Pancreatic cancer (also called pancreatic carcinoma) is a malignant tumor in the pancreas.
A tumor always originates from a single cell. The tumor first grows locally until a cluster of cells accumulates. The development into a malignant tumor often goes through several steps. There is increasing evidence that pancreatic cancer also has several ‘preliminary stages’ before the tumor becomes malignant. However, these preliminary stages almost never cause complaints, which means that the tumor can grow ‘anonymously’. Over time, the malignant tumor can grow through the inner surface of the pancreas and/or metastasize via the lymphatic system or blood vessels to the liver and lungs.
Types of pancreatic cancer
The most common form of pancreatic cancer by far is adenocarcinoma (92%). The tumors are located in the lining of the ducts that carry the enzymes, or digestive juices, that the pancreas produces. Adenocarcinoma is usually located in the head of the pancreas (56%), in 14% of cases in the middle part, the body, and 17% in the tail. In the remaining 13% there is overlap or it is unclear.
In addition, there are rarer forms of pancreatic cancer, such as neuroendocrine tumors (NET/NEC, text in Dutch only) (7%), which are located in the cells in the pancreas that produce hormones, for example, insulin and glucagon. Other forms of pancreatic cancer occur sporadically (less than 1%).
For detailed information on the other types of pancreatic tumors, see the page on different types of pancreatic cancer.
The information on this and other pages of the website is about adenocarcinoma, unless otherwise stated.
How common is pancreatic cancer?
In the Netherlands, more than 3,000 people are diagnosed with pancreatic cancer each year, 2.4% of all newly diagnosed cancer tumors. The vast majority of these are adenocarcinoma; 2.2% of diagnosed cancer tumors.
Pancreatic cancer occurs about equally in men and women. The majority of patients (85%) are over 60 years old. At an age younger than 45 years, pancreatic cancer is rare, but possible.
What are the prospects?
Pancreatic cancer is an aggressive form of cancer. The tumor is often discovered relatively late, which means that often it has already metastasized and/or spread into the surrounding tissue.
In the diagram below you can see the survival rates for adenocarcinoma. Different figures apply for NET and NEC (text in Dutch only).
(Source: kanker.nl)
Without therapy, the average survival after diagnosis is 4 to 6 months. If surgery can be performed, the percentage of patients who are still alive 5 years after diagnosis is about 20%. However, only one in five patients is eligible for surgery.
Pancreatic cancer/adenocarcinoma accounts for 6.8/6.3% of cancer deaths in the Netherlands (2022). In recent decades, the chance of surviving this disease due to better treatments, unlike other types of cancer, has hardly increased.
Different phases
Every form of cancer progresses in different stages. There are different characteristics that determine how serious the disease is. To determine how far your disease has progressed, a medical specialist uses a medical term called ‘staging’. The medical specialist pays attention to the size of the tumor, any growth of the tumor outside the pancreas and the presence of metastases in the lymph nodes and/or organs elsewhere in the body. For pancreatic cancer, there are 4 different stages internationally. They are indicated with Roman numerals from I (early stage) to IV (4, advanced stage).
Stage I
In stage I, cancer has developed and is only found in the pancreas. There is a further distinction between stage IA and stage IB. It is mainly about the size of the tumor.
- Stage IA: the tumor is smaller than 2 centimeters.
- Stage IB: the tumor is larger than 2 centimeters.
Stage II
In stage II, the cancer may have spread to nearby tissues. The cancer may also be found in the lymph nodes that are close to the pancreas. Stage II can also be subdivided into IIA and IIB. Now, for the determination, it is important to find out where the cancer has spread.
- Stage IIA: the pancreatic cancer has spread to nearby tissues and organs, but not yet to the lymph nodes.
- Stage IIB: cancer has spread to the lymph nodes and possibly to nearby organs.
Stage III
In stage III, the cancer has spread to the major blood vessels and lymph nodes.
Stage IV
Stage IV is the final stage of cancer staging. In stage IV, the cancer is of varying size and has spread to organs that are farther away from the pancreas, such as the liver, lungs, or abdominal cavity.
TNM classification of pancreatic carcinoma
Dutch specialists often use a ‘TNM classification’ of the tumor in addition to staging. By classification, the specialist means determining the stage in which the tumor is located. TNM stands for ‘Tumor’, ‘Node’ (lymph node), ‘Metastases’ (spread). The stage ultimately determines which treatment can be chosen by the specialist.
T0 no tumor present.
Tis in situ carcinoma: precancerous stage.
T1 tumor confined to the pancreas, maximum 2 cm in greatest diameter.
T2 tumor confined to the pancreas but larger than 2 cm in greatest diameter.
T3 tumor extends outside the pancreas but without ingrowth of the large blood vessels.
T4 tumor extends into large blood vessels.
N0 no regional lymph node metastasis.
N1 regional lymph node metastasis.
M0 no distant metastases.
M1 distant metastases.
Treatment plan
When determining the treatment plan for cancer, various specialists are involved. They use jointly established national guidelines. The doctors propose a specific treatment based on:
- the stage of the disease.
- the location and size of the tumor.
- the form of pancreatic cancer.
- your general physical condition.