Pancreatic Cancer

If you come to Siteman with a diagnosis of pancreatic cancer, the first thing we will do is make sure your diagnosis is correct. In addition to confirming that you have pancreatic cancer, your care team will identify what type it is and how far it’s spread. This is also called the “stage” of the cancer. It’s crucial to get every detail of a diagnosis right before designing a treatment plan. That way, your WashU Medicine physicians will be able to choose the best treatments for your specific cancer.

What are the types of pancreatic cancer?

Not all kinds of pancreatic cancer are the same. After diagnostic testing, pathologists will have what they need to know if you have cancer cells near or in your pancreas. They will also learn what kind of pancreatic cancer cells you have. There are two major types of pancreatic tumors: pancreatic adenocarcinomas and pancreatic neuroendocrine tumors.

• Pancreatic adenocarcinomas: This type of pancreatic cancer is far more common. 95 percent of patients with pancreatic cancer will have pancreatic adenocarcinoma. These tumors often start in the pancreas ducts. These ducts are small channels that carry digestive enzymes from the pancreas to the intestines.  
• Neuroendocrine (islet cell) tumors: Pancreatic neuroendocrine tumors, or “PNETS,” are rare. PNETS are also known as “islet cell” tumors or “islet cell carcinoma.” They’re a type of neuroendocrine tumor found in the pancreas. 

The remaining information on this page is for pancreatic adenocarcinoma. To learn more about PNETS, click here.

What are the symptoms of pancreatic cancer?

Pancreatic adenocarcinoma often doesn’t cause symptoms in its early stages. This is when the tumor is small.  As the tumor grows, you may notice changes like:

• Yellowing of the skin and whites of the eyes (jaundice) 
• Light-colored stools 
• Dark urine  
• Pain in the upper or middle abdomen and back  
• Weight loss for no known reason  
• Loss of appetite  
• Feeling very tired 

What are the risk factors for pancreatic cancer?

It is impossible to predict who will develop pancreatic cancer. Also, there is no guaranteed way to avoid it. However, certain traits or lifestyle factors can make pancreatic cancer more likely. These are called “risk factors.”

Some of the risk factors for pancreatic cancer include: 

• Personal behaviors like smoking 
• Health history: 
  • Chronic pancreatitis 
  • Being overweight or obese 
• Family history of pancreatic cancer or pancreatitis 
  • Having certain hereditary conditions, such as: 
    • Hereditary breast and ovarian cancer syndrome 
    • Hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome) 
    • Familial atypical multiple mole melanoma (FAMMM) syndrome 

Diagnosing pancreatic cancer

If you suspect you may have pancreatic adenocarcinoma, you will want to schedule an appointment with your primary care physician. They will examine you and do tests to get a clearer picture of what is going on.

A specialist needs to lead your diagnosis, so your doctor might refer you to Siteman. You don’t need a referral. You can make an appointment with us yourself. Many patients come to Siteman for a second opinion.

At Siteman, we will likely do additional tests to confirm that your diagnosis is right.

We understand that undergoing medical tests makes many people anxious. Your comfort is our priority – we want you to feel safe when you’re in our care. Please don’t hesitate to ask questions or to request accommodations.

What tests are used to diagnose pancreatic cancer?

Patients with symptoms of pancreatic cancer will probably have the following tests:

1. Physical exam and history: This basic exam looks at the patient’s past illnesses and treatments, and any signs of disease, or abnormalities 
2. Blood tests: Doctors will look at samples of your blood to see if there are any signs that something is wrong. 
3. Imaging tests: These are tests that look at the inside of the body. Patients with pancreatic cancer will usually have a CT scan of their belly (abdomen). A CT scan uses X-rays to take pictures of the organs and other tissues. If there is a tumor in the pancreas, it will likely show up on a CT scan.   
4. Examination of the bile ducts: This bile duct test, called endoscopic retrograde cholangiopancreatography (ERCP), is done in an operating room while you are asleep. Sometimes, pancreatic tumors will block these ducts. This causes skin to turn yellow (jaundice). For the exam, your doctors will place a small tube with a camera in your throat and guide it down to your bile ducts.  If your doctors see that the ducts are blocked by a tumor, they may place a tiny tube into the duct to open it. This is also when they may collect tissue samples (biopsy) and have them checked under a microscope for signs of cancer. 
5. Ultrasound-guided biopsy: This kind of biopsy is also called an “endoscopic ultrasound with biopsy.” The procedure is done in an operating room. While you are asleep, doctors will place a small tube with a camera down your throat. They guide it down to look closely at the pancreas. If they see anything that looks abnormal, they will be able to collect a tissue sample. This is called a biopsy. An expert called a pathologist looks at the cells under a microscope to see if there are cancer cells.