called pancreatic neuroendocrine tumors (NETs) or islet tumors. 

Pancreatic NETs can be benign or malignant, and often look alike under a microscope. Due to this, it isn't always clear if a pancreatic NET is really cancer. Sometimes, unfortunately, it only becomes clear that an NET is cancer when it spreads outside of the pancreas. 

There are several types of pancreatic NETs including:

Functioning NETs: About half of pancreatic NETs make hormones that are released into the blood and cause symptoms. These are called functioning tumors. Each one is named for the type of hormone the tumor cells make:

- Gastrinomas: come from cells that make gastrin. Approximately half of gastrinomas are cancer. 

- Insulinomas: come from cells that make insulin. Most insulinomas are benign.

- Glucagonomas: come from cells that make glucagon. Most glucagonomas are cancers.

- Somatostatinomas: come from cells that make somatostatin. Most are cancers.

- VIPoma's: come from cells that make vasoactive intestinal peptide, or VIP. Most VIPoma's are cancers. 

- PPomas: come from cells that make pancreatic polypeptide. Most are cancers.

Most functioning NETs are gastrinomas or insulinomas. The other types include:

Non-functioning NETs: These tumors don't make enough excess hormones to cause symptoms. They are more likely to be cancer than functioning tumors, and because they don't make excess hormones that cause symptoms, they can grow quite large before detected.

Carcinoid Tumors: These NETs are much more common in other parts of the digestive system, although rarely can they start in the pancreas. These tumors often make serotonin. 

The treatment and outlook for pancreatic NETs depend on the specific tumor type and the stage of the tumor, but the prognosis is generally better than that of pancreatic exocrine cancers.

Causes of Pancreatic Cancer

Scientists and doctors are unsure of exactly what causes pancreatic cancers, but they have found several risk factors that can make a person more likely to develop the 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. Cancers can be caused by DNA changes - or 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 the 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 will be discussed below. 

Acquired Gene Mutations

Most gene mutations related to pancreatic cancer occur after a person is born, rather than having been inherited. For example, these acquired gene mutations can result from exposure to cancer causing chemicals, but what causes these changes is unknown. 

Risk Factors for Pancreatic Cancer

A risk factor is anything that affects the chance of getting a disease, such as cancer. Different cancers have different risk factors, and some of these risk factors can be changed, such as smoking. Other risk factors, such as a person's age, or family history, cannot be changed. Though, by having a risk factor(s), doesn't mean that a person will get the disease. While many people who do develop the disease can have few or no known risk factors at all. 

Several factors can affect a person's chance of getting pancreatic cancer. Most of these below are risk factors for exocrine pancreatic cancer:

Tobacco use: Smoking is one of the most important risk factors for pancreatic cancer. The risk of developing pancreatic cancer is twice as high among smokers compared to non-smokers. Approximately 20 to 30 percent of pancreatic cancers are thought to be caused by cigarette smoking, including cigar and pipe smoking, and smokeless tobacco products. This is an example of a risk factor that can be changed.

Overweight/Obesity: Overweight or obese people are about 20% more likely to develop pancreatic cancer. This is a risk factor that can be changed through diet and exercise.

Workplace Exposure: to certain chemicals used in the dry cleaning and metal working industries may raise the risk of pancreatic cancer.

Age: The risk of developing pancreatic cancer increases with age. Almost all patients are over 45 years old, and about two-thirds are at least 65 years old. The average age at the time of diagnosis is 71 years old.

Gender: Men are slightly more likely to develop pancreatic cancer than women. It still remains a question as to why, but scientists believe that this may be due, at least in part, to higher tobacco use in men. The difference in pancreatic cancer was larger for men in the past, but the gap has closed in recent years.

Family History: Pancreatic cancer seems to run in some families. In those cases, the high risk is due to an inherited syndrome. In other families, the gene causing the increased risk is unknown. Although the family history is a risk factor, most people who develop pancreatic cancer do not have a family history of it.

Inherited Genetic Syndromes: Inherited gene 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. 

Diabetes: Pancreatic cancer is more common in people with diabetes, but the reason is unknown. Most of the risk is in people who have type 2 diabetes.

Chronic Pancreatitis: a long term inflammation of the pancreas can be linked with an increased risk of pancreatic cancer. Chronic pancreatitis is sometimes formed due to an inherited gene mutation. People with this inherited 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 hepatitis, or heavy alcohol use.

Stomach Problems: Infection of the stomach with the ulcer causing bacteria H. Pylori may increase the risk of pancreatic cancer. Some research suggests that excess stomach acid might also increase the 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. This is still being studied.

Physical Inactivity: Some research has suggested that the lack of physical activity might increase the risk of cancer in general, but not all studies have found this.

Can Pancreatic Cancer Be Prevented?

Unfortunately, there is no sure way to prevent pancreatic cancer as some of the above risk factors cannot be controlled. There are certain things that can help to prevent the risk such as, not smoking, maintaining a healthy weight and diet, limit alcohol use, and limiting exposure to certain chemicals at home or in the workplace. 

Early Detection

Pancreatic cancer is difficult to detect early. The pancreas is deep inside of the body, so early tumors can't be seen or felt by doctors during routine physical exams. People usually have no symptoms until the cancer has already spread to other organs. This is often why it is called the "silent killer."

Screening tests or exams are used to look for a disease in people who have no symptoms and who haven't had the disease before. At this time, major professional groups recommend not getting 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 increase. 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 increase when the person has the disease. If they do, the cancer is usually already advanced by the time this happens. 

Some of the gene changes that increase the risk of pancreatic cancer can be tested. Knowing if you are at an 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. Talking to someone with experience in hereditary cancer syndromes, such as a genetic counselor, geneticist, or an oncologist is often helpful. 

Remember, genetic tests look for mutations in your genes that cause inherited conditions. The tests are used to look for those inherited conditions, not pancreatic cancer itself. 

For people in families at high risk of pancreatic cancer, newer tests for detecting it early may help. One of these is called endoscopic ultrasound, and while it is not used to screen the general public, it may be used for someone with a strong family history of pancreatic cancer. Doctors have been able to find early, treatable pancreatic cancers in some members of high risk families with this test. 

Signs & Symptoms of Pancreatic Cancer

The symptoms of exocrine pancreatic cancers and NETs are often different. It's crucial to know that having one or more of the symptoms below does not mean that you have pancreatic cancer. Still, if you have any of these symptoms, it's very important to have them checked by a doctor, so that the cause can be found and treated, if needed.

Signs & Symptoms of Exocrine Pancreatic Cancer

Early pancreatic cancers often don't cause any signs or symptoms. Unfortunately, by the time they do, they have often already spread outside of the pancreas. 

Jaundice & Related Symptoms

Jaundice is the 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. 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 detected at an early stage. However, 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.

Stomach or Back Pain

Pain in the abdomen 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. This 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, Poor Appetite, Nausea & Vomiting

Unintended weight loss is very common in people with pancreatic cancer. They often have little or no appetite. If the cancer presses on the far end of the stomach, it can partly block it, thus making it difficult for food to get through. This can cause nausea, vomiting, and pain that tends to worsen 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 it has spread there. The doctor might be able to feel this below the right ribcage on an exam, or it might also 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.

 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. 

Signs & Symptoms of Pancreatic NET's

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 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, 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 levels in the blood. Excess glucagon can raise blood sugar, sometimes leading to diabetes. People with these tumors can also have problems with diarrhea, weight loss, and malnutrition. This can lead to symptoms, such as 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 fainting, coma and seizures.

Somastatinomas

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, and jaundice. The early symptoms of Somatostatinomas 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.

VIPoma's

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. 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. 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. Carcinoid tumors often don’t cause symptoms until they spread outside the pancreas. There, the cancer cells can release hormones directly into the blood leaving the liver. This can cause the carcinoid syndrome, with symptoms including flushing, diarrhea, wheezing, and a rapid heart rate. These symptoms often occur in episodes. 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.

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, belly pain, and weight loss.

Tests for Pancreatic Cancer

If a person has signs & 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 stage of the cancer. 

First, your doctor will examine you and ask about your medical history to learn more about your symptoms. The exam will focus mostly on the abdominal region as well as your skin and eyes. If the results of the exam are abnormal, your doctor will order tests to help find the problem, or refer you to a gastroenterologist 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. They may be done to look for suspicious areas that might be cancer, to learn if and how far the cancer has spread, to help determine if treatment is working, or to look for signs of cancer returning after treatment.

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 to guide the needle into place.

MRI Scan

MRI scans use radio waves and strong magnets instead of x-rays to create detailed images of parts of your body.

Ultrasounds

Ultrasound tests use sound waves to create images of organs. There are a couple of different types of ultrasounds that may be used, including:

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.

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. 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. The probe on the tip of the endoscope can get very close to the pancreas, so this is an excellent way to see 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, including:

Endoscopic retrograde cholangiopancreatography (ERCP): For this test, an endoscope is passed down the throat, through the esophagus and stomach, and into the first part of the small intestine. 

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.

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. PTC is not usually used unless ERCP has already been tried or can’t be done for some reason.

 Somatostatin Receptor Scintigraphy

This test 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. 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.

PET Scans

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 of the cancer.

Angiography

This is an x-ray test that looks at blood vessels. 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 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.

Blood Tests

Liver function tests: Jaundice 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 can help tell whether a patient’s jaundice is caused by disease in the liver itself or by a blockage of bile flow.

Tumor markers: Tumor markers are substances that can sometimes be found in the blood when a person has cancer. These are caked CA 19-9 and CEA - mentioned above.

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, Chromogranin A, and Glucose and C-peptide.

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.

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 including:

- Through the Skin Biopsy

- Endoscopic Biopsy

- Surgical Biopsy

Pancreatic Cancer Stages

After someone is diagnosed with pancreatic cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer's stage when talking about survival statistics.

The earliest stage pancreas cancers are stage 0 (carcinoma in situ), and then range from stages I (1) through IV (4). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means a more advanced cancer. Cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

 Prognosis

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.

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

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 NET Pancreatic Tumors (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.

Treatment - How, Approaches, Decisions

How is Pancreatic Cancer Treated?

Depending on the type and stage of the cancer and other factors, treatment options for people with pancreatic cancer can include:

• Surgery
• Ablation or Embolization Treatment 
• Chemotherapy and Other Drugs
• Drugs Used to Treat Pancreatic Neuroendocrine Tumors
• Pain Control

Sometimes, the best option for treating pancreatic cancer might include more than one type of treatment. 

 Who Treats It?

Depending on your options, you can have different types of doctors on your treatment team. The doctors on your cancer treatment team might include:

• A surgeon: a doctor who uses surgery to treat cancers or other problems
• An endocrinologist: a doctor who treats diseases in glands that secrete hormones
• A radiation oncologist: a doctor who uses radiation to treat cancer
• A medical oncologist: a doctor who uses chemotherapy and other medicines to treat cancer

Many other specialists may be involved in your care as well, including nurse practitioners, nurses, psychologists, social workers, rehabilitation specialists, and other health professionals.

Making Treatment Decisions

It’s important to discuss all of your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs. Some important things to consider include:

• Your age and expected life span
• Any other serious health conditions you have
• The stage of your cancer
• Whether or not surgery can remove the cancer
• The likelihood that treatment will cure the cancer 
• Your feelings about the possible side effects from treatment

You may feel that you must make a decision quickly, but it’s important to give yourself time to absorb the information you have just learned. Ask questions if there is anything you’re not sure about. 

If time permits, it is often a good idea to seek a second opinion. A second opinion can give you more information and help you feel more confident about the treatment plan you choose.

You may also hear about alternative or complementary methods that your doctor hasn’t mentioned to treat your cancer or relieve symptoms. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.

Complementary methods refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctor’s medical treatment. Although some of these methods might be helpful in relieving symptoms or helping you feel better, many have not been proven to work. Some might even be dangerous.

Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known about the method, which can help you make an informed decision.

For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. Whether or not you continue treatment, there are still things you can do to help maintain or improve your quality of life.

Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons you might decide not to get cancer treatment, but it’s important to talk to your doctors and you make that decision. Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms.