Definition
Pancreatic cancer is a malignant tumor that develops in the pancreas, most commonly in the exocrine part, specifically in the ducts. It is one of the most aggressive cancers and is often diagnosed at an advanced stage.

Pathogenesis
The development of pancreatic cancer is associated with genetic and environmental factors:

  • Risk factors: Alcohol, smoking, obesity, chronic pancreatitis, and diabetes.
  • Genetic predisposition: Family history and hereditary syndromes like Lynch syndrome and BRCA mutations.

Inflammation and cellular damage lead to mutations that promote carcinogenesis.

Diagnosis
Diagnosis involves:

  • Imaging studies: Ultrasound, CT, MRI, and endoscopic ultrasound to detect tumors.
  • Laboratory tests: Elevated CA 19-9 levels in the blood, though not specific.
  • Biopsy: Tissue sampling through endoscopic guidance for confirmation.

Treatment
Treatment depends on cancer stage:

  • Surgical resection: Pancreatectomy is the treatment of choice for localized disease.
  • Chemotherapy: Used pre-surgery (neoadjuvant) or post-surgery, as well as in advanced stages.
  • Radiotherapy: Often combined with chemotherapy for unresectable cases.
  • Targeted and immunotherapies: Indicated for cases with specific genetic mutations.

Prevention
Prevention includes:

  • Smoking cessation.
  • Maintaining a healthy weight and managing diabetes.
  • Regular screening for high-risk individuals, especially those with a family history.

Pancreatic cancer is difficult to diagnose in early stages. Timely detection, personalized treatment, and holistic support are crucial for improving quality of life and survival.

Diagnosis is usually confirmed by fine needle biopsy under endoscopic ultrasound guidance. It must be distinguished from benign lesions and from neuroendocrine tumours, which carry a very different prognosis.

Frequently asked questions

What are the early symptoms?

There often are none. When they appear, the most suggestive is painless jaundice with dark urine and pale stools, caused by obstruction of the bile duct. Others include upper abdominal pain radiating to the back, unexplained weight loss, loss of appetite and new onset diabetes in an older adult without obvious cause.

How is the diagnosis confirmed?

Imaging with a dedicated pancreatic protocol CT or MRI defines the lesion and its relationship to vessels. Endoscopic ultrasound with fine needle biopsy provides tissue, which is required before systemic or neoadjuvant treatment begins. It also detects small lesions that CT misses.

Is a pancreatic mass always cancer?

No. Focal pancreatitis and autoimmune pancreatitis can mimic a tumour on imaging. This is one reason tissue confirmation matters: it prevents both undertreatment and a wrong diagnosis with major consequences.

Sources


Content last updated: September 2026 (14/09/2026).