Pancreatic Cancer | Signs, Symptoms, & Treatment | MedStar Health
Doctors Reena Jha and Emily Winslow talk as the walk down a hallway in a clinical setting. They are both wearing white lab coats.

Our pancreatic cancer specialists are paving the way for better pancreaticobiliary care across the globe.

The pancreas is a pear-shaped gland located between the stomach and the spine. It has three portions: a wider end (the head), a middle section (the body) and a narrow end (the tail). This cancer occurs in the lining of the pancreas or, less commonly, in the islet cells, and it can quickly spread to nearby organs in the gastrointestinal tract, like the liver, stomach, or intestines.

Even though this is a rare type of cancer, it's the third leading cause of cancer deaths in the United States. That's because most people who have this type of cancer don't know they have it until it has advanced to a later stage when it is challenging to treat. If you've been diagnosed with this cancer, you need an experienced, multidisciplinary team of surgeons and doctors who can help you live a longer, healthier, more meaningful life.

At MedStar Health, we treat more patients with pancreatic cancer than any other health system in the region. In fact, we have a dedicated Pancreas and Liver Disease program focused exclusively on caring for patients with this type of cancer and other related diseases. Patients benefit from our team approach, which involves some of the most experienced specialists in Washington, D.C. This world-class team is composed of experts across several disciplines, from gastroenterology, surgery, radiation, and medical oncology to interventional radiology and others.

We not only offer the latest in surgical and therapeutic treatments, we're paving the way for treatments of the future through pancreatic cancer research. In partnership with the region's only National Cancer Institute-designated comprehensive cancer center, the Georgetown Lombardi Comprehensive Cancer Center, we're actively working to find new and better ways to help patients achieve the best quality of life—or even a cure.

Symptoms and risk factors

Pancreatic cancer symptoms aren't obvious in early stages.

When this cancer begins to develop, there are no obvious symptoms. Once the cancer progresses, patients may experience:

  • Upper abdominal pain
  • Jaundice, or yellowing of the skin or whites of the eyes
  • Weight loss or loss of appetite
  • Change in color to urine or stool
  • Itching (caused by jaundice)

Some people have risk factors, or things that increase their risk. Although most patients who develop it don't have clear risk factors, your risk for increases if you:

  • Smoke
  • Have immediate family members who have had pancreatic cancer
  • Are obese
  • Have certain conditions, such as chronic or hereditary pancreatitis or congenital syndromes, such as Familial Adenomatous Polyposis
  • Had or have breast cancer

Screening and prevention

Individuals with a family history of the disease or certain known genetic syndromes may benefit from testing.

There are no official screening recommendations for the general public as of yet, which is why patients don't often discover the disease until it's at an advanced stage. At MedStar Health, we're committed to helping patients with risk factors better understand their risk and undergo appropriate testing to help with early detection. We are also working to improve early detection by being part of multicenter national study trials on pancreatic cyst and pancreatic cancer research.

For example, we offer genetic counseling and testing to patients who have a strong family history of the disease or known genetic syndromes that are tied to cancer, such as Lynch syndrome. Patients with a high-risk may benefit from our High-Risk Screening Clinic, which involves multidisciplinary care from specialists who are devoted to helping you monitor and mitigate your risk. These specialists may recommend blood and/or imaging tests.

In addition, through our Pancreatic Cyst and Surveillance Clinic, we meet with patients who have pancreatic cysts that aren't cancerous but could become cancerous in the future. This close monitoring allows us to more quickly find any signs of disease when there are better treatment options.

Pancreatic cancer can't always be prevented, but a healthy lifestyle may lower your risk.

You can't prevent the disease but a healthy lifestyle may lower your risk of cancer, such as:

  • Avoiding smoking
  • Maintaining a healthy BMI
  • Eating a nutritious diet
  • Minimizing alcohol use

Diagnosis

Staging is an important part of diagnosis because it helps determine your best treatment options.

We may use several tests to diagnose and stage your cancer. This helps us gather information that will ensure we consider the right treatment approach. Through our pancreatic cyst and surveillance clinic, our specialists perform a full range of diagnostic procedures that may include:

  • A doctor holds the lighted end of a probe used in endoscopic procedure.CT scans and MRIs
  • Endoscopic ultrasound (EUS), which a thin tube with a camera on the end (endoscope) attached to an ultrasound probe that uses soundwaves to produce a detailed picture of the pancreas on a monitor. It can also serve as a method of obtaining tissue from the pancreas for a more definitive diagnosis.
  • Endoscopic retrograde cholangiopancreatography (ERCP), which uses a contrast dye and endoscope to diagnose your condition
  • Blood tests to measure bilirubin or other substances that may indicate disease
  • Biopsies, which use fine or core needles, EUS, ERCP, laparoscopy, or surgery to collect tissue samples for further analysis by a pathologist


These tests help us understand the size and location of the cancer, as well as how far it has spread. This information leads to staging, which helps us determine how to most effectively treat the tumor:

  • Stage I: The tumor is small, less than 2 cm, and contained to the pancreas
  • Stage II: The tumor is bigger than 2 cm and within the pancreas (IIA) or spread just outside of the pancreas, possibly to nearby lymph nodes (IIB)
  • Stage III: The tumor has spread outside of the pancreas to lymph nodes or major blood vessels
  • Stage IV: The tumor has spread to another organ in the body

Types of cancer

Some of the cancers we treat include:

  • Pancreatic adenocarcinoma

    The most common type of pancreatic cancer grows in the exocrine cells that line the pancreatic duct. Sometime this is called pancreatic exocrine cancer.

  • Pancreatic neuroendocrine tumors (pNETs)

    Pancreatic neuroendocrine tumors (or islet cell carcinoma) grow from the islet cells, which produce insulin in the pancreas. Islet cell tumors are rare and can often be removed from the pancreas with surgery.

  • Solid Pseudopapillary Epithelial Neoplasm (SPEN)

    Solid pseudopapillary epithelial neoplasms of the pancreas are rare, abnormal growths in the pancreas that are cancerous but typically are cured with surgical resection. They occur almost exclusively in young women and can be diagnosed by biopsy or a typical appearance on imaging examinations.

  • Metastatic lesions in the pancreas

    Metastatic lesions in the pancreas are uncommon and refer to secondary cancer growing in the pancreas that originates in another organ. Renal cell carcinoma is the most common primary tumor to spread (metastasize) to the pancreas, although melanoma, non-small cell lung cancer, and others can also spread to the pancreas.

Treatments

Our team will personalize treatment that involves the most advanced surgical and/or therapeutic approaches available today.

We provide a full range of treatments, with our recommendations based on:

  • The cancer’s stage (the size of the tumor, how far it has grown into the wall of the pancreas and whether the cancer has spread to nearby tissues, lymph nodes, or other parts of the body)
  • Whether the tumor is operable
  • Whether the cancer is newly diagnosed or has returned
  • Your overall health

Many patients benefit from several types of treatment modalities, and our team will work together to determine the right treatments—and the right order of those treatments—that will work best for you.

Surgery

Surgery is one of the only ways to cure this cancer that has not spread (metastasized) and the best way to contain tumors. Unfortunately, doctors often see later-stage disease, with tumors wrapped around arteries and veins, nerves, and the bile duct—making operations more challenging or even impossible. At that point, there are some things we can do surgically as palliative care to reduce negative symptoms and improve quality of life.

At our Center for Liver and Pancreas Surgery, our goal in surgery is to leave enough of the pancreas to produce digestive juices and insulin, reattaching the remaining organ so that it functions like it did before. But sometimes that’s not possible. We often have to remove all or other parts of nearby organs as well, to ensure we get as much of the cancer as we can. Depending on your cancer, surgical options may include minimally invasive approaches using robotic surgery that may result in less pain, a shorter hospital stay, and a faster recovery.

While pancreatic surgeries are the most complex abdominal operations, we have the most experienced team in the area, performing more procedures than any other group. In addition, we offer minimally invasive techniques that may offer less pain and faster recovery times than traditional approaches. As pioneers in some of these advanced approaches, we're among few places in the country that offer them.

Learn More About Pancreatic Cancer Surgery

Chemotherapy

Chemotherapy uses drugs and combinations of drugs to kill cancer cells. When it comes to treating your cancer, chemotherapy may be used:

  • Before surgery to help surgeons make the tumor operable
  • After surgery to kill off any remaining cancer cells (with or without radiation), or
  • Instead of surgery for inoperable tumors (with or without radiation)

But, it’s a challenging therapy for the disease. Only 25 percent of surgical patients benefit, and digestive tumors can quickly develop a resistance to today’s chemotherapies. We believe the answers lie in more tailored, personalized therapies. That's why we're studying new chemotherapy combinations, as well as using existing drugs with newer, targeted therapies. Our clinical trials also include:

  • Testing tumors for chemotherapy susceptibility
  • Shrinking tumors before surgery with chemotherapy and special radiation

Learn More About Chemotherapy

Immunotherapy and targeted therapy

Targeted therapy represents a new front in attacking cancer—drugs and other substances aimed at specific molecules to stop tumor growth. The idea is to target a tumor’s unique characteristics, including genes, proteins, supporting blood vessels, or host tissue, while limiting damage to healthy cells.

Targeted therapies may replace current treatments, or complement them, and we are studying several new targets and approaches, many of them in clinical trials:

  • Growth Factor Inhibitors: These therapies target certain surface molecules—growth factor receptors—on cancer cells that help them grow
  • Anti-Angiogenesis Factors: They block the growth of blood vessels needed by tumors
  • Drugs for Tumor Stroma (Supporting Tissue): They attack dense supporting tissue around pancreatic tumors, to potentially make them more susceptible to chemotherapy
  • Monoclonal Antibodies: They mimic immune system proteins to deliver toxins or radioactive substances directly to cancerous cells
  • Checkpoint Inhibitors: They release the normal brakes on the body’s immune system

  • Cancer Vaccines: They are designed to treat, not prevent, by boosting the immune system’s response

Learn More About Targeted Therapy

Radiation therapy

Radiation therapy uses high-energy X-rays or other radiation to attack tumors. When it comes to treating pancreatic tumors, treatment may involve radiation:

  • Before surgery alongside chemotherapy
  • Combined with chemotherapy after surgery to kill any remaining cancer cells
  • If cancer returns

At MedStar Health, we have radiation oncologists who focus exclusively on treating gastrointestinal cancers with radiation and these specialists participate on a multidisciplinary tumor board that works together to individualize treatment that's unique to each patient. We offer several types of conventional and cutting-edge radiation therapy options, including but not limited to:

  • External-Beam Radiation Therapy: Given by a machine outside the body and includes:
    • Intensity-Modulated Radiation Therapy (IMRT): Our radiation oncologists can change treatment intensity as they go based on tissue type, delivering specific doses to different parts of a tumor and sparing healthy tissue
    • Image-Guided Radiation Therapy (IGRT): Your radiation oncology team uses high-quality imaging to carefully adjust radiation beams and doses to best fit the size, shape, and location of the tumor, sparing healthy tissue.
  • Intraoperative radiation therapy (IORT): IORT is an innovative way to deliver radiation therapy during surgery. By directly targeting the tumor bed during surgery, we can use a higher dose of radiation to improve outcomes, while limiting radiation effects on healthy tissue.
  • CyberKnife™: CyberKnife is an advanced external radiation technology that delivers precisely targeted, laser-like radiation through image-guidance systems and a robot arm rotating around your body. We were one of the first teams in the country to use CyberKnife for both newly diagnosed and returning (recurring) diagnosis, and remain among the most experienced.
  • Proton therapy with HYPERSCAN™: Proton therapy with HYPERSCAN™ can be used with fewer side effects than traditional radiation. We were the first team in Washington, D.C., to offer this advanced radiation treatment, and we remain one of few in the region.

Our experienced radiation oncologists are studying a way to shrink even more tumors so additional patients can receive surgery. And, clinical trials include a look at using a targeted therapy to make cancerous cells more vulnerable to radiation, increasing treatment effectiveness.

Learn More About Radiation Therapy

Looking for expert cancer care?

With multiple locations throughout the region, patients have access to many of the nation’s renowned cancer specialists offering high quality care, second opinions and a chance for better outcomes close to where they live and work. Georgetown Lombardi Comprehensive Cancer Center, one of the nation’s comprehensive cancer centers designated by the National Cancer Institute (NCI), serves as the research engine allowing patients access to clinical trials that often lead to breakthroughs in cancer care.

Our locations

Distance from Change locationEnter your location

MedStar Franklin Square Cancer Center at Loch Raven Campus

5601 Loch Raven Blvd.
Russell Morgan Building
First Floor
Baltimore, MD 21239

MedStar Georgetown Cancer Institute at MedStar Franklin Square Medical Center

9103 Franklin Square Dr.
The Harry and Jeanette Weinberg Cancer Institute
Suite 220
Baltimore, MD 21237

Why choose us

Your treatment plan involves input from a collaborative team of renowned specialists across several disciplines. Studies prove that multidisciplinary care leads to the best patient outcomes because it involves the collective expertise of doctors in different fields. Each of our surgeons, radiation oncologists, medical oncologists, interventional radiologists, hepatologists, and other experts have extensive experience in their specialty because they focus exclusively on that particular discipline. These specialists meet weekly in a tumor board to collaborate on personalized treatment plans for every patient, and we stay in constant communication outside of these meetings as well to ensure our patients get the best possible care.

We are the most experienced team in the region specializing in robotic, laparoscopic, open, and hybrid surgeries. We are a high-volume surgical center, and our surgeons perform more pancreaticoduodenectomy procedures than anyone else in Washington, D.C. And because we operate within the region's largest abdominal transplant center, the MedStar Georgetown Transplant Institute, we have access to some of the most advanced surgical technology and instruments necessary for complex pancreatic surgeries.

Patients benefit from access to the most advanced, innovative treatment options available today. From standard-of-care therapies to novel advancements in surgery, radiation, and medical oncology, we have the full spectrum of treatment options that are available. Treatment options also include clinical trials that may be hard to find elsewhere, thanks to our collaboration with the area's only comprehensive cancer center designated by the National Cancer Institute. In addition, we treat you as a "whole patient," helping to improve your quality of life however we can through nutrition support, pain management, and psychosocial services. This holistic approach is one of the reasons we are designated as a Center of Excellence by The National Pancreas Foundation.

Awards and recognition

Recipient of an Accreditation with Commendation, the highest level of approval, from the American College of Surgeons’ Commission on Cancer (CoC)

We're the only program in Washington, D.C. approved as a Center of Excellence by The National Pancreas Foundation

Numerous surgeons, oncologists, and gastroenterologists recognized as "Top Doctors" by both Baltimore Magazine and the Washingtonian

Magnet® designation from the American Nurses Credentialing Center (ANCC)

Clinical trials and research

Clinical trials

Clinical trials are research studies that test new drugs, surgical approaches, and therapies to determine their effectiveness and safety. Because we're involved in the latest studies and clinical trials, we discover and offer many emerging and promising treatments before they're published or available elsewhere.

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Research

Our specialists are part of the Ruesch Center for the Cure of Gastrointestinal Cancers, a dedicated center within the Georgetown Lombardi Comprehensive Cancer Center. We're committed to finding new ways to treat pancreatic cancer and relentlessly pursue innovative approaches that offer our patients better oncologic outcomes and quality of life.

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Patient stories

Support services

At MedStar Health, you're supported by a caring team of individuals who work together to deliver services that maximize your physical, emotional, and mental health. Our goal is to equip you and your family members with the resources, education, and support you need to live a fulfilling life, despite your cancer diagnosis. From nutrition services and rehabilitation to support groups, counseling, and social work services, we're here to help you thrive.

Learn More About Cancer Support Services

Genetic counseling

Certain inherited syndromes can elevate your risk, and our genetic counseling and testing specialists can help you understand your genetic risk factors. This can help you and your family members take an active role in monitoring your pancreatic health through screening, which can encourage early detection when there are better treatment options.

Learn More About Genetic Counseling

Personalized rehabilitation

Cancer treatment and surgery can cause challenges that interfere with your ability to participate in things you enjoy in life, whether that's time with your family, a career, or hobby. Our rehabilitation specialists are experts in helping patients address the lingering effects of treatment, whether that's fatigue, muscle weakness, pain, or any other limitation.

Learn More About Cancer Rehabilitation

Survivorship

We're invested in caring for you even after your treatment. Through comprehensive medical and psychosocial services, we'll help you return to a healthy, satisfying life.

Learn More About Cancer Survivorship Program