Pancreatic Cancer

What it is

The pancreas sits deep in the belly, behind the stomach. It has two jobs. Most of it makes juices that help digest food. A smaller part makes hormones, including insulin.

NCI describes two kinds of pancreatic cancer, matching those two jobs. The common kind starts in the part that makes digestive juices. NCI notes it is usually found at a late stage. The other kind starts in the hormone-making cells. It is less common and has a better outlook.

What to watch for

NCI lists these signs:

• Yellowing of the skin and eyes, called jaundice
• Pale stools and dark urine
• Pain in the upper or middle belly, and in the back
• Losing weight without trying
• Losing appetite
• Feeling very tired

Jaundice is the sign most likely to bring someone in. It is hard to miss and hard to explain away.

The others are the problem. Back pain, tiredness, and appetite loss have dozens of ordinary causes. What makes them worth attention is that they last, and that several show up together.

Why it is usually found late

NCI says this cancer is hard to find early, and gives three reasons.

There are no clear symptoms at the start. The symptoms that do come look like other illnesses. And the pancreas is tucked behind other organs, so a doctor cannot feel it, and no simple test finds it.

That is worth saying plainly. People who get this diagnosis often ask what they missed. Usually the answer is nothing.

What raises the risk

Things that can change: smoking, and carrying extra weight.

Things in your health history: diabetes, and long-lasting swelling of the pancreas.

Things nobody can change: a family history of this cancer, and certain inherited conditions. NCI names Lynch syndrome, Peutz-Jeghers syndrome, hereditary breast and ovarian cancer syndrome, FAMMM syndrome, and ataxia-telangiectasia.

Is there a test before symptoms start?

No. And this is the one page here where federal guidance says not to have one.

NCI says it has no evidence-based guidance on screening for pancreatic cancer. The US Preventive Services Task Force goes further. It gives a grade D, and recommends against screening adults who have no symptoms and no known high risk.

A grade D is not a shrug. It means the group decided that screening everyone would do more harm than good. False alarms. Invasive follow-up tests on an organ that is hard to reach. Procedures on people who turn out not to have cancer.

People with a strong family history, or a known inherited syndrome, are a separate case. Some are watched at specialist centers. That is a plan made with a care team.