Disease Overview

What is the pancreas?

The pancreas is a glandular organ that is vital for digestion and sugar control. It is located high up in the abdomen and lies across your body, behind your stomach, and in front of the spine. It is about 6 inches long and shaped like a flat pear.

It is composed of three sections: the wide end of the pancreas on the right side of the body is called the head; the middle section is called the body; and the thin end on the left side of the body is called the tail.

The pancreas has two very different and important roles:

Digestive Functions
Endocrine Functions

Digestive Functions

The digestive glands of the pancreas produce enzymes that help to break down food. When food enters the stomach, pancreatic exocrine cells release digestive enzymes into a system of ducts, which lead to the main pancreatic duct. The pancreatic duct empties the pancreatic juices containing enzymes and bicarbonate into the first portion of the small intestine called the duodenum. Here, the enzymes aid in the digestion of fats, carbohydrates, and proteins in foods.

Endocrine Functions

The second function of the pancreas is the endocrine function, which involves the production of hormones. The two key hormones produced by the pancreas are insulin and glucagon, which are released into the bloodstream. Together they regulate the level of glucose (sugar) in your blood. Insulin serves to lower blood sugar levels after a meal while glucagon raises blood sugar levels in between meals.

The Two Types of Pancreatic Cancer

Pancreatic ductal adenocarcinoma (PDAC) – This cancer affects the exocrine glands in the pancreas, which produce enzymes that help the body break down food, particularly the digestion of fats, carbohydrates and proteins in foods. About 95% of all pancreatic cancers are this type.

Pancreatic Neuroendocrine Tumours (P-NETS or PanNET) – Affects the other function of the pancreas, which is to produce the hormones insulin and glucagon, which regulate blood sugar. About 5% of pancreatic cancers are this type. It’s a very rare cancer – only about 1,000 people in the US are diagnosed with this each year.

Diagnostic Terminology

Resectable – This type of pancreatic cancer can be surgically removed. A tumour may lie within the pancreas or extend beyond it, but there is no involvement of the critical arteries or veins in the area. There is no evidence of any spread to areas outside of the pancreas. Approximately 10% to 20% of patients receive this diagnosis.
Borderline Resectable – This diagnosis is used when unsure of whether or not a tumour can be removed.
Unresectable – Locally advanced and unresectable tumours are still confined to the area around the pancreas but cannot be surgically removed because they involve the critical arteries or veins, or the tumour directly extends to surrounding organs. There is no evidence of spread to any distant areas of the body. Approximately 35% to 40% of patients receive this diagnosis.
Metastatic – The tumour has spread beyond the area of the pancreas and involves other organs, such as the liver or distant areas of the abdomen. Approximately 45% to 55% of patients receive this diagnosis.

The Stages of Pancreatic Cancer

Stage I

Stage II

The tumour is only in the pancreas, and is generally resectable.

Considered locally advanced, which means the tumour has spread outside the pancreas to nearby blood vessels and lymph nodes, but not major arteries. Tumours are generally either resectable or borderline resectable, particularly if treatments are used to shrink the cancer.

Stage III

The tumour has spread to major nearby arteries and potentially nearby lymph nodes. Considered locally or regionally advanced, having spread outside the pancreas but not to another organ. Usually these tumours are unresectable.

Stage IV

The cancer has metastasized, or spread, to another part of the body, commonly the liver, lungs, abdominal wall, distant lymph nodes or a combination of the above. Tumours at this stage are unresectable.