Updated on October 15, 2024.
Pancreatic cancers are rarely detected early, are difficult to treat—and they often come back. An estimated 66,440 people in the United States will be newly diagnosed with pancreatic cancer in 2024, according to the American Cancer Society. The organization projects that 51,750 people will die from the disease, as well.
But incremental advances have begun to emerge, from powerful combinations of cancer drugs to better surgical techniques. What’s more, immunotherapies that use the human immune system to fight against this disease may hold promise for better treatments and improved pancreatic cancer prognoses in the future.
How pancreatic cancer begins
The pancreas is a pear-shaped gland located behind the stomach. It produces digestive juices that help break down food. It also manufactures hormones, such as insulin and glucagon, that are important to controlling blood sugar levels. The vast majority of pancreatic cancers begin in the cells involved in the digestive process.
Overall, pancreatic cancer ranks as the 11th most common cancer in the U.S., but causes the 3rd most cancer deaths per year, behind lung and colorectal cancers. What's more, for most patients, the pancreatic cancer survival rate remains poor.
The 5-year relative survival rate is 13 percent for all stages of the disease. Pancreatic cancer that remains localized to the pancreas has a 5-year relative survival rate of 44 percent. Cancer that has spread beyond the pancreas to distant parts of the body has 5-year relative survival rate of 3 percent.
“We’ve not had the same breakthroughs yet that we’ve seen in treating other cancers,” says Jill Onesti, MD, a surgical oncologist at Trinity Health in Grand Rapids, Michigan.
Immunotherapies, especially, have brought progress in treating some cancers, such as lung cancers and melanoma, but have not worked well in pancreatic cancers, she says. These treatments include targeted drugs, which attack specific proteins on cancer cells that enable them to thrive, as well as vaccines designed to make cancer cells more “visible” to attack by the immune system.
What are the risk factors for pancreatic cancer?
As with all cancers, the risk for developing pancreatic cancer rises with age. Healthcare providers (HCPs) diagnose the largest number of cases in individuals 65 and over. Other risk factors are less well-defined, with inherited genetic mutations accounting for no more than 10 percent of cases.
In addition to increased age and inherited genetic mutations, risk factors for pancreatic cancer that you can’t control include:
- Sex: Men are at slightly higher risk than women.
- Race: Black people are at slightly higher risk than white people.
- Family history: Pancreatic cancer seems to run in families, even aside from inherited genetic mutations.
Risk factors for pancreatic cancer that people may be able to control, at least in part, include:
- Smoking
- Chronic pancreatitis (long-term inflammation of the pancreas), which is often associated with heavy use of alcohol or smoking
- Having obesity
- Having diabetes
- Heavy exposure to certain chemicals in the workplace (these may include harmful chemicals used in dry cleaning and metal working industries)
Having one or more of these risk factors does not necessarily mean a person will develop pancreatic cancer. People with diabetes, for example, carry a higher risk of developing pancreatic cancer than those without diabetes, but a majority will never get pancreatic cancer, says Dr. Onesti. That said, some research suggests that diabetes can be an early warning sign in some patients. Further study is required to better define which patients are at the highest risk.
You can help lower your risk of obesity and diabetes by taking steps to maintain a healthy weight. This includes getting regular exercise and eating a diet that emphasizes fruits, vegetables, and whole grains and limits or avoids red and processed meats, foods with added sugars, and other highly processed foods.
Is early detection of pancreatic cancer possible?
Symptoms of pancreatic cancer tend to be vague, mimicking those of other illnesses. These may include:
- Fatigue or physical weakness not related to physical activity
- Unintended weight loss
- Poor appetite
- Nausea and vomiting
- Belly or back pain
- Jaundice (yellowing of the skin and eyes, as well as darkened urine, light-colored or greasy stools, and itchy skin)
- Enlargement of the gallbladder or liver
- Blood clots
Aside for jaundice or pain in the upper part of the stomach, Onesti says, symptoms can be difficult to interpret.
Many pancreatic cancers are found during computed tomography (CT) scan for other health issues. (CT scans use low-dose X-rays and a computer to take detailed pictures of organs inside the body.)
The ultimate goal of research into pancreatic cancer is early detection, when chances for successful treatments are best. Liquid biopsies may offer that capability. These are blood tests that scan the blood for the genetic trail that tumors leave behind as they grow.
“They are not as feasible or as accurate as we need,” Onesti says of these experimental blood tests. “But that’s the hope for the future.”
Advances in research and treatment
One area where progress in treatment has been made, Onesti says, has been in surgery for the small number of early-stage patients whose tumors have not spread beyond the pancreas. For this “elite” group of about 15 to 20 percent of patients, she says, “we are doing much better, minimizing the risk and maximizing recovery.” Once routinely hospitalized for upwards of two weeks, many patients today can go home within four or five days, she adds.
Clinical trials hold promise for further improvement, researchers believe. Some trials involve targeting the stroma, the supportive tissues surrounding pancreatic tumors that are thought to undermine how well chemotherapy works. Others involve checkpoint inhibitors, a newer class of drugs whose early successes in treating melanoma and lung cancers hint at possible benefit in pancreatic cancer. Checkpoint inhibitors block tumors’ ability to use “checkpoint” molecules in the immune system to escape attack by the immune system.
Experimental vaccines for pancreatic cancer represent another avenue of active research. Unlike traditional vaccines, cancer vaccines are designed to help treat, not prevent disease. Investigators have begun using vaccines in combination with radiation, chemotherapy, and other immunotherapies, including checkpoint inhibitors, in an attempt to improve patient outcomes.
Ultimately, no matter which of these multi-pronged strategies emerges as the most effective, the hope remains the same: to enable patients with these difficult cancers to survive longer with a better quality of life.
