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What Is Pancreatic Cancer?

The pancreas is a gland that sits behind the stomach and in front of the spine. It serves two major functions in the body: the exocrine component makes proteins called enzymes that are released into the small intestine to help the body digest food and the endocrine component makes hormones, including insulin — the substance that helps control the amount of sugar in the blood. The endocrine component also makes somatostatin, glucagon, pancreatic polypeptide (PP), and vasoactive intestinal peptide (VIP), each of which plays an important role in regulating metabolism.

Pancreatic cancer occurs when mutations develop in the cells of the pancreas, causing the cells to multiply rapidly. These cells can form a tumor that destroys normal body tissues and structures.

According to the American Cancer Society, more than 60,400 new cases of pancreatic cancer are diagnosed in the U.S. each year, resulting in approximately 48,220 deaths. In Colorado, there are approximately 810 new cases of pancreatic cancer diagnosed each year.

Pancreatic cancer is the third leading cause of cancer death in both men and women and is expected to become the second leading cause of cancer death within in the next decade.

Pancreatic Cancer Survival Rates and Prognosis

Pancreatic cancer prognosis depends on the type of cancer and the stage at which it is diagnosed. Although pancreatic cancer accounts for only 3% of all cancers in the United States, it leads to about 7% of all cancer deaths.

The five-year survival rate for patients with localized pancreatic cancer where the tumor is still confined to the pancreas is 37%. Approximately 10% of all pancreatic cancers are discovered at this stage.

Pancreatic cancer survival rate decreases as the cancer spreads beyond the immediate area of the pancreas. The five-year survival rate for patients with regional pancreatic cancer (where the cancer has spread to nearby structures or lymph nodes), is about 12%, and 37% of cases are diagnosed at this point.

The survival rate for patients with distant pancreatic cancer (where the cancer has spread to distant parts of the body such as the lungs, liver, or bones) is 3%. This accounts for about 53% of all diagnoses.

Why Come to CU Cancer Center for Pancreatic Cancer

As the only National Cancer Institute Designated Comprehensive Cancer Center in the state of Colorado and one of only four in the Rocky Mountain region, the University of Colorado Cancer Center has doctors who provide patient-centered pancreatic cancer care and researchers dedicated to diagnostic and treatment innovations.

Veteran’s Pancreatic Cancer Caught ‘At Just the Right Time’

The CU Cancer Center is home to the Pancreas and Biliary Cancer Multidisciplinary Clinic, which offers patients an “all in one” approach to clinical care. At a multidisciplinary clinic, patients are evaluated in one day by specialists who treat this specific cancer, including world-class surgeons, oncologists, radiologists, gastroenterologists, nurse practitioners, and others, who then collaborate on care. This multidisciplinary approach has proven to be the new standard of care for pancreatic cancer.

The CU Cancer Center also has a Pancreas Surveillance Clinic for high-risk patients, those who need lifelong surveillance following surgery, and those who have pre-malignant pancreatic cysts.

Due to advanced surgical techniques, more effective medicines, and a multidisciplinary approach to treatment, the CU Cancer Center is able to operate on 30% or more of pancreatic cancer patients, which is nearly double the national average. This distinction, along with proven excellence in pancreatic cancer prevention, education, care, and outcomes, lead to the CU Cancer Center being named a National Pancreas Foundation Academic Center of Excellence for pancreatic cancer.


The CU Cancer Center has developed techniques to remove pancreatic tumors that also involve the peri-pancreatic vessels (portal vein, superior mesenteric vein, hepatic artery, celiac trunk, and superior mesenteric artery). In certain cases, patients who are not considered candidates for surgery elsewhere because of a locally advanced disease may receive surgery here. 

Patients who have been told that their pancreatic cancer is unresectable (unable to be removed through surgery) might want to contact the CU Cancer Center for a second opinion. Our world-class surgeons may be able to resect a tumor that was classified as unresectable by other surgical oncologists.

There are numerous pancreatic cancer clinical trials being offered by CU Cancer Center members at any time. These trials offer patients options to traditional pancreatic cancer treatment and can result in remission or increased life spans.

CU Cancer Center doctors also treat non-cancerous disorders of the pancreas, such as acute pancreatitis, chronic pancreatitis, and hereditary pancreatitis.

We also have one of the few dedicated pediatric pancreas centers in the country. Our experts specialize in the treating of pediatric pancreatic tumors and other inflammatory pancreatic diseases with a multidisciplinary approach.

Our clinical partnership with UCHealth has produced survival rates higher than the state average for all stages of pancreatic cancer.

Pancreatic Cancer Graph

Number of Patients Diagnosed – UCHealth 619 – State of Colorado 2,218
Number of Patients Surviving – UCHealth 86 – State of Colorado 200
*n<30, 5 Year Survival – (Date of diagnosis 1/1/2010–12/31/2014)

Types of Pancreatic Cancer

Different types of cells in the pancreas can become cancerous, and the type of cell affected determines the type of pancreatic cancer. These are categorized by looking at the cells under a microscope. Doctors use this information to understand the expected growth pattern and speed of the cancer and determine the best course of treatment.

About 93% of all pancreatic tumors develop in the exocrine component of the pancreas, while only 7% develop in the endocrine component.

Exocrine Pancreatic Cancers

Pancreatic adenocarcinoma is the most common type of pancreatic cancer, accounting for about 95% of cancers of the exocrine component. These tumors usually start in the ducts of the pancreas. This is called ductal adenocarcinoma. Less commonly, tumors can form in the acini, the small sacs on the end of the ducts. This is called acinar adenocarcinoma. They may also develop from the cells that manufacture enzymes, in which case they are called acinar cell carcinomas.

Rare types of exocrine cancer that together make up the other 5% of exocrine component pancreatic cancers include adenosquamous carcinomas, colloid carcinomas, hepatoid carcinomas, pancreatoblastomas, signet ring cell carcinomas, squamous cell carcinomas, undifferentiated carcinomas, and undifferentiated carcinomas with giant cells.

Endocrine Pancreatic Cancers

Pancreatic neuroendocrine tumors (NETs) start in the endocrine cells of the pancreas. Also called islet cell tumors, NETs are less common than other pancreatic cancers but tend to have a better prognosis. NETs can be functioning or nonfunctioning based on whether they make hormones. A functioning NET is named for the hormone the cells normally make, such as insulinoma, gastrinoma, glucagonoma, somatostatinoma, PPomas, and VIPomas.

Similar and Related Cancers

Ampullary cancer starts in the ampulla of Vater, which is where the bile duct and pancreatic duct come together and empty into the small intestine. Ampullary cancer, also called carcinoma of the ampulla of Vater, isn’t technically pancreatic cancer, but it is treated in much the same way. The tumors often block the bile duct while they’re still small, causing bile to build up, which leads to yellowing of the skin and eyes (called jaundice). Because of this, ampullary cancer is usually found earlier than pancreatic cancer and often has a better prognosis.

Duodenal cancer is a rare form of cancer of the duodenum — the first and shortest part of the small intestine. When cancer cells begin to form in the duodenum, tumors can block food from passing through the digestive tract. Duodenal tumors may spread to the pancreas and treatment options (such as the Whipple procedure) are often similar. 

Distal bile duct cancer starts in bile ducts, the series of thin tubes that go from the liver to the small intestine. Bile ducts move bile from the liver and gallbladder into the small intestine, which helps digest the fats in food. Distal bile duct tumors are found farthest down the bile duct, near the small intestine. The common bile duct passes through the pancreas before it joins with the pancreatic duct and empties into the duodenum at the ampulla of Vater.

Pre-cancerous Conditions That Can Lead to Pancreatic Cancer

Some cases of pancreatic cancer may begin as pre-cancerous conditions.

The CU Cancer Center has a clinic dedicated to the management of cystic tumors of the pancreas. These tumors are common in the general population and are often discovered incidentally during a cross-sectional imaging procedure performed for non-pancreas related issues.

The detection of these tumors is very important. Although some are benign, others have the potential to progress to invasive cancer over time.

Intraductal papillary mucinous neoplasms of the pancreas (IPMN) are the most common of the cystic tumors of the pancreas. These neoplasms can progress from dysplasia to cancer over time.

There are two major categories of IPMNs. In one, called branch-duct IPMN, the disease involves only the peripheral ducts of the gland and appears as single or multiple cysts in the pancreas. Although this type of IPMN has a low risk for cancer progression, it is still possible. It is crucial that patients affected by this disease are included in a surveillance program. In case of radiological concerns during the follow-up, surgery can prevent cancer or treat it at an earlier stage.

When the disease involves the main pancreatic duct alone (main-duct IPMN) or a combination with the peripheral ducts (mixed-type IPMN), the risk of cancer increases significantly. A larger percentage of patients affected by main duct or mixed type IPMN require surgery. At the CU Cancer Center, we offer these patients the possibility to do a “personalized resection” though the use of an intra-operative endoscope that allows us to define the extension of the disease in the pancreas.

Mucinous cystic neoplasms (MCNs) are cystic tumors that can progress to cancer. These tumors occur mostly in women and are usually located in the body and/or tail of the pancreas. The removal of these tumors at the right time can prevent the cancer transformation.

Serous cystic neoplasms (SCNs) are, in contrast with mucinous cystic neoplasms, are almost always benign. The only indication for resection for these tumors is the presence of symptoms or local complications related to the growth.

Solid pseudopapillary neoplasms (SPNs) are rare, slow-growing tumors that almost always develop in young women. These tumors can be malignant. The surgical treatment of SPNs is always indicated (when feasible), even in cases of locally advanced or metastatic disease.

Even though the biology of the cystic tumors of the pancreas can vary from tumor to tumor, their appearance is very similar in many cases. That means that it is often difficult to determine the type of tumor. This is why the management of these tumors should be done in high-volume and experienced centers like the CU Cancer Center.

Pancreatic Cancer Causes and Risk Factors

Pancreatic cancer has multiple risk factors — conditions or behaviors that increase a person’s risk of developing the cancer. 

History of cystic tumors of the pancreas: Some cystic tumors of the pancreas have the potential to progress to cancer or have been associated with an increased risk of cancer. These tumors need expert evaluation to be managed. The presence of a cyst in the pancreas should always trigger a consultation in a specialized pancreas center.

Smoking: Smokers are two to three times more likely to develop pancreatic cancer than non-smokers. In fact, about 25% of pancreatic cancers are thought to be caused by tobacco use. The risk of developing pancreatic cancer starts to drop after a person stops smoking.

Weight: People who are very overweight or obese are about 20% more likely to get pancreatic cancer. Carrying extra weight around the waistline may increase the risk of pancreatic cancer even in people who are not obese.

Diabetes: Pancreatic cancer is more common in people with diabetes, specifically those with type 2 diabetes. It is unclear whether people with type 1 diabetes (also called juvenile diabetes) also have a higher risk.

Chronic pancreatitis: This long-term inflammation of the pancreas is linked to an increased risk of pancreatic cancer. Chronic pancreatitis is often diagnosed in patients who smoke or exhibit heavy alcohol use. 

Exposure to certain chemicals: Workers in industries that use certain types of chemicals — such as pesticides, benzene, certain dyes, and petrochemicals — may have a higher risk of pancreatic cancer. This is especially prevalent among people in the dry cleaning and metal working industries.

Age: The risk of pancreatic cancer increases with age. About two-thirds of people diagnosed with pancreatic cancer are 65 or older, and the average age of patients when they are diagnosed is 70.    

Gender: Men have a slightly higher chance of developing pancreatic cancer than women. This may be due in part to higher tobacco use in men.

Race and ethnicity: Black people and people of Ashkenazi Jewish heritage are slightly more likely to develop pancreatic cancer than Asian, Hispanic, or white people.

Family history: Although most people who get pancreatic cancer do not have a family history of it, there is evidence that it may run in some families. Sometimes the higher incidence is due to an inherited syndrome. In other cases, the gene causing the increased risk is unknown.

Chronic pancreatitis: People with chronic pancreatitis (which is sometimes due to an inherited gene mutation) have a heightened risk of developing pancreatic cancer.

Inherited gene mutations: Some inherited gene changes (mutations) can raise the risk of pancreatic cancer. Research suggests these gene changes may be responsible for up to 10% of all pancreatic cancer diagnoses. Some examples of genetic syndromes that can lead to pancreatic cancer include hereditary pancreatitis, usually caused by mutations in the PRSS1 gene; hereditary breast and ovarian cancer (HBOC) syndrome, caused by mutations in the BRCA1 or BRCA2 genes; familial atypical multiple mole melanoma (FAMMM) syndrome, caused by mutations in the p16/CDKN2A gene; Lynch syndrome (hereditary non-polyposis colorectal cancer or HNPCC), usually caused by a defect in the MLH1 or MSH2 genes; Peutz-Jeghers syndrome, caused by defects in the STK11 gene; Li-Fraumeni syndrome (LFS); and familial adenomatous polyposis (FAP).

Acquired gene mutations: Most gene mutations related to pancreatic cancer are acquired, rather than inherited. Some of these acquired gene mutations are linked to cancer-causing chemicals (like those found in tobacco smoke or certain industrial chemicals). However, many gene changes are random, with no external cause. Some sporadic cases of pancreatic cancer involve changes in the p16 and TP53 genes, which are also present in some inherited genetic syndromes. But many pancreatic cancers also involve changes in genes such as KRAS, BRAF, and DPC4 (SMAD4), which are not present in inherited genetic syndromes.

Diet: Some studies indicate that diets heavy in red and processed meats and saturated fats may raise the risk of pancreatic cancer. People who consume a lot of sugary drinks may also be at risk.

Physical inactivity: Some research suggests that a lack of exercise might increase a person’s risk of developing pancreatic cancer. 

Alcohol: There may be a link between heavy alcohol use and pancreatic cancer. Heavy drinking can also lead to conditions such as chronic pancreatitis, which is known to increase the risk of pancreatic cancer.

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Information reviewed by Marco Del Chiaro, MD, in February 2021.