Pancreatic cancer starts when cells grow out of control in the pancreas. Your pancreas is part of your digestive system. It's a large gland that makes enzymes that break down the food you eat. It also makes hormones that help control blood sugar levels.

Your pancreas gland includes a head, neck, body, and tail. It sits deep inside the body, hidden next to the liver and behind the stomach. This location makes tumors in the pancreas hard to see on imaging tests or feel when pressing on your belly.

Cancer of the pancreas also causes very few symptoms early on. Your doctor may “accidentally” find it when they do a scan for other reasons or when the first symptoms appear. Typical signs and symptoms include deep mid-belly pain, unintended weight loss, or yellowing of the skin.

Pancreatic cancer has 2 main types:

• Pancreatic ductal adenocarcinoma: These cancers form in cells that line the tube-like ducts of the pancreas. It’s by far the most common type.
• Neuroendocrine tumors: These form in cells that make hormones. They can be some of the slowest-growing tumors, but they can also secrete hormones that cause symptoms.

At Carilion, we also treat precancerous tumors in the pancreas before they can turn into cancer.

These are almost always found by accident. They may or may not turn into an invasive cancer. We have a special clinic just to follow these precancerous cellular changes.

They include:

• Pancreatic intraepithelial neoplasia: These are microscopic lesions that develop in the small ducts of the pancreas. These are some of the earliest cellular changes that can lead to pancreatic cancer.
• Intraductal papillary mucinous neoplasm: This is a type of tumor that grows in the pancreatic ducts and produces mucus. The risk of developing cancer depends on the size of the tumor and the type of cells found.
• Mucinous cystic neoplasm: These are fluid-filled tumors usually found in the body or tail of the pancreas. They mainly occur in women and produce mucus. They can turn into cancer if left untreated.
• Intraductal tubulopapillary neoplasm: This rare tumor grows in the pancreatic ducts and has both tubular and papillary structures. It's less common but still has the potential to develop into cancer.

Our multidisciplinary approach to the diagnosis and treatment of pancreatic cancer starts with getting the right diagnosis from a biopsy. Getting a piece of the tumor no longer requires a large incision. Our cancer team uses advanced tools to diagnose and stage your cancer.

Our interventional radiologists and gastroenterologists spend each day reviewing results from biopsies to get you answers. It's common to meet one of these as the very first member of your cancer care team. You may meet them even before you see a surgeon or cancer care specialist.

Cancer medicines

Our cancer experts work with a medical oncologist to create a plan tailored to your cancer. Cancer drugs travel through the body, where they can kill or slow the growth of cancer cells. We can give most of these drugs through an IV drip placed in your vein or by a pill you swallow.

In most cases, chemotherapy is part of your treatment regimen. It’s administered before we attempt to remove the tumor.

Cancer medicines include:

• Non-targeted: Medicines like chemotherapy kill rapidly growing cells. One very common chemotherapy for pancreatic cancer is a small pump that gives you medicine over several days. 
• Immunotherapy: These drugs help boost your immune system to attack cancer cells.
• Targeted therapy: Some cancer cells have an “Achilles’ heel” that we can use to kill the cancer cells. This approach leaves healthy cells relatively untouched. If your cancer has these targets, we may be able to use targeted therapies.

Ablation and embolization therapy

When cancer in your pancreas spreads to other organs, especially the liver, we use less-invasive ways to destroy tumors. These often don’t need to stay overnight in the hospital. 

Ablation uses a needle-like probe that conducts extreme heat, cold, or high-energy waves to destroy tumors.

Trans-arterial embolization (TAE) kills cancer cells by blocking their blood flow. A specialist injects materials to block the artery. This material may be neutral but can also be radioactive beads (radioembolization) or chemotherapy drugs (chemoembolization).

Radiation therapy

Radiation therapy uses high-energy rays or particles to target and kill cancer cells. For pancreatic cancer, we can use a machine outside your body to deliver a beam focused on your tumor and nearby lymph nodes.

We aim the radiation at the cancer cells to stop their growth and potentially destroy the tumor. Sophisticated machinery, scanners, and molding devices spare the surrounding healthy cells.

Cancer surgery

Surgery isn't necessary for all patients but when cancer is within the normal confines of the pancreas, early surgery is an option.

When pancreatic cancer has spread, though, surgery is often not the first treatment used. These tumors often “touch” nearby organs.

Whenever possible, our surgeons use less invasive techniques and smaller cuts to reach and remove your cancer. Our approach often includes laparoscopic tools and da Vinci robotic surgery. During the surgery, we may also use imaging tools to help us pinpoint the tumor for removal.

Tumor removal

Surgeries to remove cancer from the pancreas are complex. They require a high level of skill. Carilion surgeons have spent many years learning to perfect this procedure.

The surgery you need depends on the stage of the cancer.

• Pancreaticoduodenectomy: Also called a Whipple, it’s the most common pancreatic cancer surgery. It removes cancer from the head of the pancreas and sometimes the neck.
• Distal pancreatectomy: This is the surgery of choice to treat tumors in the body or tail of the pancreas and sometimes the pancreatic neck. Surgeons often must remove the spleen as part of this procedure.
• Total pancreatectomy: This surgery removes the entire pancreas, spleen, gallbladder, common bile duct, and part of the stomach and small intestine. We may do this if the cancer has spread throughout the gland, but we feel like we can still get it all out. You’ll need medicines to aid in digestion and insulin to control your blood sugar.

Supportive surgeries

Cancers that spread can affect your other organs. We can use surgery to treat some cancer-related symptoms and improve your quality of life.

Pancreatic cancer can block parts of your digestive system, causing symptoms. This can occur early on or later in the course of the disease. Our interventional experts can help relieve these types of symptoms.

These include:

• Endoscopic retrograde cholangiopancreatography: Surgeons insert a thin, flexible tube down your esophagus to look for tumors. An ultrasound camera at the tip of the tube can see the digestive tract and nearby organs. We use this approach to place a stent (a small tube) in your bile duct and take other tissue samples.
• Biliary bypass: This surgery reroutes your bile duct. Bile fluids then bypass your pancreas and flow into the small intestine instead.
• Feeding tube: Adequate nutrition is an absolute must for pancreatic cancer. Because it's so connected to our digestive system and can cause digestive symptoms. If you’re not able to eat well, your care team may suggest a feeding tube to pump nutrients into the intestines.
• External drainage tubes: Sometimes, the best way to drain blocked bile is into a bag through a tiny tube through the skin.

Clinical trials

Clinical trials are often part of pancreatic cancer treatment, sometimes from the start. We may also use them if your cancer doesn’t respond to current therapies.

Your care team may ask you to consider a trial when studying a new and exciting way to treat cancer. These studies are voluntary; you'll always have the opportunity to talk this through with your care team before enrolling.