What Is Metastatic Pancreatic Ductal Adenocarcinoma?
Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic cancer. The pancreas is a small, fish-shaped organ that helps your body digest food and makes hormones that control blood sugar. It also plays an important role in keeping other organs – like your heart, liver and kidneys – working properly.
With PDAC, cancer cells start to grow in the small tubes (called ducts) that move digestive juices out of the pancreas. When the cancer spreads beyond the pancreas to other parts of your body, it's called metastatic pancreatic ductal adenocarcinoma (mPDAC). It most commonly spreads to the abdomen (belly area), liver, lungs, brain, or bones.
"In pancreatic cancer, cancer cells tend to metastasize very early, so the cells seem to break off from the pancreas and set up shop elsewhere," says Shubham Pant, MD, a professor in the Department of Gastrointestinal Medical Oncology at the University of Texas MD Anderson Cancer Center. "That's why the majority of patients with pancreatic cancer who present are with advanced disease."
It's uncommon to find pancreatic cancer at its early stages, when it's easier to treat, because most people don't have symptoms until after it has spread to other organs.
How mPDAC Affects the Body
Cancer cells behave differently from normal cells. They don't follow the usual instructions that control growth and cell division, so they multiply quickly and can build up into a mass, called a tumor, in the pancreas. As the tumor grows or spreads, it can damage nearby tissue and interfere with how the pancreas and surrounding organs work.
One of the most common symptoms of mPDAC is belly pain that may spread to your sides or back. This can happen when a tumor presses on nerves near the pancreas or in your abdomen. Pancreatic cancer can also cause pain if it blocks off or starts to press on the first part of the small intestine.
If the cancer blocks your liver's bile duct, bilirubin – a yellow substance your liver makes to help with digestion – can build up in your blood. When this happens, it can cause your skin and the whites of your eyes to turn yellow, which is called jaundice.
Because the pancreas creates enzymes that help break down food, mPDAC can also lead to digestive symptoms, like cramps, pain, bloating, or changes to your poop.
Make sure to talk to your doctor about the best options for managing your pain and symptoms.
Causes and Risk Factors
Doctors don't know exactly what causes PDAC. In a small number of people – about 1 in 10 – the disease is linked to gene mutations inherited from a parent. But in most cases, it isn't passed down in families.
Age, sex, and race may also play a role in who gets PDAC. This type of cancer is most common in people over the age of 60. Men and people who are Black or of Ashkenazi Jewish descent are also more likely to be diagnosed with PDAC.
Other things that may raise your chances of getting PDAC include:
- Smoking cigarettes or using other tobacco products
- Drinking a lot of alcohol
- Obesity, especially carrying extra weight around the waist
- Long-term inflammation of the pancreas
- Having diabetes – especially type 2
- Exposure of pesticides and chemicals refined from oil
- A family history of pancreatic cancer
Understanding Staging and Prognosis
Cancer is usually grouped into several stages. Stage 0 is the earliest and often the easiest to treat, while stage IV is the most advanced.
With pancreatic cancer, stage 0 means the cancer is confined to the upper layers of pancreatic duct cells. In stages I, II, and III, the cancer is confined to the pancreas or nearby areas. If you have stage IV pancreatic ductal adenocarcinoma, it means it has metastasized and spread to other parts of the body. Between 45% and 55% of pancreatic cancers are diagnosed at stage IV.
Your prognosis will depend on your individual case. Most people diagnosed with mPDAC (stage IV) will live on average about one year after they've been diagnosed. The five-year survival rate for this stage is around 3.2%. These numbers are based on averages and can't predict what will happen for any one person. People respond to treatment differently, and treatment can still play a role in easing symptoms and improving quality of life.
"The statistics are the statistics," Pant says. "Patients should talk to their health care team to be an informed patient and not just get fixated on a number that pops up on Google, because everyone's journey is different."
How doctors monitor your condition
How often you'll need to go for doctor's appointments and tests depends on how your cancer is progressing and what treatment you're receiving. Some patients may need appointments every week, while others might only need to go once a month, Pant says.
Most patients also have a CT scan – and sometimes a PET or MRI scan – every two to three months. These tests give doctors a detailed look inside the body and organs and can help them see whether the tumors are growing and how well the treatment is working.
If you're receiving chemotherapy, your doctor will also order regular blood tests. These can check your red and white blood cell counts, which helps show how the treatment is affecting your body, as well as liver enzymes, to monitor how well your liver is working.
Questions to Ask Your Doctor
A pancreatic cancer diagnosis can feel overwhelming, and it's not always easy to know what questions to ask during an appointment. Coming prepared with a list of questions can help you better understand your diagnosis, treatment options, and what to expect moving forward.
Pant recommends asking your health care team the following:
- How widespread is the cancer?
- Where has the cancer spread?
- What are my treatment options?
- What are the possible side effects and risks of each treatment? Are there ways to prevent or manage them?
- Do I need pancreatic enzyme supplements?
- Do you have a pain management specialist on the care team?
- What symptoms should prompt me to call the doctor's office?
- What would be considered a medical emergency that requires a trip to the emergency room?
- How often will I need follow-up appointments or scans?
- Am I eligible for any clinical trials?
- What is the mutation status of my tumor, and what does this mean for my treatment, prognosis, and potential inherited risks for family members?
- What emotional or psychological support services are available to me?
Finding Support and Resources
Many cancer centers offer support services that go beyond medical treatment. These may include peer support groups, medical social workers, nutritional counseling, and palliative care, which focuses on managing pain and improving your quality of life. Talk to your doctor to see what options are available to you.
"When patients are diagnosed with pancreatic cancer, they might feel like their world is collapsing," Pant says. "It's a big diagnosis, but there's always help available."
Takeaways
Metastatic pancreatic ductal adenocarcinoma (mPDAC) is the most common and most advanced form of pancreatic cancer, meaning it has spread beyond the pancreas to other parts of the body. While mPDAC is not curable, treatment can help control symptoms, slow the cancer's progression, and improve your quality of life. If you've been diagnosed, it's important to understand your individual case and work with your health care team to find a treatment and care plan that fits your needs. Extra support is also available to help you navigate the emotional and physical challenges of your diagnosis.
Show Sources
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SOURCES:
Cleveland Clinic: "Pancreas," "Pancreatic Cancer."
Johns Hopkins Medicine: "Pancreatic Cancer Prognosis."
Mayo Clinic: "Pancreatic cancer."
Moffitt Cancer Center: "What Is Metastatic Pancreatic Cancer?"
National Health Service (U.K.): "Pancreatic cancer."
Pancreatic Cancer UK: "Stage 3 pancreatic cancer," "Treating jaundice if you have pancreatic cancer," "What is pain and what causes it?"
Shubham Pant, MD, professor, Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston.
UCLA Health: "Pancreatic Cancer."
