The pancreas is an organ about 15 centimeters long, located deep behind the stomach. It performs both an exocrine function, secreting enzymes that digest food, and an endocrine function, producing hormones such as insulin that regulate blood sugar. The most common form of malignant tumor that develops here is pancreatic ductal adenocarcinoma, which originates in the pancreatic duct. Because the pancreas is located deep within the body, patients often feel no particular abnormality until the tumor grows to a certain size. As the tumor enlarges or the disease progresses, various symptoms may appear, with abdominal pain being the most representative. The pain can present as discomfort in the upper abdomen or epigastric area, and in some cases extends to the back. However, it is easily mistaken for musculoskeletal pain or a simple gastrointestinal disorder, making early diagnosis difficult.
When a tumor develops in the head of the pancreas, it can block the bile duct, causing jaundice that turns the skin and the whites of the eyes yellow. This may be accompanied by darker urine, lighter-colored stool, and generalized itching. A sudden, sharp drop in weight or loss of appetite without an apparent reason can also be a sign of pancreatic cancer. When pancreatic function declines, the absorption of nutrients such as lipoproteins becomes impaired. Some patients experience digestive symptoms such as steatorrhea or chronic diarrhea. There is also a connection with diabetes. If diabetes suddenly develops in middle-aged or older adults, or if blood sugar control deteriorates rapidly, pancreatic cancer should be suspected.
The cause of pancreatic cancer has not yet been clearly identified. The risk of developing pancreatic cancer increases after the age of 50, and smokers are known to face a higher risk than non-smokers. Other risk factors include chronic pancreatitis, obesity, metabolic conditions such as diabetes, excessive alcohol consumption, and family history. Diagnosis of pancreatic cancer relies primarily on abdominal computed tomography (CT), along with various imaging tests such as magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and endoscopic ultrasound (EUS). When necessary, the presence of cancer cells is confirmed through tissue biopsy using endoscopic ultrasound-guided fine needle aspiration or endoscopic retrograde cholangiopancreatography (ERCP).
Treatment varies depending on the stage of the cancer and the patient's overall condition. Early-stage pancreatic cancer without invasion of major blood vessels can be surgically resected. The problem is that, compared with other cancers, pancreatic cancer is often already advanced at the time of diagnosis. When invasion of nearby organs or distant metastasis is present, surgical treatment is difficult, and palliative treatment centered on chemotherapy is required. Combination chemotherapy, which uses several anticancer drugs together, is mainly used, with the goal of slowing the cancer's progression, alleviating symptoms, and extending survival. Depending on the stage, adjuvant chemotherapy may be administered before or after surgery. Supportive procedures may also be performed to control symptoms caused by pancreatic cancer. A representative example is endoscopic retrograde cholangiopancreatography, performed when a tumor blocks the bile duct and causes jaundice. Inserting a stent into the narrowed bile duct to allow bile to flow back into the intestine can reduce jaundice and itching, as well as the risk of infections such as cholangitis. It is also effective in improving liver function and bringing the patient's general condition to a level where chemotherapy can be administered. If the cancer invades nearby nerves and causes severe pain in the abdomen or back, nerve block or neurolysis can be considered along with medication. Such procedures are typically performed percutaneously under image guidance and can help relieve pain and reduce the use of analgesics.
Pancreatic cancer is often difficult to address with a single treatment approach. Multidisciplinary care, in which various departments — including gastroenterology, medical oncology, hepatobiliary and pancreatic surgery, radiology, and radiation oncology — jointly assess the patient's condition and determine the treatment direction, is important. Through this approach, chemotherapy, endoscopic procedures, surgery, radiation therapy, and pain management can be planned to suit the patient's condition. Recently, the importance of precision medicine-based treatments such as next-generation sequencing (NGS) has been growing. Genetic testing is used to identify the genetic characteristics of the cancer, and if specific gene abnormalities are found, targeted therapy or immunotherapy can be considered.
While pancreatic cancer cannot be completely prevented, it is possible to reduce risk factors. Quitting smoking is one of the most effective preventive measures. Appropriate weight management, a balanced diet, and regular exercise should be combined, and conditions such as chronic pancreatitis or diabetes should be consistently managed. Above all, it is important not to dismiss changes in the body. Although early detection of pancreatic cancer is not easy, diagnosing it even slightly earlier and starting appropriate treatment plays an important role in improving prognosis. Regular checkups and paying attention to changes in one's body are the first step in preventing pancreatic cancer.
