National Cancer Institute

What You Need 

To Know About TM

Cancer

of the

Pancreas

U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES

National Institutes of Health
National Cancer Institute Services

This is only one of many free booklets for

people with cancer.

You may want more information for yourself,

your family, and your doctor.

NCI offers comprehensive research-based

information for patients and their families, health

professionals, cancer researchers, advocates, and

the public.

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1–800–4–CANCER (1–800–422–6237)

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http://www.cancer.gov/espanol

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messaging service, at http://www.cancer.gov/

livehelp

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U.S. DEPARTMENT OF

HEALTH AND HUMAN SERVICES

National Institutes of Health

National Cancer Institute

Contents

About This Booklet 1

The Pancreas 3

Cancer Cells 5

Risk Factors 6

Symptoms 8

Diagnosis 9

Staging 12

Treatment 14

Second Opinion 22

Supportive Care 23

Nutrition 25

Follow-up Care 26

Sources of Support 27

Taking Part in Cancer Research 28

Dictionary 30

National Cancer Institute Publications 40

About This Booklet

This National Cancer Institute (NCI) booklet is

about cancer* that starts in the pancreas. This disease

is also called pancreatic cancer.

Each year in the United States, more than 43,000

people are diagnosed with cancer of the pancreas. Most

are over 65 years old.

1

*Words in italics are in the Dictionary on page 30. The Dictionary

explains these terms. It also shows how to pronounce them.

Learning about medical care for cancer of the

pancreas can help you take an active part in making

choices about your care. This booklet tells about

• Diagnosis and staging

• Treatment and supportive care

• Taking part in research studies

There are two main types of pancreatic cancer.

Most often, pancreatic cancer starts in the

ducts that carry pancreatic juices. This type is

called exocrine pancreatic cancer. This booklet

is about this type.

Much less often, pancreatic cancer begins in

the cells that make hormones. This type may be

called endocrine pancreatic cancer or islet cell

cancer. This booklet is not about endocrine

pancreatic cancer. NCI’s Cancer Information

Service at 1–800–4–CANCER

(1–800–422–6237) can provide information

about this disease.
This booklet has lists of questions that you may

want to ask your doctor. Many people find it helpful to

take a list of questions to a doctor visit. To help

remember what your doctor says, you can take notes.

You may also want to have a family member or friend

go with you when you talk with the doctor—to take

notes, ask questions, or just listen.

For the latest information about cancer of the

pancreas, please visit NCI’s Web site at

http://www.cancer.gov/cancertopics/types/pancreatic.

Also, NCI’s Cancer Information Service can answer

your questions about cancer. We can also send 

you NCI booklets and fact sheets. Call

1–800–4–CANCER (1–800–422–6237) or chat 

with us online using LiveHelp, NCI’s instant

messaging service, at http://www.cancer.gov/livehelp.

2
The Pancreas

The pancreas is an organ that is about 6 inches long.

It’s located deep in your belly between your stomach

and backbone. Your liver, intestine, and other organs

surround your pancreas.

3

This picture shows the pancreas and nearby organs.

Liver

Stomach

Bile duct

Gallbladder Spleen

Small

intestine

Pancreas

Colon

Duodenum

© 2010 Terese WinslowU.S. Govt. has certain rights
The widest part of the pancreas is called the head.

The head of the pancreas is closest to the small

intestine. The middle section is called the body, and the

thinnest part is called the tail.

The pancreas makes pancreatic juices. These juices

contain enzymes that help break down food. The juices

flow through a system of ducts leading to the main

pancreatic duct. The pancreatic juices flow through the

main duct to the duodenum, the first part of the small

intestine.

The pancreas is also a gland that makes insulin and

other hormones. These hormones enter the bloodstream

and travel throughout the body. They help the body use

or store the energy that comes from food. For example,

insulin helps control the amount of sugar in the blood.

4

This picture shows the head, body, and tail of the

pancreas.

Bile

duct

Pancreatic

duct

Head

Body

Tail

Duodenum

© 2010 Terese WinslowU.S. Govt. has certain rights
Cancer Cells

Cancer begins in cells, the building blocks that make

up tissues. Tissues make up the pancreas and the other

organs of the body.

Normal cells grow and divide to form new cells as

the body needs them. When normal cells grow old or

get damaged, they die, and new cells take their place.

Sometimes, this process goes wrong. New cells

form when the body doesn’t need them, and old or

damaged cells don’t die as they should. The buildup of

extra cells often forms a mass of tissue called a growth

or tumor.

Tumors in the pancreas can be benign (not cancer)

or malignant (cancer). Benign tumors are not as

harmful as malignant tumors:

• Benign tumors (such as cysts): 

—are usually not a threat to life

—can be removed and usually don’t grow back

—don’t invade the tissues around them 

—don’t spread to other parts of the body

• Malignant growths: 

—may be a threat to life 

—sometimes can be removed but can grow back 

—can invade and damage nearby tissues and organs 

—can spread to other parts of the body 

5
Pancreatic cancer can invade other tissues, shed

cancer cells into the abdomen, or spread to other

organs:

• Invade: A malignant pancreatic tumor can grow and

invade organs next to the pancreas, such as the

stomach or small intestine.

• Shed: Cancer cells can shed (break off) from the

main pancreatic tumor. Shedding into the abdomen

may lead to new tumors forming on the surface of

nearby organs and tissues. The doctor may call these

seeds or implants. The seeds can cause an abnormal

buildup of fluid in the abdomen (ascites).

• Spread: Cancer cells can spread by breaking away

from the original tumor. They can spread through

the blood vessels to the liver and lungs. In addition,

pancreatic cancer cells can spread through lymph

vessels to nearby lymph nodes. After spreading, the

cancer cells may attach to other tissues and grow to

form new tumors that may damage those tissues.

See the Staging section on page 12 for information

about cancer of the pancreas that has spread.

Risk Factors

When you get a diagnosis of cancer, it’s natural to

wonder what may have caused the disease. Doctors

can’t always explain why one person gets pancreatic

cancer and another doesn’t. However, we do know that

people with certain risk factors may be more likely

than others to develop cancer of the pancreas. A risk

factor is something that may increase the chance of

getting a disease.

6
Studies have found the following risk factors for

cancer of the pancreas:

• Smoking: Smoking tobacco is the most important

risk factor for pancreatic cancer. People who smoke

tobacco are more likely than nonsmokers to develop

this disease. Heavy smokers are most at risk.

• Diabetes: People with diabetes are more likely than

other people to develop pancreatic cancer.

• Family history: Having a mother, father, sister, or

brother with pancreatic cancer increases the risk of

developing the disease.

• Inflammation of the pancreas: Pancreatitis is a

painful inflammation of the pancreas. Having

pancreatitis for a long time may increase the risk of

pancreatic cancer.

• Obesity: People who are overweight or obese are

slightly more likely than other people to develop

pancreatic cancer.

Many other possible risk factors are under active

study. For example, researchers are studying whether a

diet high in fat (especially animal fat) or heavy

drinking of alcoholic beverages may increase the risk

of pancreatic cancer. Another area of active research is

whether certain genes increase the risk of disease.

Many people who get pancreatic cancer have none

of these risk factors, and many people who have

known risk factors don’t develop the disease.

7
Symptoms

Early cancer of the pancreas often doesn’t cause

symptoms. When the cancer grows larger, you may

notice one or more of these common symptoms: 

• Dark urine, pale stools, and yellow skin and eyes

from jaundice

• Pain in the upper part of your belly 

• Pain in the middle part of your back that doesn’t go

away when you shift your position 

• Nausea and vomiting

• Stools that float in the toilet

Also, advanced cancer may cause these general

symptoms:

• Weakness or feeling very tired

• Loss of appetite or feelings of fullness

• Weight loss for no known reason

These symptoms may be caused by pancreatic

cancer or by other health problems. People with these

symptoms should tell their doctor so that problems can

be diagnosed and treated as early as possible.

8
Diagnosis

If you have symptoms that suggest cancer of the

pancreas, your doctor will try to find out what’s

causing the problems.

You may have blood or other lab tests. Also, you

may have one or more of the following tests:

• Physical exam: Your doctor feels your abdomen to

check for changes in areas near the pancreas, liver,

gallbladder, and spleen. Your doctor also checks for

an abnormal buildup of fluid in the abdomen. Also,

your skin and eyes may be checked for signs of

jaundice.

• CT scan: An x-ray machine linked to a computer

takes a series of detailed pictures of your pancreas,

nearby organs, and blood vessels in your abdomen.

You may receive an injection of contrast material so

your pancreas shows up clearly in the pictures. Also,

you may be asked to drink water so your stomach

and duodenum show up better. On the CT scan, your

doctor may see a tumor in the pancreas or elsewhere

in the abdomen.

• Ultrasound: Your doctor places the ultrasound

device on your abdomen and slowly moves it

around. The ultrasound device uses sound waves

that can’t be heard by humans. The sound waves

make a pattern of echoes as they bounce off internal

organs. The echoes create a picture of your pancreas

and other organs in the abdomen. The picture may

show a tumor or blocked ducts.

9
• EUS: Your doctor passes a thin, lighted tube

(endoscope) down your throat, through your

stomach, and into the first part of the small intestine.

An ultrasound probe at the end of the tube sends out

sound waves that you can’t hear. The waves bounce

off tissues in your pancreas and other organs. As

your doctor slowly withdraws the probe from the

intestine toward the stomach, the computer creates a

picture of the pancreas from the echoes. The picture

can show a tumor in the pancreas. It can also show

how deeply the cancer has invaded the blood

vessels.

Some doctors use the following tests also: 

• ERCP: The doctor passes an endoscope through

your mouth and stomach, down into the first part of

your small intestine. Your doctor slips a smaller tube

through the endoscope into the bile ducts and

pancreatic ducts. (See picture of ducts on page 4.)

After injecting dye through the smaller tube into the

ducts, the doctor takes x-ray pictures. The x-rays can

show whether the ducts are narrowed or blocked by

a tumor or other condition.

• MRI: A large machine with a strong magnet linked

to a computer is used to make detailed pictures of

areas inside your body.

• PET scan: You’ll receive an injection of a small

amount of radioactive sugar. The radioactive sugar

gives off signals that the PET scanner picks up. The

PET scanner makes a picture of the places in your

body where the sugar is being taken up. Cancer cells

show up brighter in the picture because they take up

sugar faster than normal cells do. A PET scan may

show a tumor in the pancreas. It can also show

cancer that has spread to other parts of the body.

10
• Needle biopsy: The doctor uses a thin needle to

remove a small sample of tissue from the pancreas.

EUS or CT may be used to guide the needle. A

pathologist uses a microscope to look for cancer

cells in the tissue.

11

You may want to ask the doctor these

questions before having a biopsy:

• Do you recommend that I have a biopsy? If so,

why?

• How long will it take? Will I be awake? Will it

hurt?

• Is there a risk that a needle biopsy procedure

will cause the cancer to spread? What are the

chances of infection or bleeding after the

biopsy? Are there any other risks?

• How soon will I know the results? How do I

get a copy of the pathology report?

• If I do have cancer, who will talk with me

about treatment? When?
Staging

If cancer of the pancreas is diagnosed, your doctor

needs to learn the extent (stage) of the disease to help

you choose the best treatment.

Staging is a careful attempt to find out the

following:

• The size of the tumor in the pancreas

• Whether the tumor has invaded nearby tissues 

• Whether the cancer has spread, and if so, to what

parts of the body

12
When cancer of the pancreas spreads, the cancer

cells may be found in nearby lymph nodes or the liver.

Cancer cells may also be found in the lungs or in fluid

collected from the abdomen.

When cancer spreads from its original place to

another part of the body, the new tumor has the same

kind of abnormal cells and the same name as the

original (primary) tumor. For example, if pancreatic

cancer spreads to the liver, the cancer cells in the liver

are actually pancreatic cancer cells. The disease is

metastatic pancreatic cancer, not liver cancer. It’s

treated as pancreatic cancer, not as liver cancer.

Doctors sometimes call the new tumor in the liver

“distant” disease.

To learn whether pancreatic cancer has spread, your

doctor may order CT scans or EUS.

Also, a surgeon may look inside your abdomen with

a laparoscope (a thin, tube-like device that has a light

and a lens for seeing inside the body). The surgeon

inserts the laparoscope through a small incision in your

belly button. The surgeon will look for any signs of

cancer inside your abdomen. You’ll need general

anesthesia for this exam.

These are the stages of cancer of the pancreas:

• Stage I: The tumor is found only in the pancreas.

• Stage II: The tumor has invaded nearby tissue but

not nearby blood vessels. The cancer may have

spread to the lymph nodes.

• Stage III: The tumor has invaded nearby blood

vessels.

• Stage IV: The cancer has spread to a distant organ,

such as the liver or lungs.

13
Treatment

Treatment options for people with cancer of the

pancreas are surgery, chemotherapy, targeted therapy,

and radiation therapy. You’ll probably receive more

than one type of treatment.

The treatment that’s right for you depends mainly on

the following:

• The location of the tumor in your pancreas 

• Whether the disease has spread

• Your age and general health

At this time, cancer of the pancreas can be cured

only when it’s found at an early stage (before it has

spread) and only if surgery can completely remove the

tumor. For people who can’t have surgery, other

treatments may be able to help them live longer and

feel better.

You may want to talk with your doctor about taking

part in a clinical trial. Clinical trials are research

studies testing new treatments. They are an important

option for people with all stages of cancer of the

pancreas. See the Taking Part in Cancer Research

section on page 28.

You may have a team of specialists to help plan

your treatment. Your doctor may refer you to a

specialist, or you may ask for a referral. Specialists

who treat cancer of the pancreas include surgeons,

medical oncologists, radiation oncologists, and

gastroenterologists. Your health care team may also

include an oncology nurse.

14
15

For help relieving or reducing pain, you may work

with a specially trained doctor, a nurse, a palliative

care team, or another pain control specialist. See the

Supportive Care section on page 23.

For help reducing eating problems and maintaining

your weight, you may work with a registered dietitian.

See the Nutrition section on page 25.

Your health care team can describe your treatment

choices, the expected results of each, and the possible

side effects. Because cancer treatments often damage

healthy cells and tissues, side effects are common.

These side effects depend on many factors, including

the type and extent of treatment. Side effects may not

be the same for each person, and they may even

change from one treatment session to the next. Before

treatment starts, ask your health care team about

possible side effects and how treatment may change

your normal activities. You and your health care team

can work together to develop a treatment plan that

meets your needs.
16

You may want to ask your doctor these

questions before you begin treatment:

• What is the stage of the disease? Has the

cancer spread? 

• Do I need any more tests to find out whether I

can have surgery?

• What is the goal of treatment? What are my

treatment choices? Which do you suggest for

me? Why?

• What are the expected benefits of each kind of

treatment?

• What can I do to prepare for treatment?

• Will I need to stay in the hospital? If so, for

how long?

• What are the risks and possible side effects of

each treatment? How can side effects be

managed?

• How will you treat my pain?

• What is the treatment likely to cost? Will my

insurance cover it?

• How will treatment affect my normal

activities? Am I likely to have eating problems

or other problems? 

• Would a research study (clinical trial) be a

good choice for me? 

• Can you recommend other doctors who could

give me a second opinion about my treatment

options?

• How often should I have checkups?
Surgery

Surgery may be an option for people with an early

stage of pancreatic cancer. The surgeon usually

removes only the part of the pancreas that has cancer.

But, in some cases, the whole pancreas may be

removed.

The type of surgery depends on the location of the

tumor in the pancreas. Surgery to remove a tumor in

the head of the pancreas is called a Whipple procedure.

The Whipple procedure is the most common type of

surgery for pancreatic cancer. You and your surgeon

may talk about the types of surgery and which may be

right for you.

In addition to part or all of your pancreas, the

surgeon usually removes the following nearby tissues:

• Duodenum

• Gallbladder

• Common bile duct 

• Part of your stomach

Also, the surgeon may remove your spleen and

nearby lymph nodes.

Surgery for pancreatic cancer is a major operation.

You will need to stay in the hospital for one to two

weeks afterward. Your health care team will watch for

signs of bleeding, infection, or other problems.

It takes time to heal after surgery, and the time

needed to recover is different for each person. You may

have pain or discomfort for the first few days.

Medicine can help control your pain. Before surgery,

you should discuss the plan for pain relief with your

health care team. After surgery, they can adjust the plan

if you need more pain control. See the Supportive Care

section on page 23.

17
It’s common to feel weak or tired for a while. You

may need to rest at home for one to three months after

leaving the hospital.

After surgery, it may be hard to digest food. For four

to six weeks after Whipple surgery, you may feel

bloated or full, and you may have nausea and

vomiting. A dietitian can help you change your diet to

reduce your discomfort. Problems with eating usually

go away within three months. See the Nutrition section

on page 25.

18

You may want to ask your doctor these

questions before having surgery:

• What type of surgery do you recommend for

me? Why?

• Will tissues other than the tumor in the

pancreas be removed? Why?

• How many times have you performed this

surgery? How many pancreatic cancer patients

do you treat each year?

• How will I feel after surgery?

• Am I likely to have eating problems? Will I

need a special diet? Who can help me if I have

a problem?

• If I have pain, how will you control it?

• How long will I be in the hospital?

• Will I have any long-term effects because of

the surgery?
Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Most

people with pancreatic cancer get chemotherapy. For

early pancreatic cancer, chemotherapy is usually given

after surgery, but in some cases, it’s given before

surgery. For advanced cancer, chemotherapy is used

alone, with targeted therapy, or with radiation therapy.

Chemotherapy for pancreatic cancer is usually given

by vein (intravenous). The drugs enter the bloodstream

and travel throughout your body.

Chemotherapy may be given in an outpatient part of

the hospital, at the doctor’s office, or at home. Rarely,

you may need to stay in the hospital.

The side effects depend mainly on which drugs are

given and how much. Chemotherapy kills fast-growing

cancer cells, but the drugs can also harm normal cells

that divide rapidly: 

• Blood cells: When drugs lower the levels of healthy

blood cells, you’re more likely to get infections,

bruise or bleed easily, and feel very weak and tired.

Your health care team will check for low levels of

blood cells. If your levels are low, your health care

team may stop the chemotherapy for a while or

reduce the dose of the drug. There are also

medicines that can help your body make new blood

cells.

• Cells in hair roots: Chemotherapy may cause hair

loss. If you lose your hair, it will grow back after

treatment, but the color and texture may be changed.

• Cells that line the digestive tract: Chemotherapy

can cause a poor appetite, nausea and vomiting,

diarrhea, or mouth and lip sores. Your health care

team can give you medicines and suggest other

ways to help with these problems. They usually go

away when treatment ends.

19
Some drugs used for pancreatic cancer also may

cause tingling or numbness in your hands and feet.

Your health care team can suggest ways to control

many of these side effects.

You may wish to read the NCI booklet

Chemotherapy and You.

Targeted Therapy 

People with cancer of the pancreas who can’t have

surgery may receive a type of drug called targeted

therapy along with chemotherapy.

Targeted therapy slows the growth of pancreatic

cancer. It also helps prevent cancer cells from

spreading. The drug is taken by mouth.

Side effects may include diarrhea, nausea, vomiting,

a rash, and shortness of breath. You may want to read

the NCI fact sheet Targeted Cancer Therapies.

20

You may want to ask your doctor these

questions about chemotherapy or targeted

therapy:

• Why do I need this treatment?

• Which drug or drugs will I have?

• How do the drugs work?

• When will treatment start? When will it end?

• Will I have any long-term side effects?
Radiation Therapy

Radiation therapy uses high-energy rays to kill

cancer cells. It can be given along with other

treatments, including chemotherapy.

The radiation comes from a large machine. The

machine aims beams of radiation at the cancer in the

abdomen. You’ll go to a hospital or clinic 5 days a

week for several weeks to receive radiation therapy.

Each session takes about 30 minutes.

Although radiation therapy is painless, it may cause

other side effects. The side effects include nausea,

vomiting, or diarrhea. You may also feel very tired.

Your health care team can suggest ways to treat or

control these side effects.

You may find it helpful to read the NCI booklet

Radiation Therapy and You.

21

You may want to ask your doctor these

questions about radiation therapy:

• Why do I need this treatment?

• When will the treatments begin? When will

they end?

• How will I feel during treatment?

• How will we know if the radiation treatment is

working?

• Will I have any long-term side effects?
Second Opinion

Before starting treatment, you may want a second

opinion about your diagnosis, the stage of cancer, and

the treatment plan. You may also want to find a

medical center that has a lot of experience treating

people with pancreatic cancer.

Some people worry that the doctor will be offended

if they ask for a second opinion. Usually the opposite

is true. Most doctors welcome a second opinion. And

many health insurance companies will pay for a second

opinion if you or your doctor requests it. Some

companies require a second opinion.

If you get a second opinion, the second doctor may

agree with your first doctor’s diagnosis and treatment

plan. Or, the second doctor may suggest another

approach. Either way, you have more information and

perhaps a greater sense of control. You can feel more

confident about the decisions you make, knowing that

you’ve looked at all of your options.

It may take some time and effort to gather your

medical records and see another doctor. In most cases,

it’s not a problem to take several weeks to get a second

opinion. The delay in starting treatment usually will

not make treatment less effective. To make sure, you

should discuss this delay with your doctor.

There are many ways to find a doctor for a second

opinion. Ask your doctor, a local or state medical

society, or a nearby hospital or medical school for

names of specialists.

22
Also, you can request a consultation with specialists

at the National Institutes of Health Clinical Center in

Bethesda, Maryland. Specialists in NCI’s Surgery

Branch provide consultations and surgical care for

people with pancreatic cancer. The telephone number

is 301– 496– 4164. The Web site is located at

http://go.cancer.gov/surgery.

In addition, you can get information about treatment

centers near you from NCI’s Cancer Information

Service at 1–800–4–CANCER (1–800–422–6237) 

or LiveHelp (http://www.cancer.gov/livehelp).

Other sources can be found in the NCI fact sheet

How To Find a Doctor or Treatment Facility If You

Have Cancer.

Supportive Care

Cancer of the pancreas and its treatment can lead to

other health problems. You can have supportive care

before, during, and after cancer treatment.

Supportive care is treatment to control pain and

other symptoms, to relieve the side effects of therapy,

and to help you cope with the feelings that a diagnosis

of cancer can bring. You may receive supportive care

to prevent or control these problems and to improve

your comfort and quality of life during treatment.

You can get information about supportive care 

on NCI’s Web site at http://www.cancer.gov/

cancerinfo/coping and from NCI’s Cancer Information

Service at 1–800–4–CANCER (1–800–422–6237) 

or LiveHelp (http://www.cancer.gov/livehelp).

23
Pain Control

Cancer of the pancreas and its treatment may lead to

pain. Your doctor or a specialist in pain control can

suggest ways to relieve or reduce pain. You may want

to ask if your hospital has a palliative care team.

There are many ways to relieve or reduce pain:

• Pain medicine: Your health care team can suggest

medicines that will relieve pain. If you have

constipation or other side effects from the medicine,

your health care team will help you manage the

problems.

• Nerve block: The doctor may inject alcohol into the

area around certain nerves in the abdomen to block

the pain.

• Other methods: You may find that massage or

acupuncture helps relieve pain. Also, you may learn

other methods, such as hypnosis, relaxation, music

therapy, imagery, and biofeedback.

More information about pain control can be found in

the NCI booklet Pain Control.

Blockage

If the tumor in the pancreas grows large enough to

squeeze the common bile duct or block the duodenum,

your health care team can suggest ways to help: 

• Surgery: The surgeon can create a bypass through

the blocked bile duct or duodenum. A bypass allows

fluids to flow through the digestive tract. It can help

relieve jaundice and pain resulting from the

blockage.

• Stent: The doctor uses an endoscope to place a stent

in the blocked area. A stent is a tiny plastic or metal

mesh tube that helps keep the duct or duodenum

open.

24
Sadness and Other Feelings

It’s normal to feel sad, anxious, or confused after a

diagnosis of a serious illness. Some people find it

helpful to talk about their feelings. See the Sources of

Support section on page 27.

Nutrition 

Nutrition is an important part of your care. Getting

the right nutrition can help you feel better and have

more strength. However, pancreatic cancer and its

treatment may make it hard for you to digest food and

to maintain your weight. You may not feel like eating

for a variety of reasons, such as feeling tired or feeling

full soon after eating.

25
You may find it helpful to work with a dietitian. A

dietitian can help you choose foods and nutrition

products that will meet your needs and can make you

feel more comfortable with eating. Your health care

team will check you for weight loss and ask whether

you are having problems with nausea, vomiting, or

diarrhea. If your nutrition problems do not get better

quickly enough, you may be offered another way of

getting nutrition, such as a feeding tube.

For general information about nutrition during

cancer treatment, you may want to read the NCI

booklet Eating Hints. It contains useful ideas and

recipes.

Nutrition after Surgery

After surgery, your health care team will check you

for problems with digestion or with your blood sugar

level, and they will help you manage such changes. If

you have problems with digestion, you may need to

take a supplement to replace the digestive enzymes that

are normally made by the pancreas. You may also need

to take minerals and vitamins. If you have problems

with the sugar level in your blood, you may need to

take medicine to control blood sugar.

Follow-up Care

You’ll need regular checkups (such as every 3

months) after treatment for cancer of the pancreas.

Checkups help ensure that any changes in your health

are noted and treated if needed. If you have any health

problems between checkups, you should contact your

doctor.

Cancer of the pancreas may come back after

treatment. Your doctor will check for return of cancer.

Checkups may include a physical exam, blood tests, or

CT scans.

26
NCI has publications to help answer questions about

follow-up care and other concerns. You may find it

helpful to read the NCI booklet Facing Forward: Life

After Cancer Treatment. You may also want to read the

NCI fact sheet Follow-up Care After Cancer

Treatment.

Sources of Support 

Learning that you have cancer of the pancreas can

change your life and the lives of those close to you.

These changes can be hard to handle. It’s normal for

you, your family, and your friends to need help coping

with the feelings that a diagnosis of cancer can bring.

Concerns about treatments and managing side

effects, hospital stays, and medical bills are common.

You may also worry about caring for your family,

keeping your job, or continuing daily activities.

Here’s where you can go for support:

• Doctors, nurses, and other members of your health

care team can answer questions about treatment,

working, or other activities.

• Social workers, counselors, or members of the

clergy can be helpful if you want to talk about your

feelings or concerns. Often, social workers can

suggest resources for financial aid, transportation,

home care, or emotional support.

• Support groups also can help. In these groups,

patients or their family members meet with other

patients or their families to share what they have

learned about coping with the disease and the effects

of treatment. Groups may offer support in person,

over the telephone, or on the Internet. You may want

to talk with a member of your health care team

about finding a support group.

27
• NCI’s Cancer Information Service at

1–800–4–CANCER (1–800–422–6237) and at

LiveHelp (http://www.cancer.gov/livehelp) can

help you locate programs, services, and NCI

publications. They can send you a list of

organizations that offer services to people with

cancer.

For tips on coping, you may want to read the NCI

booklet Taking Time: Support for People With Cancer.

Taking Part in Cancer Research

Doctors all over the world are conducting many

types of clinical trials (research studies in which people

volunteer to take part). Clinical trials are designed to

find out whether new treatments are safe and effective.

28
Doctors are studying new drugs, other treatments,

and their combinations, including combinations of

surgery, chemotherapy, targeted therapy, and radiation

therapy.

Even if the people in a trial do not benefit directly,

they may still make an important contribution by

helping doctors learn more about cancer of the

pancreas and how to control it. Although clinical trials

may pose some risks, doctors do all they can to protect

their patients.

If you’re interested in being part of a clinical trial,

talk with your doctor. You may want to read the NCI

booklet Taking Part in Cancer Treatment Research

Studies. It describes how treatment studies are carried

out and explains their possible benefits and risks.

NCI’s Web site includes a section on clinical trials at

http://www.cancer.gov/clinicaltrials. It has general

information about clinical trials as well as detailed

information about specific ongoing studies of cancer of

the pancreas. NCI’s Cancer Information Service at

1–800–4–CANCER (1–800–422–6237) and at

LiveHelp at http://www.cancer.gov/livehelp can

answer questions and provide information about

clinical trials.

Also, you may wish to contact NCI’s Surgery

Branch at the National Institutes of Health Clinical

Center in Bethesda, Maryland. The telephone number

is 301– 496– 4164. The Web site is located at

http://go.cancer.gov/surgery.

29
Dictionary 

Definitions of thousands of terms are on NCI’s Web

site in NCI’s Dictionary of Cancer Terms. You can

access it at http://www.cancer.gov/dictionary.

Acupuncture (AK-yoo-PUNK-cher): The technique of

inserting thin needles through the skin at specific

points on the body to control pain and other symptoms.

It is a type of complementary and alternative medicine.

Ascites (uh-SY-teez): Abnormal buildup of fluid in the

abdomen that may cause swelling. In late-stage cancer,

tumor cells may be found in the fluid in the abdomen.

Ascites also occurs in patients with liver disease.

Benign (beh-NINE): Not cancerous. Benign tumors

may grow larger but do not spread to other parts of the

body. Also called nonmalignant.

Biofeedback: A method of learning to voluntarily

control certain body functions such as heartbeat, blood

pressure, and muscle tension with the help of a special

machine. This method can help control pain.

Blood vessel: A tube through which the blood

circulates in the body. Blood vessels include a network

of arteries, arterioles, capillaries, venules, and veins.

Bypass: A surgical procedure in which the doctor

creates a new pathway for the flow of body fluids.

Cancer (KAN-ser): A term for diseases in which

abnormal cells divide without control and can invade

nearby tissues. Cancer cells can also spread to other

parts of the body through the blood and lymph

systems.

Cell (sel): The individual unit that makes up the tissues

of the body. All living things are made up of one or

more cells.

30
Chemotherapy (KEE-moh-THAYR-uh-pee):

Treatment with drugs that kill cancer cells.

Clinical trial (KLIH-nih-kul TRY-ul): A type of

research study that tests how well new medical

approaches work in people. These studies test new

methods of screening, prevention, diagnosis, or

treatment of a disease. Also called clinical study.

Common bile duct: A tube or vessel in the body that

carries bile from the liver and gallbladder into the

duodenum (the upper part of the small intestine).

Contrast material: A dye or other substance that helps

show abnormal areas inside the body. It is given by

injection into a vein, by enema, or by mouth. Contrast

material may be used with x-rays, CT scans, MRI, or

other imaging tests.

CT scan: A series of detailed pictures of areas inside

the body taken from different angles. The pictures are

created by a computer linked to an x-ray machine. Also

called CAT scan, computed tomography scan,

computerized axial tomography scan, and

computerized tomography.

Cyst (sist): A sac or capsule in the body. It may be

filled with fluid or other material.

Diabetes (dy-uh-BEE-teez): Any of several diseases in

which the kidneys make a large amount of urine.

Diabetes usually refers to diabetes mellitus in which

there is also a high level of glucose (a type of sugar) in

the blood because the body does not make enough

insulin or use it the way it should.

Duct (dukt): In medicine, a tube or vessel of the body

through which fluids pass.

Duodenum (doo-ah-DEE-num): The first part of the

small intestine that connects to the stomach.

31
Endocrine (EN-doh-krin): Refers to tissue that makes

and releases hormones that travel in the bloodstream

and control the actions of other cells or organs. Some

examples of endocrine tissues are the pancreas,

pituitary, thyroid, and adrenal glands.

Endoscope (EN-doh-SKOPE): A thin, tube-like

instrument used to look at tissues inside the body. An

endoscope has a light and a lens for viewing and may

have a tool to remove tissue.

Enzyme (EN-zime): A protein that speeds up chemical

reactions in the body.

ERCP: A procedure that uses an endoscope to

examine and x-ray the pancreatic duct, hepatic duct,

common bile duct, duodenal papilla, and gallbladder.

An endoscope is a thin, tube-like instrument with a

light and a lens for viewing. The endoscope is passed

through the mouth and down into the first part of the

small intestine (duodenum). A smaller tube (catheter) is

then inserted through the endoscope into the bile and

pancreatic ducts. A dye is injected through the catheter

into the ducts, and an x-ray is taken. Also called

endoscopic retrograde cholangiopancreatography.

EUS: A procedure in which an endoscope is inserted

into the body. An endoscope is a thin, tube-like

instrument that has a light and a lens for viewing. A

probe at the end of the endoscope is used to bounce

high-energy sound waves (ultrasound) off internal

organs to make a picture (sonogram). Also called

endoscopic ultrasound and endosonography.

Exocrine (EK-soh-krin): Refers to tissue that makes

and releases substances into a duct (tube). Some ducts

lead to other organs but most lead out of the body.

Some examples of exocrine tissues are the tear glands,

sweat glands, and the pancreas.

32
Gallbladder (GAWL-bla-der): The pear-shaped organ

found below the liver. Bile is concentrated and stored

in the gallbladder.

Gastroenterologist (GAS-troh-EN-teh-RAH-loh-jist):

A doctor who specializes in diagnosing and treating

disorders of the digestive system.

Gene: The functional and physical unit of heredity

passed from parent to offspring. Genes are pieces of

DNA, and most genes contain the information for

making a specific protein.

General anesthesia (JEN-rul A-nes-THEE-zhuh): A

temporary loss of feeling and a complete loss of

awareness that feels like a very deep sleep. It is caused

by special drugs or other substances called anesthetics.

General anesthesia keeps patients from feeling pain

during surgery or other procedures.

Gland: An organ that makes one or more substances,

such as hormones, digestive juices, sweat, tears, saliva,

or milk. Endocrine glands release the substances

directly into the bloodstream. Exocrine glands release

the substances into a duct or opening to the inside or

outside of the body.

Hormone (HOR-mone): One of many chemicals made

by glands in the body. Hormones circulate in the

bloodstream and control the actions of certain cells or

organs. Some hormones can also be made in the

laboratory.

Hypnosis: A trance-like state in which a person

becomes more aware and focused and is more open to

suggestion.

Imagery (IH-mij-ree): Technique in which people

focus on positive images in their mind.

Incision (in-SIH-zhun): A cut made in the body to

perform surgery.

33
Inflammation (IN-fluh-MAY-shun): Redness,

swelling, pain, and/or a feeling of heat in an area of the

body. This is a protective reaction to injury, disease, or

irritation of the tissues.

Insulin (IN-suh-lin): A hormone made by the islet cells

of the pancreas. Insulin controls the amount of sugar in

the blood by moving it into the cells, where it can be

used by the body for energy.

Intestine (in-TES-tin): The long, tube-shaped organ in

the abdomen that completes the process of digestion.

The intestine has two parts, the small intestine and the

large intestine. Also called bowel.

Intravenous (IN-truh-VEE-nus): Into or within a vein.

Intravenous usually refers to a way of giving a drug or

other substance through a needle or tube inserted into a

vein. Also called IV.

Islet cell (I-let sel): A pancreatic cell that produces

hormones (such as insulin and glucagon) that are

secreted into the bloodstream. These hormones help

control the level of glucose (sugar) in the blood. Also

called endocrine pancreas cell and islet of Langerhans

cell.

Jaundice (JAWN-dis): A condition in which the skin

and the whites of the eyes become yellow, urine

darkens, and the color of stool becomes lighter than

normal. Jaundice occurs when the liver is not working

properly or when a bile duct is blocked.

Laparoscope (LA-puh-ruh-SKOPE): A thin, tube-like

instrument used to look at tissues and organs inside the

abdomen. A laparoscope has a light and a lens for

viewing and may have a tool to remove tissue.

Liver (LIH-ver): A large organ located in the upper

abdomen. The liver cleanses the blood and aids in

digestion by secreting bile.

34
Lymph node (limf node): A rounded mass of

lymphatic tissue that is surrounded by a capsule of

connective tissue. Lymph nodes filter lymph

(lymphatic fluid), and they store lymphocytes (white

blood cells). They are located along lymphatic vessels.

Also called lymph gland.

Lymph vessel (limf): A thin tube that carries lymph

(lymphatic fluid) and white blood cells through the

lymphatic system. Also called lymphatic vessel.

Malignant (muh-LIG-nunt): Cancerous. Malignant

tumors can invade and destroy nearby tissue and

spread to other parts of the body.

Medical oncologist (MEH-dih-kul on-KAH-loh-jist):

A doctor who specializes in diagnosing and treating

cancer using chemotherapy, hormonal therapy,

biological therapy, and targeted therapy. A medical

oncologist often is the main health care provider for

someone who has cancer. A medical oncologist also

gives supportive care and may coordinate treatment

given by other specialists.

Metastatic (meh-tuh-STA-tik): Having to do with

metastasis, which is the spread of cancer from the

primary site (place where it started) to other places in

the body.

MRI: A procedure in which radio waves and a

powerful magnet linked to a computer are used to

create detailed pictures of areas inside the body. These

pictures can show the difference between normal and

diseased tissue. MRI makes better images of organs

and soft tissue than other scanning techniques, such as

computed tomography (CT) or x-ray. MRI is especially

useful for imaging the brain, the spine, the soft tissue

of joints, and the inside of bones. Also called magnetic

resonance imaging, NMRI, and nuclear magnetic

resonance imaging.

35
Needle biopsy (NEE-dul BY-op-see): The removal of

tissue or fluid with a needle for examination under a

microscope. When a wide needle is used, the procedure

is called a core biopsy. When a thin needle is used, the

procedure is called a fine-needle aspiration biopsy.

Obesity (oh-BEE-sih-tee): A condition marked by an

abnormally high, unhealthy amount of body fat.

Oncology nurse (on-KAH-loh-jee): A nurse who

specializes in treating and caring for people who have

cancer.

Organ: A part of the body that performs a specific

function. For example, the heart is an organ.

Palliative care (PA-lee-uh-tiv): Care given to improve

the quality of life of patients who have a serious or

life-threatening disease. The goal of palliative care is to

prevent or treat as early as possible the symptoms of a

disease, side effects caused by treatment of a disease,

and psychological, social, and spiritual problems

related to a disease or its treatment. Also called

comfort care, supportive care, and symptom

management.

Pancreas (PAN-kree-us): A glandular organ located in

the abdomen. It makes pancreatic juices, which contain

enzymes that aid in digestion, and it produces several

hormones, including insulin. The pancreas is

surrounded by the stomach, intestines, and other

organs.

Pancreatic (PAN-kree-A-tik): Having to do with the

pancreas.

Pancreatic duct (PAN-kree-A-tik dukt): Part of a

system of ducts in the pancreas. Pancreatic juices

containing enzymes are released into these ducts and

flow into the small intestine.

36
Pancreatic juice (PAN-kree-A-tik joos): Fluid made

by the pancreas. Pancreatic juices contain proteins

called enzymes that aid in digestion.

Pancreatitis (PAN-kree-A-TY-tis): Inflammation of

the pancreas. Chronic pancreatitis may cause diabetes

and problems with digestion. Pain is the primary

symptom.

Pathologist (puh-THAH-loh-jist): A doctor who

identifies diseases by studying cells and tissues under a

microscope.

PET scan: A procedure in which a small amount of

radioactive glucose (sugar) is injected into a vein, and

a scanner is used to make detailed, computerized

pictures of areas inside the body where the glucose is

used. Because cancer cells often use more glucose than

normal cells, the pictures can be used to find cancer

cells in the body. Also called positron emission

tomography scan.

Radiation oncologist (RAY-dee-AY-shun on-KAHloh-jist): A doctor who specializes in using radiation to

treat cancer.

Radiation therapy (RAY-dee-AY-shun THAYR-uhpee): The use of high-energy radiation from x-rays,

gamma rays, neutrons, protons, and other sources to

kill cancer cells and shrink tumors. Radiation may

come from a machine outside the body (external-beam

radiation therapy), or it may come from radioactive

material placed in the body near cancer cells (internal

radiation therapy). Systemic radiation therapy uses a

radioactive substance, such as a radiolabeled

monoclonal antibody, that travels in the blood to

tissues throughout the body. Also called irradiation and

radiotherapy.

Radioactive (RAY-dee-oh-AK-tiv): Giving off

radiation.

37
Registered dietitian (dy-eh-TIH-shun): A health

professional with special training in the use of diet and

nutrition to keep the body healthy. A registered

dietitian may help the medical team improve the

nutritional health of a patient.

Risk factor: Something that increases the chance of

developing a disease. Some examples of risk factors

for cancer are age, a family history of certain cancers,

use of tobacco products, being exposed to radiation or

certain chemicals, infection with certain viruses or

bacteria, and certain genetic changes.

Side effect: A problem that occurs when treatment

affects healthy tissues or organs. Some common side

effects of cancer treatment are fatigue, pain, nausea,

vomiting, decreased blood cell counts, hair loss, and

mouth sores.

Small intestine (in-TES-tin): The part of the digestive

tract that is located between the stomach and the large

intestine.

Spleen: An organ that is part of the lymphatic system.

The spleen makes lymphocytes, filters the blood, stores

blood cells, and destroys old blood cells. It is located

on the left side of the abdomen near the stomach.

Supportive care: Care given to improve the quality of

life of patients who have a serious or life-threatening

disease. The goal of supportive care is to prevent or

treat as early as possible the symptoms of a disease,

side effects caused by treatment of a disease, and

psychological, social, and spiritual problems related to

a disease or its treatment. Also called comfort care,

palliative care, and symptom management.

Surgeon: A doctor who removes or repairs a part of

the body by operating on the patient.

Surgery (SER-juh-ree): A procedure to remove or

repair a part of the body or to find out whether disease

is present. An operation.

38
Targeted therapy (TAR-geh-ted THAYR-uh-pee): A

type of treatment that uses drugs or other substances,

such as monoclonal antibodies, to identify and attack

specific cancer cells. Targeted therapy may have fewer

side effects than other types of cancer treatments.

Tissue (TISH-oo): A group or layer of cells that work

together to perform a specific function.

Tumor (TOO-mer): An abnormal mass of tissue that

results when cells divide more than they should or do

not die when they should. Tumors may be benign (not

cancer), or malignant (cancer). Also called neoplasm.

Ultrasound (UL-truh-SOWND): A procedure in which

high-energy sound waves are bounced off internal

tissues or organs and make echoes. The echo patterns

are shown on the screen of an ultrasound machine,

forming a picture of body tissues called a sonogram.

Also called ultrasonography.

Whipple procedure: A type of surgery used to treat

pancreatic cancer. The head of the pancreas, the

duodenum, a portion of the stomach, and other nearby

tissues are removed.

X-ray: A type of high-energy radiation. In low doses,

x-rays are used to diagnose diseases by making

pictures of the inside of the body. In high doses, x-rays

are used to treat cancer.

39
National Cancer Institute Publications

NCI provides publications about cancer, including

the booklets and fact sheets mentioned in this booklet.

Many are available in both English and Spanish.

You may read publications online and print your

own copy. Also, people in the United States and its

territories may order NCI publications:

• By telephone: People in the United States and its

territories may order these and other NCI

publications by calling the NCI’s Cancer

Information Service at 1–800–4–CANCER

(1–800–422–6237).

• On the Internet: Many NCI publications may be

viewed, downloaded, and ordered from

http://www.cancer.gov/publications. This Web site

also explains how people outside the United States

can mail or fax their requests for NCI booklets.

Cancer Treatment and Supportive Care

• How To Find a Doctor or Treatment Facility If You

Have Cancer (also in Spanish)

• Chemotherapy and You (also in Spanish)

• Targeted Cancer Therapies

• Radiation Therapy and You (also in Spanish)

• Understanding Radiation Therapy: What To Know

About External Beam Radiation Therapy (also in

Spanish)

• Pain Control (also in Spanish)

• Eating Hints (also in Spanish)

40
41

Coping with Cancer

• Taking Time: Support for People with Cancer 

• Managing Radiation Therapy Side Effects: What To

Do When You Feel Weak or Tired (Fatigue) (also in

Spanish)

Life After Cancer Treatment

• Facing Forward: Life After Cancer Treatment (also

in Spanish)

• Follow-up Care After Cancer Treatment

• Facing Forward: Ways You Can Make a Difference

in Cancer

Advanced or Recurrent Cancer

• Coping With Advanced Cancer

• When Cancer Returns

Complementary Medicine

• Thinking about Complementary & Alternative

Medicine

Caregivers

• When Someone You Love Is Being Treated for

Cancer: Support for Caregivers

• When Someone You Love Has Advanced Cancer:

Support for Caregivers

• Facing Forward: When Someone You Love Has

Completed Cancer Treatment

• Caring for the Caregiver: Support for Cancer

Caregivers
Quitting Smoking

• Clearing the Air: Quit Smoking Today

Research Studies

• Taking Part in Cancer Treatment Research Studies

• Providing Your Tissue for Research: What You Need

To Know

• Donating Tissue for Cancer Research: Biospecimens

and Biorepositories

42
The National Cancer Institute 

The National Cancer Institute (NCI), part of the

National Institutes of Health, is the Federal

Government’s principal agency for cancer research

and training. NCI conducts and supports basic and

clinical research to find better ways to prevent,

diagnose, and treat cancer. The Institute also supports

education and training for cancer research and

treatment programs. In addition, NCI is responsible

for communicating its research findings to the

medical community and the public.

Copyright permission

You must have permission to use or reproduce the

artwork in this booklet for other purposes. The

artwork was created by private sector illustrators,

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copyrights to artwork they develop under contract to

NCI. In many cases, artists will grant you permission,

but they may require a credit line and/or usage fees.

To inquire about permission to reproduce NCI

artwork, please write to: 

Office of Communications and Education

National Cancer Institute

6116 Executive Boulevard, Room 3066 

MSC 8323

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You do not need our permission to reproduce or

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NCI booklet is in the public domain, and it is not

subject to copyright restrictions. However, we would

appreciate a credit line and a copy of your translation

of this NCI booklet.
NIH Publication No.10-1560

Revised May 2010

Printed September 2010