Pancreatic Cancer Signs & Treatments

Pancreatic cancer is one of the most serious forms of cancer. Mostly because it’s often diagnosed at an advanced stage. According to the National Cancer Institute, pancreatic cancer is the fourth leading cause of cancer death in the United States, even though it's the eighth-most common type of cancer.

Each year, between 60,000 and 70,000 cases of pancreatic cancer will be diagnosed. But thanks to improved imaging, advanced surgical techniques and chemotherapy, patients today have more pancreatic cancer treatment options — and more hope — than ever before. Especially when it’s caught early and treated by experienced cancer specialists.

Joshua Kays, MD, is at the forefront of this evolving field. He is a surgical oncologist with Franciscan Physician Network Indy Southside Surgical in Indianapolis. Dr. Kays is board-certified in general surgery and complex general surgical oncology and provides hepatobiliary and pancreas care including liver resections, bile duct reconstructions and pancreatic surgeries.

Dr. Kays also treats gastric cancers, gastrointestinal stromal tumors, primary liver cancers, neuroendocrine tumors of the intestine and pancreatic cancer.

“I see a lot of pancreatic cysts — some are precancerous and some are completely benign,” he added.

Rethinking Pancreatic Cancer And What’s Different Today

“When patients come to me with a tumor of the liver or the pancreas, they typically think worst-case scenario immediately,” Dr. Kays said.

That fear is understandable — pancreatic cancer symptoms often don’t appear until the disease is already advanced. This makes it harder to treat. But that is changing.

“Our options improve all the time. There’s surgery, chemotherapy, radiation therapy and immunotherapies that are in development and improving outcomes,” said Dr. Kays.

Pancreatic cancer is still serious. According to the National Cancer Institute, the 5-year pancreatic cancer survival rate is around 13%. But survival is improving — especially for metastatic pancreatic cancer.

“When I started training, the average survival for metastatic pancreatic cancer was about six to nine months. With advances, we’ve gotten that over 20 months,” Dr. Kays said. “It is very important to keep a positive attitude because you never know what discoveries are on the horizon that will improve outcomes significantly.”

Two Types Of Pancreatic Cancer — And They Behave Differently

“Interestingly, there are different types of pancreatic cancer,” Dr. Kays explained. “In general, we divide them into two main types. One is adenocarcinoma. This is what people think of — this is the aggressive one that most people associate with pancreatic cancer.

“But there’s another, very different type of tumor called a neuroendocrine tumor. It comes from those cells that create the hormones. These can behave very differently than the adenocarcinoma.”

It is important to understand which type a patient has. This helps specialists choose the right pancreatic cancer treatment options.

Pancreatic Cancer Risk Factors

“Risk factors for pancreatic cancer are very similar to risk factors of other gastrointestinal cancers,” Dr. Kays said. “Smoking is probably your number one risk factor.”

Other factors that may raise a person’s risk of pancreatic cancer include:

• Alcohol abuse
• Certain genetic mutations
• Chronic pancreatitis
• Family history of pancreatic cancer
• Obesity
• Some pancreatic cysts
• Age above 60 years

Women, in particular, may see increased rates of the disease. A recent study published in the peer-reviewed journal Gastroenterology showed that pancreatic cancer is rising faster among younger women, particularly Black women, than among men of the same age.

Pancreatic Cancer Symptoms Can Be Vague

As for pancreatic cancer symptoms? Researchers are looking for ways to screen for early signs because many people don’t notice symptoms until the disease is advanced. We call this cancer a “silent killer” because early symptoms can be vague and hard to recognize.

Symptoms of pancreatic cancer

“Symptoms can include abdominal pain or weight loss that a person didn’t mean to have, or they can be as obvious as jaundice. The skin turns yellow, urine turns yellow, eyes turn yellow,” said Dr. Kays.

Other possible symptoms of pancreatic cancer include:

• Unintentional weight loss
• Decreased appetite
• Changes in bowel habits
• New-onset diabetes

Unfortunately, surveys show most Americans can’t name a single symptom of pancreatic cancer. This is why we need more awareness and early evaluation.

Why Pancreatic Cancer Can Be Slow To Diagnose

Pancreatic cancer is often diagnosed in the later stages due to vagueness of symptoms.

"About 80% of patients that get diagnosed are going to have advanced-stage pancreatic cancer," Dr. Kays said.

Dr. Kays encourages anyone with risk factors or unexplained symptoms to seek care early.

“Sometimes we do find these tumors early,” he said. “And when we do, our chances of a good outcome go way up."

If you're experiencing symptoms that are concerning to you, talk to a specialist who understands. Connect with the experts at Franciscan Health to schedule an evaluation, get a second opinion or learn more about personalized treatment for pancreatic cancer. 

How Doctors Diagnose Pancreatic Cancer

“Diagnosing pancreatic cancer takes multiple steps,” Dr. Kays said.

It includes a physical exam, blood tests including bilirubin levels and tumor markers, and imaging such as a CT (computerized tomography) scan that will look for a mass in the pancreas that may be concerning or spreading.

"You're going to end up getting some kind of scan, whether it's a CT scan or an MRI of the abdomen, that will typically show a mass in the pancreas, but even that's not enough to diagnose pancreatic cancer," Dr. Kays said.

Next comes an endoscopic ultrasound, a procedure done while the patient is asleep.

“A physician takes a scope, puts it down your mouth with a little ultrasound on the end of it, and can find where that tumor is and biopsy that tumor,” said Dr. Kays. “Through that approach, we can then look at that tissue under the microscope and determine whether or not this truly is cancer.”

What Pancreatic Cancer Treatment Looks Like

“The primary treatment is chemotherapy plus surgery in patients who are candidates for surgery,” said Dr. Kays.

If surgeons can remove the tumor, a typical treatment plan may include:

• Three months of initial chemotherapy
• Imaging to assess the tumor response
• Surgical resection or removal of the tumor
• Additional three months of chemotherapy

In cases where surgery isn’t an option, we may use other treatments — like radiation or newer tumor-directed therapies.

“The treatment options for pancreatic cancer evolve all the time,” Dr. Kays emphasized.

Why There’s More Hope Than Ever For Pancreatic Cancer Patients

Pancreatic cancer is complex and often aggressive — but it’s no longer a hopeless diagnosis. Improvements in imaging, surgical techniques and drug therapies are changing the outcomes for many patients.

"We have made leaps and bounds with our treatments," Dr. Kays said. "It's going to be a combination of surgery and chemotherapy in everybody who has pancreatic cancer. Those are going to be the two cornerstones of treatment. Sometimes we will add radiation, but that's more on an individual basis."

Dr. Kays has seen remarkable progress in the treatment of pancreatic cancer during his career.

"With the modern chemotherapies, if you have what we call resectable pancreatic cancer, meaning you were able to proceed, have surgery, have it taken out, median survival, or the time that it takes 50% of the people to die is about 40 months. So you're looking at three and a half years," he said. "Now that's doesn't sound like much, but that is much improved over about the 12 to 15 months that we would quote people back when I started, you know, my career.

"Even metastatic disease, we're pushing 20 to 24 months. These are people whose cancer has spread, they're not candidates for surgery. With the modern treatments, we're still getting almost two years of survival. Whereas again, go back to when I started, we'd tell them three to six months. So you know, we're not there yet. We are making great progress, but we still have a lot more to make. But it's also not hopeless either."