Pancreatic Cancer
Videos
Overview
Pancreatic cancer most often begins in the cells lining the ducts of the pancreas (pancreatic ductal adenocarcinoma). Although it accounts for only about 3% of cancers, it is the third leading cause of cancer death in the United States, because it is usually discovered late and spreads early (Siegel et al., CA: A Cancer Journal for Clinicians, 2025). Overall five-year survival is about 13%, but outcomes are considerably better for the minority of patients whose cancer is found while it can still be removed surgically.
Surgery is the only treatment that offers a chance of cure. For cancers in the head of the pancreas, the operation is a pancreaticoduodenectomy (Whipple procedure); for cancers in the body or tail, a distal pancreatectomy. Modern care combines surgery with chemotherapy, given before and/or after the operation, which has meaningfully improved survival (Conroy et al., PRODIGE 24 trial, New England Journal of Medicine, 2018).
A smaller group of pancreatic tumors, called neuroendocrine tumors, behave very differently and usually have a much better prognosis; see neuroendocrine tumors.
Pancreatic Cysts
Pancreatic cysts are increasingly found by chance on CT and MRI scans done for other reasons. Most are benign and never cause problems, but some types, particularly mucinous cysts such as IPMNs, can become cancerous over time. Cysts are monitored with periodic imaging, and those with concerning features, such as growth, a solid component or a dilated main pancreatic duct, may be removed (Mizrahi et al., Lancet, 2020).
Causes
Pancreatic cancer develops from genetic changes in pancreatic cells, often arising from precancerous lesions such as pancreatic intraepithelial neoplasia or cystic lesions like intraductal papillary mucinous neoplasms (IPMNs) (Mizrahi et al., Lancet, 2020). Contributing factors include:
- Smoking, the strongest modifiable risk factor
- Obesity, an established cause (Lauby-Secretan et al., New England Journal of Medicine, 2016)
- Long-standing diabetes
- Chronic pancreatitis
- Inherited gene mutations such as BRCA2, BRCA1, PALB2, ATM and Lynch syndrome
- Heavy alcohol use, mainly through chronic pancreatitis
Risk Factors
- Age, most cases after 65
- Smoking
- Obesity
- Type 2 diabetes, and especially new-onset diabetes after age 50, which can be an early sign (Mizrahi et al., Lancet, 2020)
- Chronic pancreatitis
- Family history of pancreatic cancer in two or more first-degree relatives
- Inherited syndromes including BRCA mutations, Peutz-Jeghers and familial melanoma syndromes
- Pancreatic cysts with high-risk features
Who It Affects
Pancreatic cancer mainly affects older adults, with slightly higher rates in men and in Black Americans. People with a strong family history or inherited mutations may be eligible for surveillance programs with MRI or endoscopic ultrasound.
Complications
- Bile duct blockage causing jaundice, itching and infection
- Duodenal obstruction causing vomiting
- Weight loss and malnutrition from poor digestion and appetite
- New or worsening diabetes
- Blood clots
- Pain from tumor involvement of nerves
- Spread to the liver, lungs or abdominal lining
Symptoms
- Painless jaundice: yellow skin and eyes, dark urine and pale stools
- Upper abdominal or mid-back pain
- Unintended weight loss and loss of appetite
- Oily, foul-smelling stools
- New-onset diabetes or sudden worsening of existing diabetes
- Nausea, early fullness and fatigue
- Blood clots without another explanation
Because early symptoms are vague, pancreatic cancer is often mistaken for indigestion, gallbladder trouble or back strain. Persistent symptoms, especially with weight loss, deserve imaging rather than repeated reassurance.
Diagnosis
- Pancreas-protocol CT scan: the key test to detect the tumor and determine whether it can be removed
- Endoscopic ultrasound with biopsy to confirm the diagnosis
- MRI for cysts and liver lesions
- CA 19-9 blood test to help assess and monitor the disease
- ERCP with stent placement to relieve jaundice when needed
- Germline genetic testing, now recommended for all patients with pancreatic cancer
- Staging laparoscopy in selected patients to look for small spread not visible on scans
Why Genetic Testing Matters
About 5% to 10% of people with pancreatic cancer carry an inherited mutation. Identifying it can open the door to targeted treatments, such as PARP inhibitors for BRCA mutations, and allows family members to be tested and enter surveillance programs (Mizrahi et al., Lancet, 2020).
Differential Diagnosis
- Chronic pancreatitis
- Bile duct stones
- Bile duct cancer (cholangiocarcinoma) or ampullary cancer
- Neuroendocrine tumors
- Autoimmune pancreatitis
- Benign pancreatic cysts
Lifestyle Modifications
- Do not smoke; quitting reduces risk over time.
- Maintain a healthy weight.
- Limit alcohol.
- Manage diabetes and report sudden changes in control.
- During treatment: pancreatic enzyme replacement, high-protein nutrition and physical activity help maintain strength.
Treatment Options
Resectable Cancer
Patients whose tumor has not involved major blood vessels or spread are candidates for surgery, often combined with chemotherapy before and after. After surgery, modified FOLFIRINOX chemotherapy significantly improved survival compared with gemcitabine in the PRODIGE 24 trial (Conroy et al., PRODIGE 24 trial, New England Journal of Medicine, 2018).
- Whipple procedure: removal of the head of the pancreas, the duodenum, the gallbladder and part of the bile duct, with reconstruction of the digestive tract
- Distal pancreatectomy: removal of the body and tail of the pancreas, often with the spleen, frequently performed laparoscopically or robotically
Borderline Resectable and Locally Advanced Cancer
Chemotherapy, sometimes with radiation, is given first; some patients respond well enough to undergo surgery.
Metastatic Cancer
Treatment focuses on chemotherapy, targeted therapy for specific mutations, symptom control and quality of life, including stents for blockages and nerve blocks for pain.
See surgical oncology and complex tumor surgery.
Recovering From Pancreatic Surgery
Pancreatic operations are major procedures. Patients typically stay in the hospital about five to seven days after a Whipple procedure, with shorter stays after minimally invasive distal pancreatectomy. Possible complications include a leak from the pancreatic connection, delayed stomach emptying and infection. Outcomes are best at centers and with surgeons experienced in complex pancreatic surgery, and recovery is supported by enzyme replacement, nutrition counseling and diabetes management.
When to See a Doctor
See a doctor promptly for yellowing of the skin or eyes, unexplained weight loss, persistent upper abdominal or back pain, or new-onset diabetes after age 50 with weight loss.
When to Seek Treatment
Seek urgent care for jaundice with fever and chills, persistent vomiting, or severe abdominal pain.
Long-Term Outlook
After treatment, patients are followed with imaging and CA 19-9 testing and receive ongoing nutritional and diabetes care. Advances in chemotherapy, genetic testing and targeted therapies continue to improve outcomes.
Related Reading and Videos
Read more in our articles GLP-1 Medications and Cancer: Do They Raise or Lower Your Risk? and From Heartburn to Barrett's to Cancer: Why Chronic Reflux Should Never Be Ignored. Watch What Actually Happens in the Operating Room During My Surgery? on our video library. Related conditions include Colon Cancer, Pancreatitis and Stomach Cancer (Gastric Cancer). Treatments that may be involved include Gastric Outlet Obstruction Surgery, Minimally Invasive Surgery (Laparoscopic, Robotic & Endoscopic) and Major Surgical Oncology and Complex Benign Tumor Surgery.
Prognosis
Prognosis depends on stage and whether the tumor can be removed. Patients who undergo successful surgery and chemotherapy have substantially better survival than those whose cancer cannot be removed (Conroy et al., PRODIGE 24 trial, New England Journal of Medicine, 2018) (Siegel et al., CA: A Cancer Journal for Clinicians, 2025).
Why Choose Dr. de la Cruz-Muñoz
Pancreatic cancer care requires an experienced surgeon working within a multidisciplinary team. Dr. de la Cruz-Muñoz is a board-certified surgeon experienced in complex abdominal and tumor surgery, including minimally invasive approaches when appropriate, and coordinates closely with gastroenterology, oncology and radiation oncology. Patients receive a clear explanation of their options and a coordinated plan from diagnosis through recovery.
Dr. de la Cruz-Muñoz has performed more than 15,000 minimally invasive procedures over more than 25 years in practice, including complex foregut, hernia, gallbladder and abdominal operations as well as bariatric surgery.
Featured Procedures
FAQ
For distal (lower) stomach cancer, large randomized trials say yes:
• KLASS-02 (Korea): 3-year relapse-free survival of 80.3% vs 81.3%, with fewer early complications (15.7% vs 23.4%) (Hyung et al., Journal of Clinical Oncology, 2020).
• CLASS-01 (China): 3-year disease-free survival of 76.5% vs 77.8% (Yu et al., JAMA, 2019).
• JLSSG0901 (Japan): cancer control was equivalent at 5 years (Etoh et al., JAMA Surgery, 2023).
• LOGICA (Netherlands), a Western trial: complications (44% vs 42%) and complete-resection rates (95% in both groups) were similar, with less blood loss after laparoscopy (van der Veen et al., Journal of Clinical Oncology, 2021).
The key is an experienced minimally invasive surgeon.
Both relieve the obstruction, but they suit different patients. Endoscopic stenting is less invasive and lets patients eat sooner with a shorter hospital stay, making it a good choice for those with limited life expectancy or poor fitness. Its downside is a higher rate of re-obstruction and repeat procedures (Troncone et al., World Journal of Gastroenterology, 2020). Surgical gastrojejunostomy is more durable, allows a wider range of foods, and needs fewer reinterventions, so it is favored for patients who are surgically fit and expected to live longer than about two months (Ahmed et al., American Gastroenterological Association, 2021). A newer middle option, EUS-guided gastroenterostomy, combines endoscopic recovery with surgery-like durability but requires specialized expertise (Martinet et al., Langenbeck's Archives of Surgery, 2024).
Pancreatic cancer is a malignant tumor of the pancreas, most often pancreatic ductal adenocarcinoma. It is often diagnosed late because early symptoms are vague, which makes it one of the deadliest cancers. Risk factors include smoking, obesity, diabetes, chronic pancreatitis, older age and certain inherited gene mutations. Warning signs include jaundice, unexplained weight loss, upper abdominal or back pain and new-onset diabetes. Pancreatic neuroendocrine tumors are a different, usually slower-growing type.
Treatment depends on whether the tumor can be removed. For resectable cancers, surgery — a Whipple procedure for tumors in the head of the pancreas or a distal pancreatectomy for tumors in the body or tail — is followed by chemotherapy. Borderline tumors are often treated with chemotherapy, sometimes with radiation, before surgery. For advanced disease, chemotherapy, targeted therapy based on tumor genetics and supportive care, including relief of bile duct or intestinal blockage, are the focus. Treatment at a multidisciplinary center improves outcomes.
It can be when it is found early enough to remove. Surgery is the only treatment that offers a chance of cure, but only about 15–20% of pancreatic cancers are removable at diagnosis. For those patients, surgery followed by chemotherapy gives the best results; in one major trial, patients who received modern combination chemotherapy after surgery lived a median of more than four years (Conroy et al., New England Journal of Medicine, 2018). For cancers that are borderline, chemotherapy before surgery can sometimes make an operation possible. Any new diabetes, unexplained weight loss or painless jaundice deserves prompt evaluation.
Early pancreatic cancer often causes few symptoms. Warning signs include painless jaundice (yellowing of the skin or eyes, dark urine, pale stools), upper abdominal pain that may spread to the back, unexplained weight loss, loss of appetite, new-onset diabetes in an adult without the usual risk factors, greasy stools and fatigue. These symptoms have many causes, but the combination — especially jaundice or new diabetes with weight loss — warrants prompt evaluation with imaging.
