--- title: Pancreatic Cancer url: "https://www.yyhmedical.com/en/guide/solid/pancreatic-cancer" type: MedicalWebPage inLanguage: en-US --- # Pancreatic Cancer > Pancreatic cancer is a malignancy that develops in the pancreas. The most common type is pancreatic ductal adenocarcinoma (PDAC), which arises from the cells lining the pancreatic ducts. Other pancreatic tumors, such as pancreatic neuroendocrine tumors, have different biologic features and treatment approaches. ## Overview The pancreas is located deep in the upper abdomen and plays important roles in digestion and blood sugar regulation. Pancreatic tumors can arise from exocrine cells or neuroendocrine cells. The term “pancreatic cancer” most commonly refers to exocrine pancreatic cancer, particularly pancreatic ductal adenocarcinoma. This page focuses on pancreatic ductal adenocarcinoma rather than pancreatic neuroendocrine tumors. Pancreatic cancer can arise in the head, body, or tail of the pancreas. Tumor location can influence symptoms. Tumors in the pancreatic head are more likely to obstruct the bile duct and cause jaundice, while tumors in the body or tail may remain less noticeable until they become larger or spread. For treatment planning, pancreatic cancer is often described as resectable, borderline resectable, locally advanced, or metastatic rather than simply “early” or “late.” ## Causes and Risk Factors Most patients with pancreatic cancer do not have a single identifiable cause. Established or recognized risk factors include:Smoking、Increasing age、Obesity、Chronic pancreatitis、A family history of pancreatic cancer、Inherited variants involving genes such as BRCA1, BRCA2, PALB2, and ATM、Certain inherited cancer-predisposition syndromes、Diabetes, particularly in some older adults with newly developed or unexpectedly worsening diabetes. The relationship between diabetes and pancreatic cancer is complex. Long-standing diabetes may be associated with an increased risk of pancreatic cancer, while pancreatic cancer itself can sometimes cause new-onset diabetes or make existing diabetes more difficult to control. ## Signs and Symptoms Early pancreatic cancer may cause no symptoms, and when symptoms do occur, they are often nonspecific. Possible signs and symptoms include: Upper abdominal or back pain、Yellowing of the skin or eyes、Dark urine、Pale stools、Itching、Loss of appetite、Unexplained weight loss、Nausea, bloating, or digestive discomfort、Fatigue、New-onset diabetes or unexpectedly worsening blood glucose control. Abdominal pain is not always the first symptom. Tumors in the head of the pancreas may obstruct the bile duct and cause jaundice, sometimes before significant pain develops. ## Diagnosis When pancreatic cancer is suspected, evaluation focuses on identifying a pancreatic mass, determining the extent of disease, and confirming the tumor type when needed. Common tests include: - Contrast-enhanced CT. Pancreas-protocol CT is important for diagnosis and for determining whether the tumor may be surgically resectable. - MRI/MRCP. These tests may be useful when CT findings are unclear, when more detailed evaluation of the pancreatic or bile ducts is needed, or when contrast-enhanced CT is not appropriate. - Endoscopic ultrasound (EUS). EUS allows detailed evaluation of pancreatic lesions and can be used to obtain tissue samples when needed. - Pathology. Tissue confirmation is generally required before systemic therapy. In selected patients with a highly suspicious resectable tumor who are proceeding directly to surgery, preoperative biopsy may not always be required. - CA19-9. CA19-9 is commonly used to help assess pancreatic cancer and monitor treatment response, but it cannot diagnose pancreatic cancer by itself and is not an effective screening test for the general population. It may also be elevated in benign conditions such as pancreatitis or bile duct obstruction. ## Treatment **Resectable Pancreatic Cancer** For resectable pancreatic cancer, surgery remains an important part of treatment with curative intent, but surgery is usually combined with systemic chemotherapy. Operations may include the Whipple procedure for tumors in the pancreatic head, distal pancreatectomy for tumors in the body or tail, and total pancreatectomy in selected cases. Some patients undergo surgery first followed by adjuvant chemotherapy, while others may receive treatment before surgery. NCI lists neoadjuvant chemotherapy with or without radiation, surgery, and postoperative chemotherapy among treatment options for resectable or borderline resectable pancreatic cancer. For suitable patients who did not receive preoperative therapy, adjuvant chemotherapy is generally recommended after recovery from surgery. mFOLFIRINOX is an important option for patients fit enough to tolerate it, while other regimens may be used depending on overall health and tolerance. ### ****Borderline Resectable and Locally Advanced Pancreatic Cancer**** Borderline resectable pancreatic cancer is often treated with systemic therapy before surgery, sometimes with radiation therapy, followed by reassessment for resection. Locally advanced disease is generally treated initially with systemic therapy. If the tumor responds and remains free of distant spread, a multidisciplinary team may reassess whether surgical removal has become feasible. An initially unresectable tumor does not always remain permanently unresectable, although only selected patients ultimately become surgical candidates. ### ### ****Metastatic Pancreatic Cancer**** Systemic therapy is the main treatment for metastatic pancreatic cancer. For patients who are fit enough for combination treatment, first-line options may include FOLFIRINOX or gemcitabine plus nab-paclitaxel. NALIRIFOX is also a first-line option for metastatic pancreatic adenocarcinoma; the U.S. FDA approved liposomal irinotecan with oxaliplatin, fluorouracil, and leucovorin for this setting in 2024. Less intensive treatment may be appropriate for patients who are not able to tolerate aggressive combination chemotherapy. Second-line treatment depends on what was used previously. For example, fluorouracil plus liposomal irinotecan may be considered after gemcitabine-based therapy, while gemcitabine plus nab-paclitaxel may be considered after prior FOLFIRINOX in suitable patients. Radiation therapy is not usually the main systemic treatment for metastatic pancreatic cancer. It may be used selectively to control a local tumor or relieve symptoms such as pain. **Molecular Testing and Targeted Therapy** The older description of erlotinib, cetuximab, and bevacizumab as the main targeted treatments for pancreatic cancer is no longer an appropriate summary. Modern precision treatment focuses on identifying uncommon but potentially actionable molecular alterations. Examples include: - Germline BRCA1/2 variants: Some tumors may be particularly sensitive to platinum-based therapy, and maintenance olaparib may be considered in selected patients with metastatic disease after response to platinum treatment. - MSI-H/dMMR tumors: A small number of patients may benefit from PD-1 checkpoint inhibition. - NTRK fusions: Rare tumors with these alterations may be treated with TRK-targeted therapy. Other rare actionable alterations may also be identified through broader molecular profiling.  **Supportive Care** Supportive care is an important part of pancreatic cancer treatment at every stage. Biliary obstruction and jaundice may be treated with endoscopic biliary stenting or other drainage procedures. Pain can be managed with medications, radiation therapy, nerve-block procedures, and other approaches. Some patients develop pancreatic exocrine insufficiency, which may cause bloating, fatty stools, weight loss, and malnutrition. Pancreatic enzyme replacement and nutritional support may help. Gastric or duodenal obstruction may be managed with endoscopic stenting, surgical bypass, or other approaches depending on the situation. ## Content attribution (YMYL) - Author: - Medically reviewed by: - Last reviewed: - First published: > --- Original (HTML):https://www.yyhmedical.com/en/guide/solid/pancreatic-cancer This is a clean Markdown mirror for large language models; the original page is authoritative.