Pancreatic cancer is caused when cells in your pancreas are damaged or have mutations in their DNA. The pancreas is a 6-inch-long gland that sits between the stomach and spine. When damaged pancreatic cells multiply, they often can spread to other areas of the body.

The exact cause of pancreatic cancer isn’t fully understood. Most pancreatic cancer is random or caused by lifestyle habits, such as smoking or being overweight, or old age. Some pancreatic cancers are genetic. About 10% of all pancreatic cancers are due to an inherited gene mutation, which is associated with a strong family history of pancreatic cancer.

Different types of cancers develop in different parts of the pancreas. The two most common types are:

• Pancreatic adenocarcinoma: Cancer that develops in the glandular tissue of the pancreas. Glandular tissue, which includes glands and ducts, makes up 98% of the pancreas and produces enzymes to help digest food. Adenocarcinoma is the most common type of pancreatic cancer.
• Islet cell cancer (also known as pancreatic neuroendocrine tumors, or NETs): Cancer that develops in the neuroendocrine cells, or islet cells, of the pancreas. The other 2% of the pancreas is made up of islet cells, which release insulin and other hormones. Islet cell cancer develops more slowly and is often easier to treat.

• An expert breakdown of pancreatic cancer

When cancer is found early, chances of survival are much higher. Learn more about how doctors find and diagnose cancer.

The pancreas is located deep inside the body. It is hard for doctors to see or feel any early pancreatic cancer signs during a physical exam. Symptoms often aren’t obvious. And you may not notice any symptoms until the cancer is very advanced. There’s no standard test to diagnose pancreatic cancer. A tumor in the pancreas is only visible with a computed tomography (CT) scan or magnetic resonance imaging (MRI).

If a specialist sees a tumor through a scan, they will take a sample of the tumor (called a biopsy). This test helps figure out what the tumor is and if it’s cancerous.

Some scans might show that you have a pancreatic cyst or pseudocyst.

• A cyst is a pocket or collection of fluid with a lining like the lining of your pancreatic ducts.
• A pseudocyst is a collection of fluid with a capsule or scar tissue surrounding it.

On imaging, cysts and pseudocysts can appear similar. They behave differently due to their lining and how they form. This allows us to differentiate between the two. Most are not cancerous and do not cause symptoms. However, some cysts can become cancerous and do require surgery or other treatment.

• Pseudocysts: Pseudocysts are often the result of pancreatitis (inflammation of the pancreas). Pancreatitis is usually caused by heavy alcohol use or gallstones. A pseudocyst will never become cancer and will sometimes go away on its own. If it does not cause symptoms, it may be safely left alone. Sometimes, it will grow, get infected or cause significant symptoms, and it will need to be drained or require surgery.
• Serous Cystadenomas: These cysts contain thin, watery fluid. They generally do not become cancer or increase the risk of cancer. Surgery is occasionally recommended when they cause symptoms or when they have the appearance of a more suspicious cyst.
• Mucinous Cystic Neoplasms and Intraductal Papillary Mucinous Neoplasms (IPMN): Both kinds of cysts contain a protein called mucin and have some risk of becoming a cancer.
  • When IPMNs are in the main pancreatic duct, the risk of developing pancreatic cancer is much higher. In this case, surgery is recommended.
  • When IPMNs are along smaller ducts, the risk of cancer is lower. In this case, your care team will evaluate the best treatment option.

For people who do not undergo surgery, regular screening (imaging and lab tests) is recommended. This can help to catch any possible cancer early. For cysts that are higher risk, continued screening of the pancreas is necessary, even after surgical removal.

Liver cancer (and other hepatobiliary cancers) often doesn’t have symptoms until the cancer is more advanced. But your doctor can do a blood test at your routine annual check-up to assess the general health of your liver. This simple blood test looks for any signs of inflammation or swelling in the liver that could lead to cirrhosis.

If results of a blood test are normal, there is no need for other types of liver tests. If your blood test shows first signs of liver damage, you also may need these tests:

• CT scan to look for visual signs of cirrhosis
• Biopsy to confirm diagnosis of cirrhosis or fibrosis (which leads to cirrhosis)
• Regular ultrasound screenings of your liver

People at a high risk for developing liver cancer should be screened every 6 months. Liver cancer can be avoided with preventative health screenings. People at high risk include:

• Anyone with cirrhosis from any cause; hepatitis C, hepatitis B, alcohol and fatty liver disease are the most common causes of cirrhosis in the United States.
• Persons of Asian descent with chronic hepatitis B (men aged 40 and over, women aged 50 and over).
• Persons of African descent, aged 20 and over, with chronic hepatitis B.
• Persons of any age with chronic hepatitis B and a family history of liver cancer.

The Providence Cancer Institute has an expert medical and surgical program for pancreatic cancer. A third of all pancreatic cancer patients in Oregon come to us for their treatment because we offer expertise that no one else in the state offers.

Types of treatment for pancreatic cancer include:

Surgical options: Surgical options involve some minimally invasive techniques and robotic surgery. Examples include:

• Whipple procedure (pancreatoduodenectomy): This procedure is for patients with cancer in the head of the pancreas. The surgeon removes part of the pancreas, common bile duct and gallbladder. Then, they create new connections between remaining organs to restore normal gastrointestinal function.
• Distal pancreatectomy/splenectomy: This procedure is used for patients with disease in the tail of the pancreas. The surgeon removes part of the pancreas, along with the splenic artery and vein. They may also remove the entire spleen and any lymph nodes along the blood vessels.
• Radiofrequency ablation (RFA): This technique uses a “heating probe” to destroy cancer cells.

Targeted chemotherapy and immunotherapy: These treatments can be used together or separately to target cancer cells. Drugs may be injected into a vein or taken by mouth to enter the bloodstream and treat the cancer. Providence has been developing new immunotherapy treatments for over 25 years. Providence is also known globally for robust research and breakthrough treatments offered to patients.

Radiation therapy: Providence offers multiple types of radiation therapy, including new MRI-guided radiation therapy (MR-Linac).

Treatment for liver cancer depends on the stage of the cancer. For early stages of liver cancer, treatments may include:

Ablation: Ablation involves removing body tissue. There are two common types of ablations for liver cancer treatment:

• Radiofrequency or microwave ablation: If tumors are small, they can be destroyed with a type of heat.
• Ethanol ablation: If the tumors are small, injecting the body with ethanol may kill the tumor cells.

Surgical resection: Liver cancer may be removed surgically.

Radioembolization yttrium-90: Cancer-fighting radiation is delivered directly to liver tumors by injecting them with millions of tiny beads coated with a safe radioactive element called yttrium-90. These beads block blood supply to the tumor, destroying cancer cells.

Tumors that respond to radiation, chemotherapy or yttrium-90 can sometimes then be removed surgically. In some cases, patients are also eligible for a liver transplant.

Radiation therapy: Providence offers multiple types of radiation therapy, including new MRI-guided radiation therapy (MR-Linac). This technology can deliver more precise radiation treatment because of its ongoing MRI monitoring of organ movement during treatment. MR-Linac decreases damage to healthy tissues and organs. It provides stronger, shorter and more effective radiation therapy, compared to standard methods.

Targeted chemotherapy and immunotherapy: Chemotherapy and immunotherapy can be used together or separately to target cancer cells. These drugs may be injected into a vein or taken by mouth to enter the bloodstream and treat the cancer. Providence has been developing new immunotherapy treatments for over 25 years. Providence is also known globally for robust research and breakthrough treatments offered to patients.