Screening and Diagnosis

Pancreatic Cancer Risk Factors

The cause of pancreatic cancer is unknown, but it can be associated with mutations in DNA, which are inherited or caused by lifestyle choices. Other factors that can increase your risk of developing pancreatic cancer include:

• Age: Most pancreatic cancer occurs in people over the age of 55 years.
• Smoking: Heavy cigarette smokers are two or three times more likely than nonsmokers to develop pancreatic cancer.
• Weight and physical inactivity: Pancreatic cancer is more common in people with obesity and in people who don't get much physical activity.
• Diabetes: Pancreatic cancer is more common in people who have Type 2 diabetes than in people who do not.
• Sex assigned at birth: More people who were assigned male at birth are diagnosed with pancreatic cancer than people who were assigned female at birth.
• Race: Black people are more likely than Asian, Latin American, or white people to be diagnosed with pancreatic cancer in the U.S.
• Family history: The risk for developing pancreatic cancer is higher if you have a first-degree relative (parent or sibling) with the disease.
• Certain dietary habits: Eating charred, well-done meat on a regular basis has been linked to an increased risk of pancreatic cancer.
• Workplace exposures: Exposure to certain occupational pesticides, dyes and chemicals used in the metal industry may increase the risk of pancreatic cancer.
• Some genetic syndromes: Certain inherited gene mutations, such as in the BRCA2 gene, increase the risk of pancreatic cancer.
• Chronic pancreatitis: Long-term inflammation of the pancreas has been linked with increased risk for pancreatic cancer.
• Von Hippel-Lindau disease, or a family history of Von Hippel-Lindau disease.

Diagnosing Pancreatic Cancer

Your care team will use a variety of leading-edge methods to diagnose pancreatic cancer.

Tests and imaging to diagnosis your pancreatic cancer may include:

• Ultrasound: This will use high-frequency sound waves to create an image of the internal organs, including the liver, pancreas, spleen and kidneys, and to assess blood flow through various vessels. The ultrasound may be done with an external or internal device.
• Computed tomography scan (CT scan): This diagnostic imaging procedure uses a combination of X-rays and computer technology to produce images of the body. CT scans are more detailed than general X-rays.
• Magnetic resonance imaging (MRI): Using large magnets, radiofrequencies and a computer, an MRI produces detailed images of organs and structures in the body.
• Endoscopic retrograde cholangiopancreatography (ERCP): This procedure combines an X-ray and an endoscope, a long, flexible, lighted tube guided through the digestive tract, to diagnose and treat problems in the liver, gallbladder, bile ducts and pancreas.
• Percutaneous transhepatic cholangiography (PTC): A needle is put through the skin and into the liver where the dye (contrast) is injected so that the bile duct structures can be seen by X-ray. This test is generally only done if an ERCP cannot be done.
• Pancreas biopsy: A sample of pancreatic tissue is removed, with a needle or during surgery, to be examined under a microscope for cancerous cells.
• Special blood tests: Blood tests can show if jaundice (when the skin yellows) is due to a blockage in the bile duct or to another cause, such as liver disease. If you have been diagnosed with pancreatic cancer, your physician may give you a special blood test, called CA 19-9 to track the activity of pancreatic cancer cells.
• Positron emission tomography (PET): For this test, a radioactive substance, usually bound to a type of sugar, is injected through a vein before your body is scanned. The radioactive sugar collects in cancer cells, which will show up on images. A PET scan is sometimes done along with a CT scan.

Stages of Pancreatic Cancer

“Staging” is the term oncologists use to define where pancreatic cancer is located and how much it has spread. After the stage of pancreatic cancer is determined, your physician can recommend a particular course of treatment.

Most cancer teams use the system developed by the American Joint Committee on Cancer, known as the TNM staging system.

T = Tumor
Where is the primary tumor and how large is it?

N = Nodes
Has the tumor spread to nearby lymph nodes (part of your immune system)?

M = Metastasis
Has cancer spread to other parts of the body?

For each letter, there are five numbered stages, from zero to four, depending on how much the cancer has spread. The lower the number, the more the cancer cells look like normal cells and the easier they are to treat and cure. A higher number means it has spread more.

The place where cancer forms is called the primary site. Cancer can spread from the primary site to other parts of the body. Even if pancreatic cancer is found in other parts of your body, it’s still considered pancreatic cancer. For example, if pancreatic cancer has spread to the liver, it’s called metastatic pancreatic cancer, not liver cancer.

For treatment, physicians often use a simpler system of categorizing pancreatic cancer:

• Resectable cancer: These cancers can be surgically removed (resected).
• Borderline resectable cancer: These cancers can be surgically removed but are very close to major blood vessels, or other important parts of your body.
• Locally advanced cancer: These cancers are still only in the area around the pancreas, but they cannot be removed completely with surgery, often because they are growing into nearby blood vessels. This category is also called unresectable because the cancer cannot be removed with surgery.
• Metastatic cancer: These cancers have spread to other parts of the body, so they cannot be removed completely with surgery (meaning they are also unresectable). Surgery may still be done, but it's used to relieve symptoms that the tumors in other areas of the body are causing.

Talk to your physician about your stage of cancer and how that will impact your treatment.

For more information about the stages of pancreatic cancer, please visit our Health Library.