Pancreatic Cancer: What It Is, Causes, Symptoms, Diagnosis & Treatment

What is Pancreatic Cancer?

Pancreatic cancer begins when abnormal cells develop in the tissues of the pancreas. The pancreas lies behind the stomach and produces digestive enzymes and hormones that help regulate blood glucose.

Most pancreatic cancers arise from exocrine cells, which produce digestive enzymes. Pancreatic ductal adenocarcinoma is the most common exocrine pancreatic cancer. Pancreatic neuroendocrine tumours develop from hormone-producing cells and differ in their behaviour, staging and treatment.

Types of Pancreatic Cancer

The types of pancreatic cancer are:

Stages of Pancreatic Cancer

Pancreatic cancer is classified into stages according to the tumour's size, lymph-node involvement and spread to distant organs. These stages are mentioned below:

How Common is Pancreatic Cancer in India?

Pancreatic cancer is relatively uncommon in India compared to other more frequently diagnosed cancers, like breast cancer and oral cancer. However, its high mortality and tendency to be diagnosed at an advanced stage make it clinically important.

As per the India factsheet on Global Cancer Observatory, India recorded approximately 20,477 new pancreatic cancer cases in 2024, along with 19,953 deaths. The 5-year prevalence of the disease was approximately 1.6 per 1,00,000 population for both sexes combined. Nationwide Indian registry data specific to pancreatic cancer remain limited.

Symptoms of Pancreatic Cancer

Pancreatic cancer may cause few or no noticeable symptoms during its early stages. Symptoms vary according to the tumour’s location and whether it has affected the bile duct, the digestive system, or nearby organs.

The table below lists some of the early warning symptoms and advanced stage symptoms of pancreatic cancer:

Diseases Similar to Pancreatic Cancer

Several diseases involving the pancreas, bile ducts and nearby abdominal organs can cause overlapping symptoms. Jaundice, abdominal discomfort, weight loss and digestive changes may occur in more than one condition. However, their anatomical origin, progression and treatment differ.

The table below gives a comparative overview of such conditions and their critical features for better understanding:

Pancreatic Cancer Vs. Cholangiocarcinoma Vs. Gallbladder Cancer

Causes of Pancreatic Cancer

The exact cause of pancreatic cancer is not always known. The disease develops when genetic changes cause pancreatic cells to grow and divide abnormally.

Some of the factors that increase the risk of developing pancreatic cancer are listed below:

• Tobacco Use: Cigarette smoking is an established modifiable risk factor for pancreatic cancer.

• Increasing Age: Pancreatic cancer occurs more frequently in older adults, although younger people can also develop it.

• Chronic Pancreatitis: Long-term inflammation and scarring of the pancreas are associated with an increased risk.

• Family History: Risk may be higher when close relatives have had pancreatic cancer.

• Inherited Gene Changes: Variants involving genes may increase susceptibility.

• Obesity: Excess body weight is associated with a higher risk of pancreatic cancer.

• Diabetes: Long-standing diabetes is associated with pancreatic cancer, while new-onset diabetes may occasionally be an early consequence of the disease.

Complications of Pancreatic Cancer

Pancreatic cancer and its treatment may cause complications by blocking nearby structures, reducing pancreatic function or spreading to other parts of the body. Some of the complications associated with pancreatic cancer are:

• Jaundice: A tumour may obstruct the bile duct, causing yellowing of the skin and eyes, itching, dark urine and pale stools.

• Pain: Tumour growth may press on nearby nerves and organs, causing persistent upper abdominal or back pain.

• Weight Loss and Malnutrition: Reduced appetite, treatment side effects and poor nutrient absorption can cause significant weight and muscle loss.

• Pancreatic Exocrine Insufficiency: Reduced production of digestive enzymes may cause bloating, diarrhoea, oily stools, and malabsorption.

• Diabetes: Damage to insulin-producing pancreatic cells may cause new diabetes or make existing diabetes more difficult to manage.

• Bile-Duct or Intestinal Obstruction: Tumour growth may block bile flow or prevent food from passing normally through the stomach and small intestine.

• Blood Clots: Pancreatic cancer increases the risk of deep vein thrombosis and pulmonary embolism.

• Ascites: Advanced cancer may cause fluid to collect inside the abdomen.

• Metastasis: Pancreatic cancer commonly spreads to the liver, peritoneum, lungs or other sites.

When Should You See a Healthcare Provider?

It is highly recommended to see a qualified healthcare provider if you develop any or multiple of the following symptoms:

• Persistent upper abdominal or back pain

• Unexplained weight loss

• Loss of appetite

• Yellowing of the skin or eyes

• Dark urine or pale stools

• Persistent vomiting

• New-onset diabetes without a clear explanation

• Existing diabetes that suddenly becomes difficult to control

• Ongoing digestive problems or oily stools

• Unexplained weakness or fatigue

How is Pancreatic Cancer Diagnosed?

Diagnosis of pancreatic cancer usually combines clinical assessment, imaging, blood tests and tissue examination. A brief overview is provided below:

Diagnostic Overview Table

How is Pancreatic Cancer Managed or Treated?

Pancreatic cancer treatment depends on the stage, place and overall location. Care should be planned by a multidisciplinary team that may include surgical, medical, and radiation oncologists, gastroenterologists, radiologists, pathologists, dietitians, and palliative care specialists.

Common treatment approaches for pancreatic cancer may include:

Common Medicines Used to Treat Pancreatic Cancer

Medicines form an important part of pancreatic cancer treatment, particularly when surgery is not possible or when chemotherapy is needed before or after surgery. The choice depends on cancer stage, resectability, overall health and molecular test results. Medicines may control or reduce the cancer, but they do not replace potentially curative surgery in patients who are suitable for complete tumour removal.

Common medications that may be prescribed by doctors for pancreatic cancer treatment may include:

• Gemcitabine: Gemcitabine may be used alone or with other medicines to treat pancreatic cancer. It can help slow cancer growth and may be used after surgery or for advanced disease.

• Nab-paclitaxel: Nab-paclitaxel may be combined with gemcitabine for some patients with advanced pancreatic cancer. This combination can help control tumour growth and disease progression.

• Fluorouracil (5-FU): Fluorouracil is used in combination chemotherapy regimens for pancreatic cancer. It can be given as part of treatment before or after surgery or for advanced disease.

• Oxaliplatin: Oxaliplatin is one component of FOLFIRINOX, a multi-medicine chemotherapy regimen used in suitable patients.

• Irinotecan: Irinotecan is another component of FOLFIRINOX. It may also be used in other specialist-selected regimens.

• Folinic Acid: Folinic acid, also called leucovorin, is given with fluorouracil as part of FOLFIRINOX and related regimens.

• Capecitabine: Capecitabine is an oral medicine that can be used in selected chemotherapy regimens. It may be used after surgery or alongside other treatments, depending on the treatment plan.

• Olaparib: Olaparib may be used as maintenance treatment in selected patients with metastatic pancreatic cancer who have specific inherited BRCA1 or BRCA2 mutations and whose disease has not progressed after platinum chemotherapy.

Note: Cancer medicines require specialist prescriptions and monitoring. The dose and combination depend on the patient's cancer stage, treatment response, organ function and overall health. These medicines should not be started or stopped without the treating oncologist's advice.

Living with Pancreatic Cancer: Daily Challenges and Caregiving

Living with pancreatic cancer may involve repeated hospital visits, chemotherapy, surgery, nutritional support and regular monitoring. Individualised supportive care can help manage symptoms and maintain quality of life.

Some of the commonly faced challenges and essential care points during pancreatic cancer treatment and recovery may include:

What is the Prognosis of Pancreatic Cancer?

The prognosis of pancreatic cancer depends mainly on whether the tumour is localised and can be completely removed, whether lymph nodes or distant organs are involved, the response to systemic therapy and the patient’s overall health.

Localised resectable pancreatic cancer has the best possibility of long-term control, although recurrence can still occur. Locally advanced and metastatic disease is generally treated to control cancer, relieve symptoms and prolong survival rather than provide a surgical cure.

How Can I Prevent Pancreatic Cancer?

Not every case of pancreatic cancer can be prevented. However, certain measures may reduce risk:

• Avoid smoking and other tobacco products.

• Maintain a healthy body weight.

• Remain physically active.

• Follow a balanced diet containing vegetables, fruit, whole grains and appropriate protein sources.

• Limit alcohol intake, particularly because heavy alcohol use may contribute to pancreatitis.

• Obtain medical care for chronic pancreatitis and diabetes.

• Discuss genetic counselling when several close relatives have had pancreatic cancer or a relevant inherited cancer syndrome is known.

Routine pancreatic cancer screening is not recommended for the average-risk population. People with a strong family history or recognised inherited susceptibility may be offered specialist surveillance using MRI, MRCP or endoscopic ultrasound.

Pancreatic Cancer Treatment Cost in India

Pancreatic cancer treatment costs can vary substantially because treatment may involve surgery, chemotherapy, radiation therapy or combinations of these. The estimated surgery cost for pancreatic cancer is around ₹2 lakh to ₹8 lakh, depending on the surgery type and complications. Additional chemotherapy, diagnostic, hospitalisation, and supportive care expenses may increase the overall treatment cost.

An overview of pancreatic cancer treatment costs in India is given in the table below:

Note: These are indicative costs and actual expenses may vary by hospital, city, treatment plan, cancer stage, medicines, complications and duration of care.

Does Health Insurance Cover Pancreatic Cancer?

Yes. Most health insurance policies in India provide coverage for pancreatic cancer treatment, depending on the policy terms and conditions. The insurance coverage may include treatment expenses, room charges, attendant care, chemotherapy, radiation therapy, blood tests and physical examination. However, the coverage, waiting periods, exclusions and claim procedures vary among insurers. Reviewing policy documents carefully is advised.

A critical illness insurance policy or a cancer insurance policy can be useful for pancreatic cancer treatment, as it provides a lump sum payment when the disease is diagnosed. However, a waiting period of up to 90 days may apply before a claim can be filed.

How Much Health Insurance Coverage is Needed for Pancreatic Cancer Treatment?

Health insurance coverage amount for pancreatic cancer depends on the level of treatment, the stage at which medical care is provided, the hospital type and surgical assistance. In India, overall treatment costs can range widely from a few lakhs for early-stage treatment to ₹15 - 30 lakh or more for advanced or extensive care.

A mediclaim policy of ₹25–50 lakh is often considered more suitable for specialised care, chemotherapy and advanced surgeries for pancreatic cancer. However, if there are other complications or pre-existing conditions, a coverage of ₹50 lakh to ₹1 crore or a combination of base health insurance plus a top up insurance policy can be beneficial.