Pancreatic ductal adenocarcinoma (PDA) is the most common type of pancreatic cancer, accounting for at least 90% of cases. Doctors may use the terms PDA and pancreatic cancer interchangeably since most pancreatic cancers are PDA.

Adenocarcinoma means cancer that begins in the glandular tissue that lines many organs, including the pancreas. Ductal adenocarcinoma forms in the ducts of the pancreas.

PDA is one of the deadliest forms of cancer because diagnosis usually comes only once the disease has spread. At this point, surgery cannot cure it, which means the outlook is poor.

A person with PDA should discuss the outlook with their doctor because each case varies. A variety of treatment options can slow the disease, reduce pain, and in less common cases, cure the cancer in its early stages.

This article will explain what pancreatic ductal adenocarcinoma is. It will also detail symptoms, causes, treatment, and outlook.

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Pancreatic ductal adenocarcinoma is a cancer that begins in the duct cells of the pancreas. It often does not cause symptoms in the early stages, allowing it time to spread to other organs.

It is a type of exocrine cancer. This means that it occurs when exocrine cells, which form the ducts and exocrine glands of the pancreas, grow out of control.

Pancreatic ductal adenocarcinoma is the most common type of pancreatic cancer. It is also the fourth-leading cause of cancer deaths worldwide.

Five-year survival rates are around 8%. However, survival rates are constantly changing with new treatments, and the main factor determining survival is whether it is possible to surgically remove the cancer.

Survival rates mean the percentage of people who are still alive after a certain period of time since diagnosis. It is usually stated in five years.

Pancreatic cancer does not usually cause symptoms in the early stages. As the cancer grows, though, a person may develop symptoms such as:

  • jaundice because of a blockage in the bile duct
  • stomach or abdominal pain
  • weight loss
  • swollen gallbladder
  • itching
  • weakness
  • dark bowel movements
  • clay-colored bowel movements
  • dark urine

People with early pancreatic cancer may not have any signs or symptoms. This is why regular checkups can be important. They may show subtle signs on bloodwork or a medical exam.

A person should contact a doctor if they:

  • have a family history of pancreatic cancer or a genetic syndrome that increases the risk of cancer
  • have chronic abdominal pain
  • have bowel movements that are an unusual color
  • develop jaundice, which causes yellow or green-looking skin or eyes
  • feel weak or sick
  • lose weight without trying

Almost all pancreatic cancers are PDA, and doctors typically use the terms pancreatic cancer and PDA interchangeably. Some less common forms of this disease include:

  • Other exocrine cancers: PDA is a type of exocrine cancer. Some other forms of exocrine cancer in the pancreas include squamous cell carcinoma, adenosquamous cell carcinoma, and signet cell carcinoma.
  • Ampullary cancer: This is cancer of the ampulla of Vater, which is the point where the bile duct of the liver and the pancreatic duct come together. This is technically not a cancer of the pancreas but rather a ductal cancer. This type of cancer usually has an earlier diagnosis, so the outlook is better.
  • Precancerous and benign growths: Precancerous growths can become cancer without treatment. They include mucinous cystic neoplasms and solid pseudopapillary neoplasms. Benign growths such as serous cystic neoplasms and intraductal papillary mucinous neoplasms are usually benign but can affect functioning or eventually become cancer.

Like all cancers, PDA occurs when genetic changes in the pancreatic cells allow the cells to grow out of control, forming tumors.

About 10% of pancreatic cancers occur in people with an inherited genetic syndrome that increases the risk of pancreatic and other cancers. For example, BRCA1 and BRCA2 mutations, which also increase the risk of breast and ovarian cancer, may lead to pancreatic cancer. Some other genetic syndromes that can play a role include:

  • Lynch syndrome
  • Peutz-Jeghers syndrome
  • Von Hippel-Lindau syndrome
  • multiple endocrine neoplasia type 1 (MEN1)

Other modifiable and nonmodifiable factors, including health characteristics and lifestyle, may also increase the risk of developing pancreatic cancer. They include:

Treatment depends on how far the cancer has spread and a person’s treatment goals. Surgery may remove early stage cancer, curing it. A doctor may recommend other treatments, including chemotherapy, along with surgery to shrink the cancer and reduce the risk that it will return.

When surgical removal is not possible, treatment options include:

When doctors cannot surgically remove the cancer, a cure is not possible, though researchers continue to explore treatment options.

The outlook for pancreatic cancer depends primarily on how advanced the cancer is. Only about 10–20% of people with PDA initially present with cancer that a doctor can surgically remove. If the cancer has not spread, surgery may cure it.

However, 90% of people with PDA die within one year because their cancer has already spread.

No specific strategy can guarantee that a person will not get pancreatic cancer, but a number of changes can reduce the risk. They include:

  • regular cancer screenings for people with a high risk, especially those with genetic syndromes that can cause pancreatic cancer
  • quitting smoking
  • maintaining or attaining a healthy body weight
  • reducing alcohol intake
  • reducing exposure to harmful chemicals by wearing protective equipment
  • becoming more physically active
  • managing and treating chronic diseases such as diabetes

Pancreatic cancer is usually, but not always, a terminal illness. It can be a scary diagnosis, but treatment may reduce pain and prolong a person’s life. When treatment is not possible, palliative and hospice care can provide physical and psychological support.

People with a family history of pancreatic cancer, as well as those who have concerns about developing cancer, should talk with a doctor about the best way to reduce their risk.