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NCCN Guidelines for Patients



Pancreatic Cancer, Version 1.2017


About pancreatic cancer

The pancreas | Cancer basics

Learning that you or a loved one has

cancer can be overwhelming. Part 1

reviews some basics about pancreatic

cancer that may help you better

understand this disease. This information

may also help you start planning for


The pancreas

The pancreas is a gland found behind the stomach.

A gland is an organ that makes fluids or chemicals

the body needs. The pancreas is about 6 inches long

and has 3 main parts:



The widest part is called the head.



The middle part is called the body.



The narrow end is called the tail.

The pancreas makes hormones, such as insulin. It

also makes proteins, called enzymes, that help to

digest food. Endocrine cells of the pancreas make

hormones. Enzymes are made by exocrine cells in

the small ducts of the pancreas. Ducts are tiny tubes

or vessels that fluids pass through. The small ducts

connect to the main pancreatic duct that extends

from the tail to the head of the pancreas.

The liver is near the pancreas, above the gallbladder.

The liver removes waste from blood and makes

bile. Bile is a fluid that helps to digest food. The

gallbladder stores bile from the liver. The common

bile duct carries bile from the liver into the main

pancreatic duct. From the main pancreatic duct,

bile and enzymes empty into the duodenum. The

duodenum is the first part of the small intestine,

which absorbs nutrients from eaten food.


Figure 1.

Cancer basics

Cancer is a disease of cells—the building blocks that

form tissue in the body. Normal cells grow and then

divide to make new cells. New cells are made as

the body needs them. When normal cells grow old

or get damaged, they die. Cancer cells don’t do this.

Cancer cells make new cells that aren’t needed and

don’t die quickly when old or damaged.

See Figure


Over time, cancer cells grow and divide enough to

form a primary tumor. Primary tumors can grow large

and invade nearby tissues. Primary tumors can also

send cancer cells to other areas in the body to form


Genes are the codes within the cell that carry the

instructions for making new cells. They also control

how cells behave. Changes in genes turn normal

cells into cancer cells. Within the pancreas, exocrine

or endocrine cells can become cancer cells. About

90 out of 100 pancreatic cancers start in exocrine

cells that line the ducts of the pancreas. This type of

pancreatic cancer is called ductal adenocarcinoma

and is the focus of this patient book.

Risk factors

Anything that increases your chances of cancer

is called a risk factor. Certain risk factors can be

seen with this cancer type. Risk factors can be

activities that people do, things you have contact

with in the environment, or traits passed down from

parents to children through genes. Genes are coded

instructions for your cells.

A process called mutation is when something goes

wrong in the genetic code. Mutations can be passed

on from a parent and may be present before you

are born (inherited), or may be caused later in life

by genetic damage (acquired). People with inherited

genetic mutations have a higher risk for certain

cancers, but that doesn’t mean they will definitely

develop cancer. Only a small number of cancers are

a result of inherited mutations.