Understanding Pancreatic Cancer 

Cancer of the pancreas, a large gland deep in the abdomen, is an especially complex illness. Things to know: 

  • Pancreatic cancer shows no or few signs at first, making it difficult to diagnose early. 
  • New-onset diabetes is an important risk factor. 
  • Patients do best at a major cancer center with extensive experience diagnosing and treating pancreatic cancer.  
  • Pancreatic cancer remains challenging to treat, but doctors are making progress. 

This page is devoted mostly to exocrine pancreatic cancer, which makes up about 95% of cases. Learn more about pancreatic neuroendocrine cancer.

Anatomy of the Pancreas
Anatomy of the Pancreas
The pancreas lies deep in the abdomen, behind the stomach. It is a gland that releases digestive juices (enzymes) and hormones.

What is pancreatic cancer?

Pancreatic cancer occurs when abnormal cells in the pancreas grow out of control. The pancreas is a gland tucked between the stomach and spine. It’s shaped like a long, horizontal pear. It’s about 6 inches long and has three main parts: a head, body and tail. 

The pancreas does two main things: 

  • It makes juices (enzymes) to digest food. 
  • It makes hormones (such as insulin) to control blood sugar. 

Who gets pancreatic cancer?

An estimated 62,210 people in the U.S. are expected to be diagnosed with pancreatic cancer in 2022. Pancreatic cancer is relatively rare, making up just over 3% of new cancers. Research is vital, though, because it is a leading cause of cancer death. 

Risk factors

Scientists have identified several factors that put people at higher risk: 

Gender: It’s slightly more common in men. 

Age: Nearly 90% of patients are 55 or older when diagnosed. Two-thirds are 65 or older. 

Race/ethnicity: Black people are at slightly higher risk than white people. White people are at slightly higher risk than Asians, Pacific Islanders, Latinos, Native Americans and Native Alaskans. 

Smoking: Smokers are about twice as likely to get pancreatic cancer, according to the American Cancer Society. Smokeless tobacco also increases risk. 

Obesity: Being very overweight increases risk about 20%, according to the American Cancer Society. 

Family history: Those with a family history of pancreatic cancer or pancreatitis (inflammation of the pancreas) are at higher risk. Inherited syndromes such as multiple endocrine neoplasia and defects in the BRCA1 and BRCA2 genes also increase risk. At OHSU, we offer: 

Chronic pancreatitis: Repeated bouts of pancreatic inflammation are linked to an increased risk. 

Diabetes: Most diabetes patients will not get pancreatic cancer. But diabetes is linked to an increased risk of pancreatic cancer. Research also suggests pancreatic cancer can cause diabetes, perhaps by disrupting how the pancreas produces insulin.  

New-onset diabetes: This type of diabetes, in particular, has a strong link to pancreatic cancer. It may indicate a higher risk of pancreatic cancer, or it may be a sign that cancer is already present. It is of particular concern in a patient without risk factors for diabetes.

Pancreatic cancer outcomes

Pancreatic cancer is challenging to treat, in part because of: 

  • Few signs: Pancreatic cancer shows few symptoms early on. About 80% of patients are diagnosed after the cancer has spread to other parts of the body. 
  • The location of the pancreas: The pancreas is deep in the abdomen, where it’s hard to see and reach. It’s also curved around large blood vessels, complicating surgical options. Blood vessels and many nearby lymph nodes (part of the immune system) can speed its spread. 
  • Complex tumors: Pancreatic tumors often have several cell types. This makes them more challenging to match with treatments. 
  • A related condition: Pancreatic cancer patients are especially likely to develop a wasting syndrome called cachexia (kuh-KECK-see-uh). These patients lose a lot of muscle and weight, leaving them less able to tolerate cancer treatments.  

These factors result in discouraging long-term survival rates. At the same time, statistics are averages that can’t predict the outcome for any one patient. In addition, five-year relative survival rates, the most common measure, are by definition based on treatments that were available five or more years ago.

Signs of hope: Five-year survival rates have more than doubled over the past 20 years. The Knight Cancer Institute and other major cancer centers can offer surgery to more patients than ever.  

Quality of life: Surgically removing all the cancer remains essential to a cure, but it’s not the only way to extend and improve life. The Knight Cancer Institute is devoted to giving every patient the best quality of life possible for as long as possible. 

Signs and symptoms of pancreatic cancer

These symptoms also have other causes and don’t necessarily mean you have pancreatic cancer. Signs include: 

  • Jaundice: Cancer can block the bile duct, leading to a buildup of a dark yellow-brown substance called bilirubin. This can turn the skin and eyes yellow. 
  • Itchiness and dark urine: Bilirubin buildup can make the skin itch and turn urine dark. 
  • Stool changes: If cancer blocks bilirubin and pancreatic juices from breaking down fats in the digestive system, stools can be lighter colored and greasy. 
  • Weight loss for unknown reasons 
  • Appetite loss 
  • Fatigue 
  • Pain in the back or belly 
  • Diarrhea  
  • Vomiting 

Types of pancreatic cancer

Exocrine pancreatic cancer: This type starts in the pancreas’s exocrine cells, which make enzymes to digest food. The most common type, ductal adenocarcinoma, starts in the pancreatic duct, where the enzymes are released. The pancreatic duct runs the length of the pancreas and connects with the small intestine.  

Pancreatic neuroendocrine cancer: This type starts in endocrine cells, which produce hormones. These cells are found in clusters like islands, so they’re also called islet cells. Learn more about pancreatic neuroendocrine cancer at the bottom of the page.  

Treatment and outcomes vary with where in the pancreas the cancer starts: the head/neck, body or tail. 

Most start in the head. Because the head is next to the bile duct, cancer here is more likely to block the duct and cause jaundice and other symptoms. This can lead to earlier detection and better outcomes. 

Resectable: The cancer can be surgically removed (resected).  

Borderline resectable: The cancer has invaded major blood vessels but still might be removable with surgery if combined with additional treatment. Chemotherapy and/or radiation therapy can sometimes shrink the tumor before surgery. Expert surgeons can sometimes reconstruct affected blood vessels. 

Unresectable: The cancer has spread too far for surgical removal.

Pancreatic cancer staging

This is staging for exocrine pancreatic cancer. 

Stage I: The tumor is confined to the pancreas.  

  • Stage IA: The tumor is no bigger than 2 centimeters at its widest point.  
  • Stage IB: The tumor is bigger than 2 centimeters but no bigger than 4 centimeters. 

Stage II:  

  • Stage IIA: The tumor is confined to the pancreas and bigger than 4 centimeters. 
  • Stage IIB: The tumor ranges from smaller than 2 centimeters to larger than 4 centimeters. Cancer has spread to one to three nearby lymph nodes.   
Diagram illustrating stage IIA Pancreatic Cancer, with an inset showing the size comparison of the tumor and a 4cm walnut

Stage III: One of the following: 

  • The tumor ranges from smaller than 2 centimeters to larger than 4 centimeters. Cancer has spread to four or more nearby lymph nodes. 
  • The tumor involves nearby major blood vessels and any number of lymph nodes. 

Stage IV: Cancer has spread to distant parts of the body such as the liver or lungs. 

Pancreatic neuroendocrine cancer

This type starts in cells that make hormones such as insulin and glucagon to control blood sugar. These tumors are also called pancreatic neuroendocrine tumors or PNETs. Things to know: 

  • Less than 5% of pancreatic cancers are this type.
  • Overall, this type is slower-growing, more likely to be resectable (removable with surgery) and has better outcomes.
  • Signs and symptoms, if any, vary depending on the type of PNET and any hormones affected.  
  • Patients are usually white and younger (in their 50s) at diagnosis. 
  • These tumors are also called islet cell tumors because they form in cell clusters that resemble islands. 
  • People with multiple endocrine neoplasia type 1 (MEN1) syndrome, an inherited genetic condition, are at higher risk. 

Types and signs/symptoms of PNETs

  • Functional: These tumors cause the pancreas to overproduce hormones. This can cause symptoms that lead to quicker diagnosis and better outcomes. Symptoms vary by hormone type.

  • Nonfunctional: These tumors do not produce hormones. With no symptoms, vague symptoms or symptoms that look like those of other illnesses, these tumors frequently aren’t diagnosed until they’re advanced. Signs include: 

    • Diarrhea
    • Stomach upset 
    • Pain in the belly or back 
    • Jaundice 
    • Weight loss 

Functional tumors, which cause the pancreas to make too much hormone, come in several types. Gastrinomas and insulinomas are the most common.

Gastrinomas: These tumors make gastrin, which causes the stomach to make acid to digest food. Too much gastrin can lead to stomach ulcers (open sores) and pain.

Insulinomas: These make insulin. Too much can lead to low blood sugar, which can cause confusion, fatigue, irritability, weakness and lightheadedness.

Glucagonomas: These make glucagon, which raises blood sugar levels. Too much can cause diabetes, with symptoms such as thirst and frequent urination. Patients can also develop other symptoms, including a red blistering rash on the face, stomach or legs.

Somatostatinomas: These tumors make somatostatin, which controls other hormones. Symptoms of too much somatostatin include high blood sugar, diarrhea, gallstones, jaundice, weight loss and foul-smelling stools.

VIPomas: These produce vasoactive intestinal peptide. Too much can cause symptoms such as severe watery diarrhea, thirst, headaches, dizziness, fatigue, weight loss, muscle weakness and belly pain or cramps.

PPomas: These make pancreatic polypeptide, which helps regulate the pancreas. Symptoms can include watery diarrhea, belly pain and an enlarged liver. 

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