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Why is pancreatic cancer so deadly? How to spot early signs of the disease

The disease has the lowest survival rate of all major cancers.
CT SCAN of Thorax and Abdomen (Computed Tomography- CAT)
The pancreas is a 6-inch long gland that lies between the stomach and the spine. It’s hidden behind other organs including the small intestine, liver, gallbladder, spleen and bile ducts.Springsky / Getty Images/iStockphoto
/ Source: TODAY

There's no lump to feel with pancreatic cancer. It's stealthy and deadly, so by the time most people are diagnosed, they face a grim prognosis with few treatment options.

Most people, 83%, are unaware of the symptoms of pancreatic cancer, which has no early detection test, a new survey commissioned by the Pancreatic Cancer Action Network found.

Older adults are least likely to know the signs, even though 90% of patients diagnosed with the disease are 55 and older, the group noted.

November is Pancreatic Cancer Awareness Month, putting the spotlight on a disease that will claim the lives of almost 50,000 Americans this year, according to the National Cancer Institute. It ranks as the fourth leading cause of cancer death in the U.S.

Recent high-profile patients include "Sex and the City" actor Willie Garson, who died in 2021 and "Jeopardy!" host Alex Trebek, who passed away in November 2020.

Supreme Court Justice Ruth Bader Ginsburg died in September 2020; and Rep. John Lewis, died in July 2020, just months after he learned he had stage 4 pancreatic cancer.

Actor Patrick Swayze was one of the first high-profile patients to go public with his diagnosis before his death in 2009.

Trebek had been working with the World Pancreatic Coalition to teach people about the symptoms. In a public service announcement released in 2019, Trebek said he wished he had been aware of the warning signs.

"I wish I had known earlier that the persistent stomach pain I experienced prior to my diagnosis was a symptom of pancreatic cancer," he said in the PSA.

What is pancreatic cancer?

The pancreas is a 6-inch long gland that lies between the stomach and the spine, the National Cancer Institute noted. It helps the body break down food and regulate blood sugar.

About 95% of pancreatic cancers begin in exocrine cells, which produce the digestive “juices.”

Pancreatic cancers that begin in endocrine cells — which make hormones like insulin — are far less common, but also less aggressive.

What are the symptoms of pancreatic cancer?

The early stage of the disease often causes no symptoms, which is why the cancer is so deadly: It’s usually caught only when it becomes large and spreads outside of the gland. It’s also hidden behind other organs including the stomach, small intestine, liver, gallbladder, spleen and bile ducts.

Since the pancreas is located so deep inside the abdomen, patients won’t feel a lump like they might with breast cancer or notice any other obvious clues, Dr. Anirban Maitra, scientific director of the Pancreatic Cancer Research Center at the University of Texas MD Anderson Cancer Center in Houston, told NBC News.

Symptoms, when they do occur, can be vague and mimic the warning signs of other illnesses. They include:

  • Jaundice, or yellowing of the skin and whites of the eyes.
  • Light-colored stools.
  • Dark urine.
  • Itchy skin.
  • Persistent abdominal pain or back pain.
  • Unexplained weight loss.
  • Loss of appetite.
  • Feeling very tired.
  • Nausea and vomiting.
  • A new diagnosis of Type 2 diabetes.

Fewer than 20% of pancreatic cancers are confined to the pancreas when they are found, according to the Hirshberg Foundation for Pancreatic Cancer Research.

What are the risk factors for pancreatic cancer?

There are some risk factors that a person can’t change, including older age and having a family history of pancreatic cancer. Men and Black Americans are slightly more likely to develop pancreatic cancer than women and whites.

The National Cancer Institute and the American Cancer Society also list risk factors that people do have influence over. They include:

  • Smoking.
  • Being very overweight.
  • Workplace exposure to certain chemicals used in the dry cleaning and metal working industries.

How is pancreatic cancer diagnosed?

There are currently no approved early detection methods, but researchers hope tests that can pick up biomarkers for the cancer will become available in the coming years.

When patients complain of symptoms, the cancer can be found with imaging tests such as a CT scan, MRI and ultrasound. Certain blood tests, procedures and a biopsy can also help doctors diagnose the disease.

What is the treatment?

Surgery to remove part or all of the pancreas is an option for the minority of people whose pancreatic cancer was detected in its early stages.

Most people with pancreatic cancer receive chemotherapy, according to the Hirshberg Foundation for Pancreatic Cancer Research.

But pancreatic cancer is a very a difficult disease to treat — it's aggressive and it's hard for treatments to actually make it into the area where the tumor is located, Dr. Joe Hines, director of the UCLA Agi Hirshberg Center for Pancreatic Disease in Los Angeles, previously told TODAY.

Julie Fleshman, president and CEO of the Pancreatic Cancer Action Network, compared it to getting past the rind on a watermelon.

"Imagine a watermelon, and the tumor is in the middle of the watermelon. There's that thick membrane that goes around the watermelon, the green skin — you can't get through it. There's a similar microenvironment that's around the pancreatic cancer tumor," she said.

Patients now undergo genetic testing to see what type of treatment would work best for their particular tumor, Hines noted.

An experimental gene therapy halted the progression of one woman's advanced pancreatic cancer, doctors announced in June 2022, which could be a major step forward in the treatment of the disease, NBC News reported.

What is the survival rate?

The overall statistics remain grim: Only 11% of patients live five years after learning they have pancreatic cancer, according to the American Cancer Society.

That makes it the lowest survival rate of all major cancers, according to the Pancreatic Cancer Action Network.

The number drops to 3% of patients whose pancreatic cancer has spread to distant parts of the body, as in Lewis' and Trebek’s case.

Ginsburg had been a rare long-term survivor, having been treated for pancreatic cancer in 2009.

“Nobody knows why these patients live longer than other people with pancreatic cancer, but something is clearly setting them apart,” said Dr. Vinod Balachandran, a member of Memorial Sloan Kettering’s David M. Rubenstein Center for Pancreatic Cancer Research in New York City, in a statement.

He’s the author of a 2017 study that found that “something” seemed to be the robustness of their own immune systems, with long-term survivors having almost 12 times the number of T cells — a type of immune cell that helps the body fight against invaders — inside their tumors than other patients.