How Long Do You Have to Live with Stage 4 Pancreatic Cancer?

Pancreatic cancer occurs when cells in the pancreas grow abnormally out of control.

Pancreatic adenocarcinoma is the most common type of pancreatic cancer, accounting for about 95% of cancers of the pancreas. Pancreatic neuroendocrine tumors (NETs), or islet cell tumors, are less common but usually have a better prognosis.

What Are Symptoms of Pancreatic Cancer?

Symptoms of pancreatic cancer include: 

• Yellowing of the skin and eyes (jaundice)
• Dark urine
• Light-colored or greasy stools
• Itchy skin
• Abdominal pain
• Back pain
• Unintended weight loss 
• Loss of appetite
• Nausea
• Vomiting
• Pain after eating
• Blood clots
  • In the leg: deep vein thrombosis (DVT) symptoms can include pain, swelling, redness, and warmth in the affected leg
  • In the lung: pulmonary embolism (PE) symptoms can include difficulty breathing or chest pain
• Diabetes
  • Symptoms can include thirst, hunger, and frequent urination 

Pancreatic cancer is believed to be caused by genetic changes (mutations), however, the exact cause for these mutations is unknown. 
Risk factors for developing pancreatic cancer include: 

• Tobacco use
  • This is one of the most common causes of pancreatic cancer 
  • About 25% of pancreatic cancers are thought to be caused by cigarette smoking
  • The risk of developing pancreatic cancer is about twice as high among smokers compared to those who have never smoked
• Being overweight or obese 
  • People with a body mass index (BMI) of 30 or more are about 20% more likely to develop pancreatic cancer
  • Gaining weight as an adult 
  • Carrying extra weight around the waistline even in people who are not overweight
• Diabetes
• Chronic pancreatitis
• Workplace exposure to certain chemicals such as those used in the dry cleaning and metal working industries 
• Age
  • Risk increases with age
  • About two-thirds of patients are at least 65 years old
  • The average age at diagnosis is 70
• Gender: men are slightly more likely to develop pancreatic cancer than women (this may be due to greater tobacco use in men)
• Race: African Americans are slightly more likely to develop pancreatic cancer than whites
• Family history
• Inherited genetic syndromes

Pancreatic cancer is diagnosed with a patient history and physical exam, along with tests such as:

• Imaging tests 
  • Computed tomography (CT) scan
  • Multiphase CT scan or a pancreatic protocol CT scan
  • CT-guided needle biopsy
• Magnetic resonance imaging (MRI)
  • MR cholangiopancreatography (MRCP)
  • MR angiography (MRA)
• Ultrasound
  • Abdominal ultrasound
  • Endoscopic ultrasound (EUS)
• Cholangiopancreatography
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Magnetic resonance cholangiopancreatography (MRCP)
  • Percutaneous transhepatic cholangiography (PTC)
  • Positron emission tomography (PET) scan
  • Angiography
• Blood tests
  • Liver function tests
  • Tumor markers
    • CA 19-9
    • Carcinoembryonic antigen (CEA)
  • Complete blood count (CBC) 
  • Chemistry panel
• Biopsy
  • Percutaneous (through the skin) biopsy
  • Endoscopic biopsy
  • Surgical biopsy
• Genetic counseling and testing
  • Can help determine what treatments might be useful
  • Family members of the patient may consider genetic counseling and testing 

Treatment for pancreatic cancer includes one or more of the following:

• Surgery 
  • Potentially curative surgery: used when tests suggest it’s possible to remove (resect) all the cancer
    • Whipple procedure (pancreaticoduodenectomy): removes a cancer in the head of the pancreas. 
    • Distal pancreatectomy: removes only the tail of the pancreas or the tail and a portion of the body of the pancreas, along with the spleen 
    • Total pancreatectomy: removal of entire pancreas, as well as the gallbladder, part of the stomach and small intestine, and the spleen
  • Palliative surgery: used if the cancer is too widespread to be removed completely; done to relieve symptoms or to prevent complications like a blocked bile duct or intestine
    • Stent placement to relieve a blocked bile duct 
    • Bypass surgery to relieve a blocked bile duct
• Ablation or embolization treatments 
  • Ablation: used to destroy tumors, usually with extreme heat or cold
    • Works best for tumors no more than about 2 cm (just under an inch) 
    • Radiofrequency ablation (RFA) 
    • Microwave thermotherapy 
    • Ethanol (alcohol) ablation (also known as percutaneous ethanol injection) 
    • Cryosurgery (also known as cryotherapy or cryoablation) 
  • Embolization 
    • Arterial embolization (also known as trans-arterial embolization or TAE) 
    • Chemoembolization (also known as trans-arterial chemoembolization or TACE
    • Radioembolization 
• Radiation therapy 
  • External beam radiation therapy
• Chemotherapy 
  • Before surgery (neoadjuvant chemotherapy) or after surgery (adjuvant chemotherapy)
    • Gemcitabine (Gemzar)
    • 5-fluorouracil (5-FU)
    • Oxaliplatin (Eloxatin)
    • Albumin-bound paclitaxel (Abraxane)
    • Capecitabine (Xeloda)
    • Cisplatin
    • Irinotecan (Camptosar)
  • For advanced pancreatic cancer
    • Gemcitabine (Gemzar)
    • 5-fluorouracil (5-FU) or capecitabine (Xeloda) (an oral 5FU drug) 
    • Irinotecan (Camptosar) or liposomal irinotecan (Onivyde)
    • Platinum agents: cisplatin and oxaliplatin (Eloxatin)
    • Taxanes: Paclitaxel (Taxol), docetaxel (Taxotere), and albumin-bound paclitaxel (Abraxane)
• Targeted therapy
  • EGFR inhibitor: erlotinib (Tarceva) 
  • PARP inhibitor: olaparib (Lynparza) 
  • NTRK inhibitors: larotrectinib (Vitrakvi) and entrectinib (Rozlytrek)
• Immunotherapy 
  • PD-1 inhibitor: pembrolizumab (Keytruda) 
• Pain control