Approximately 57,000 people in the United States are diagnosed with pancreatic cancer each year. Pancreatic cancer begins in the cells of the pancreas, a small pear-shaped organ that lies behind the stomach. The pancreas produces hormones such as insulin and enzymes that aid digestion. In pancreatic cancer, some cells start growing out of control, forming a tumor, which can affect the organ’s functions and, if left untreated, spread throughout the body.

Yale Medicine is committed to detecting pancreatic cancer early and using state-of-the-art technology to treat the condition.

Because the pancreas is deep in the body, cancer there often develops silently. “It has to grow to a certain size before it blocks off the drainage to the liver or before it causes pain,” says James Farrell, MD, director of the Pancreatic Diseases Program at Yale Medicine. When symptoms appear, they may include:

• Abdominal pain
• Loss of appetite
• Weight loss
• Yellowing of skin or eyes (jaundice)
• Depression
• Problems controlling blood sugar

Cancer can start in different parts of the pancreas.

• Adenocarcinoma or pancreatic exocrine cancer. This more common type of pancreatic cancer originates in the cells that line the ducts of the pancreas. It can grow quickly, and not cause symptoms until it is fairly advanced.

• Islet cell cancer or pancreatic endocrine cancer. This less-common form begins in the pancreatic cells that produce hormones. It may grow more slowly and may cause dramatic symptoms early on related to an increase in the hormones produced by the organ. As a result, this type is more likely to be discovered and treated earlier in the progression of the disease.

Anyone can get pancreatic cancer, although the risk increases with age. “It’s usually diagnosed in people over the age of 60,” says Dr. Farrell. “As the population ages, we are seeing more cases of it.”

Its prevalence is slightly higher among smokers and people who have:

• Excess body weight
• Diabetes
• Chronic inflammation of the pancreas (pancreatitis)
• A family history of pancreatic cancer, or of some cancer syndromes, including Lynch syndrome, BRCA2 mutations, and familial atypical mole malignant melanoma

To diagnose pancreatic cancer, a doctor will do a physical exam and order an imaging study, usually either computerized tomography (CT) or magnetic resonance imaging (MRI), to look for abnormalities in the pancreas. Some imaging may be done endoscopically, through a tube inserted into the esophagus while the patient is under anesthesia.

The doctor may remove some fluid or cells from the area, either endoscopically or via a needle inserted through the abdomen. A pathologist will look at the cells under a microscope to determine whether they are benign or malignant (cancerous).

Treatment for pancreatic cancer may include some combination of surgery, chemotherapy, and radiation.

Surgery is only helpful for earlier-stage cancers, which haven’t spread in the area or to other parts of the body. “Only about 10 to 15% of patients with pancreatic cancer are eligible for surgery,” says Dr. Farrell. “The remaining patients are given chemotherapy and radiation treatment.”

Yale Medicine offers state-of-the-art chemotherapy regimens. “In recent years, more effective combinations of drugs have really changed the landscape,” Dr. Farrell says. “It’s not a panacea for all patients, but it is an improvement.”

Yale Medicine has an early detection program for pancreatic cancer. “We don’t advocate screening for the entire population for a variety of reasons, but we have focused on certain high-risk groups to try to pick up early cancers,” says Dr. Farrell.

Patients who may get special attention include those with a family history of pancreatic cancer, a genetic mutation that predisposes them to it, or patients who are found to have pancreatic cysts on CT scans or MRI. Those patients may receive screening MRIs or endoscopic ultrasounds, and any suspicious areas may be biopsied. Problems may be discovered “at a stage where they can be operated on, or even before they develop into cancers,” Dr. Farrell says.

In addition to offering state-of-the-art treatments for pancreatic cancer, Yale Medicine physicians have a precision medicine program. Doctors stay on top of new information about the genetic landscape and the molecular biology of pancreatic cancer, and they offer targeted treatments when possible.