Pancreatic Cancer

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Pancreatic cancer develops when cells in the pancreas begin to grow uncontrollably. There are two types of pancreatic cancer tumors, exocrine and endocrine. Exocrine tumors are more common, while endocrine tumors are rare and make up less than 5 percent of all pancreatic cancer.

If you or a loved one has been diagnosed with pancreatic cancer, or if you've been told you're at high risk for developing the disease, talk to us. It's important to learn about your options and take action right away.

City of Hope has one of the most experienced pancreatic cancer programs in the United States. We are designated a comprehensive cancer center by the National Cancer Institute, and for more than a decade, U.S. News & World Report has named City of Hope one of the top cancer hospitals in America. Additionally, numerous City of Hope physicians are named "Top Doctors for Cancer" by Newsweek.

Our world-class team of specialists can answer your questions, address your concerns, and deliver a personalized treatment plan with the most innovative, leading-edge therapies available anywhere.

Request a Consultation

If you have been diagnosed with pancreatic cancer or at high risk and are looking for a second opinion consultation about your treatment, you may request an appointment online or contact us at 800-826-4673. Please visit Making Your First Appointment for more information. 

Located near Los Angeles with clinical network locations in Southern California, City of Hope has one of the most experienced pancreatic cancer programs in the United States. We are designated a comprehensive cancer center by the National Cancer Institute, and for more than a decade, U.S. News & World Report has named City of Hope one of the top cancer hospitals in America.

Highlights of our pancreatic cancer treatment program include:

  • Minimally invasive, robotically assisted surgery and procedures, such as ablation and embolization
  • Ultraprecise radiation therapy, including helical TomoTherapy
  • Unique chemotherapy and targeted therapy regimens
  • Targeted drug combinations for greater effectiveness and fewer side effects
  • Pioneering drug research and clinical trials
  • Palliative treatments to reduce symptoms and improve quality of life

What is the pancreas?

Your pancreas is small, only about six inches long, but it plays an important role in your digestive system. Located deep within the abdomen, the pancreas produces insulin to help regulate your blood sugar level and aids in breaking down the foods you eat.

What are pancreatic cysts and the different types?

The term “pancreatic cyst” functionally extends to a range of growths containing fluid, from the benign and to the potentially precancerous:
  • Retention cysts: Also known as “simple cysts,” these tend to be small and typically require no treatment.
  • Serous cystadenomas: The most common of benign pancreatic cysts, serous cystadenomas are small but tend to appear in cluster.
  • Mucinous cystic neoplasms: These cysts, which generally appear in women, have the highest probability of turning malignant at about 25 percent.
  • Intraductal papillary mucinous neoplasm: Typically affect older men and pose a risk for cancer if left untreated, IPMN’s are associated with pancreatitis and other ailments that target the pancreas.
  • Pseudocysts: Usually arising from pancreatitis, these sacs of fluid differ from “true” pancreatic cysts because they lack a lining of epithelial cells similar to the inner layer of the intestines. These cysts do not turn malignant, so a patient’s treatment plan typically depends upon the presence and severity of symptoms.

Symptoms of pancreatic cysts

Pancreatic cysts do not necessarily present symptoms. When they do, the issues can range from rather mild to extremely serious:
  • Abdominal pain
  • Nausea
  • Abnormal feelings of fullness
  • Jaundice

What is pancreatic cancer?

Pancreatic cancer develops when cells in the pancreas begin to grow uncontrollably. There are two types of pancreatic cancer tumors, exocrine and endocrine. Exocrine tumors are more common, while endocrine tumors are rare and make up less than 5 percent of all pancreatic cancer.

What increases your risk of pancreatic cancer?

A risk factor is something that increases your likelihood of getting a disease. This could be a behavior, a health condition, a hereditary trait — anything that affects your chances of developing an illness.

Pancreatic cancer has several risk factors associated with it — some of which you change and others you cannot.

Risk factors you have control over include:
  • Smoking: According to the American Cancer Society, 20 to 30 percent of pancreatic cancer cases are thought to be brought on by smoking.
  • Obesity: Being overweight or obese boosts your chances of developing pancreatic cancer.
Risk factors you cannot control are:
  • Age: The older you get, the more likely you are to receive a pancreatic cancer diagnosis. Nearly all cases occur in people over 45 years of age.
  • Race and gender: African-Americans and men have a somewhat higher chance of getting pancreatic cancer.
  • Inherited genetic syndromes: It is possible that pancreatic cancer runs in some families. Genetic syndromes like Lynch, Peutz-Jeghers and Von Hippel-Lindau can all cause pancreatic cancer. Abnormal BRCA1 or BRCA2 genes passed down from parent to child also increases your likelihood of developing pancreatic cancer. If you are high risk due to hereditary factors, there may be genetic testing options available to you. Talk to your doctor to assess your needs and evaluate the best course of action.
  • Certain illnesses: If you suffer from diabetes, chronic pancreatitis or cirrhosis of the liver, you may have a higher chance of getting pancreatic cancer.

What are the symptoms of pancreatic cancer?

You might not exhibit symptoms of pancreatic cancer until it has advanced, so it is important to know your body and be vigilant about any changes you experience that cause alarm.

Some symptoms associated with pancreatic cancer are:

  • Yellowing of the eyes and skin (jaundice)
  • Dark-colored urine
  • Unexplained weight loss
  • Itchy skin
  • Belly and back pain
  • Blood clots
  • Nausea and vomiting
  • Loss of appetite
  • Irregular stools

How we diagnose pancreatic cancer

The pancreas is located deep within the body, making it difficult to detect early tumors during a routine physical exam. Additionally, there are no reliable screening options for pancreatic cancer, so it tends to be diagnosed at later stages when the cancer has grown and spread. At City of Hope, our knowledgeable and skilled team will work with you to ensure that your cancer is detected, diagnosed and staged using the latest methods.

In addition to physical exams and blood tests, doctors at City of Hope use a variety of diagnostic tools to check for pancreatic cancer:

  • CT Scan – Radiologists use computer-controlled X-ray imaging generated from multiple angles to create a precise 3D view. City of Hope employs “triphasic” or triple-phase scanning, which captures images at three different time intervals, for greater accuracy.
  • ERCP - A thin, flexible tube with a camera attached is inserted into the mouth, down into the stomach and the bile duct, to look for abnormalities as well as inject dyes to better visualize the pancreas with X-rays.
  • Endoscopy / Laparoscopy - A thin, lit tube is inserted either orally or through a small incision in the abdomen. This procedure can identify tumors, and also remove tissue samples for examination.
  • Biopsy – An examination of tissue samples for signs of cancer.
  • Genetic testing - A genetic test of the cells tissue samples can show whether the cancer is sensitive or resistant to specific treatments.
  • PET Scan – This imaging tool takes advantage of the fact that cancer cells consume more glucose and multiply faster than non-cancerous cells. After a radioactive form of glucose is injected into a vein, cancer cells will appear brighter than normal cells. PET scans can detect tumor cells earlier than physical exams and other forms of scanning.
  • MRI - Using a powerful magnet, radio waves and computer imaging, MRI's capture detailed pictures which can help determine whether a tumor can be surgically removed.
  • Ultrasound – Sound waves bounced off internal organs create an image called a sonogram which can help determine the number of tumors and their locations.

How we treat pancreatic cancer


In its early stages, pancreatic cancer can be treated effectively with surgery. For patients with advanced pancreatic cancer, surgery can still be useful for relieving pain, restoring function and improving survival rates.

At City of Hope, we have one of the most experienced pancreatic surgery teams in the U.S. Our surgeons have performed thousands of procedures, and we frequently treat patients whose tumors are considered inoperable at other facilities. We also work continuously to improve the effectiveness and reduce complications of pancreatic cancer surgery, and we are at the forefront of developing minimally-invasive procedures.

There are several forms of pancreatic cancer surgery:

  • The Whipple Resection: Named for the Columbia University surgeon who developed the procedure, the Whipple operation involves removing the “head” of the pancreas, where many tumors form. In this procedure the surgeon also removes the duodenum (the first piece of the small intestine), part of the bile duct (the tube that drains bile from the liver into the bowel), the surrounding lymph nodes, the gallbladder, and sometimes part of the stomach. City of Hope surgeons have extensive experience in this highly complex operation, performing more than 100 Whipple procedures each year.

  • Distal Pancreatectomy: In this procedure the bottom half, or “tail” of the pancreas is removed, usually along with the spleen.

  • Total Pancreatectomy: Removing the entire pancreas along with bile duct, gallbladder, nearby lymph nodes and parts of the stomach and small intestine.
    When appropriate, these operations can be done with minimally-invasive techniques, which can be as effective as open surgery, but with less pain, reduced loss of blood, faster recovery, shorter hospital stays and a lower risk of complications.

  • Laparoscopic Surgery: In laparoscopic surgery, doctors make a tiny incision in the abdomen and insert a thin, lighted tube with a camera at the end, to get a clear picture of the pancreas, and remove tumors using special miniaturized instruments.
  • Robotic Surgery: City of Hope is a leader in robotic-assisted surgery, with world-class experts in the da Vinci Surgical System. In this procedure a surgeon directs a specially-designed robot, equipped with a camera and miniature surgical tools. A sophisticated computerized imaging system provides real-time, three-dimensional views far superior to the surgeon’s eye alone. This system provides excellent results in complex and delicate operations, and the small incisions enable faster recovery.


Ablation destroys tumor cells without surgically removing them. In these procedures, the doctor inserts a thin, needle-like probe into the tumor and uses extreme heat or cold to eradicate tumor cells:

  • Cryoablation: Very cold gasses pass through the probe to freeze the tumor, killing the cancer cells.
  • Radiofrequency Ablation:  A high-frequency current heats the tumor and destroys the cancer cells.
  • Microwave Ablation: Microwaves transmitted through the probe heat and destroy the abnormal tissue.
  • Nanoknife Treatment:  A special instrument sends an electrical current through the tumor, destroying cancer cells.


Embolization shrinks tumors by blocking their supporting blood vessels. This can be done either with particles, chemotherapy drugs or radioactive beads injected into the artery feeding the tumors.


Chemotherapy drugs may be given before an operation to try and shrink the tumors — increasing chances of surgical success — or following surgery to kill stray cancer cells and prevent a recurrence. It is also used when tumors can't be removed surgically. Chemotherapy may also be given in combination with radiation therapy to enhance the cancer-fighting effectiveness of both.

For patients who are healthy enough, a combination of several chemotherapy drugs may be administered for maximum cancer-fighting effectiveness. However, patients who are too weak to tolerate combination treatments may be given a single drug. Chemotherapy is often administered in cycles, with a rest periods in between to allow the body to recover.

Targeted Therapy

Targeted therapy drugs work differently than standard chemotherapy by targeting cancer-specific cells and processes. Some of these drugs are designed to stop changes in cells and cell DNA that cause cancer. Others block the signals that cancer cells use to fuel their growth and spread, or they may stimulate the body's immune system to destroy cancer cells from within (known as immunotherapy.)

Newest Drugs and Clinical Trials

At City of Hope, we constantly evaluate new chemotherapy and targeted therapy drugs for treating pancreatic cancer. Patients at City of Hope have access to newly-developed drugs and drug combinations through our clinical trials program.

Radiation Therapy

Typical radiation treatment is applied externally using one or more beams focused on the tumor.

At City of Hope, we've refined our radiation treatments to precisely target tumors and preserve nearby  tissue. Image-Guided Radiation Therapy (IGRT) uses sophisticated computer software and 3-D images from CT scans. The newest advance in this area is Helical TomoTherapy, and City of Hope is a leader in its use.

Radiation may be given before surgery, often in combination with chemotherapy, to shrink tumors and help make the surgery more effective. When tumors cannot be removed surgically, radiation may be used to relieve pain and other symptoms.

City of Hope’s renowned physicians and researchers utilize the latest in technology and innovation to treat cancer, coupled with our enduring belief in providing unparalleled compassionate care.

Surgical Oncology

Yuman Fong, M.D.

Clinical Specialties

  • Surgical Oncology
Laleh Melstrom, M.D., M.S., F.A.C.S.

Clinical Specialties

  • Surgical Oncology
  • Liver Cancer and Metastases
  • Pancreatic Surgery
  • Gallbladder and Bile Duct Surgery
  • Robotic Minimally Invasive Surgery
Mustafa Raoof, M.D.

Clinical Specialties

  • Surgical Oncology
Gagandeep Singh, F.A.C.S., M.D.

Clinical Specialties

  • Gallbladder and Bile Duct Surgery
  • Liver Surgery
  • Pancreatic Surgery
  • Surgical Oncology
Lawrence Wagman, M.D

Clinical Specialties

  • Surgical Oncology
Susanne Gray Warner, M.D.

Clinical Specialties

  • Surgical Oncology
  • Liver Surgery
  • Pancreatic Surgery
  • Gallbladder and Bile Duct Surgery
  • Minimally Invasive Surgery
  • Robotic Minimally Invasive Surgery
  • General Surgery
Yanghee Woo, M.D.

Clinical Specialties

  • Surgical Oncology
  • Robotic Minimally Invasive Surgery
  • Minimally Invasive Surgery

Medical Oncology

Joseph Chao, M.D.

Clinical Specialties

  • Medical Oncology
Vincent Chung, M.D.

Clinical Specialties

  • Medical Oncology
Marwan G. Fakih, M.D.

Clinical Specialties

  • Medical Oncology
Daneng Li, M.D.

Clinical Specialties

  • Medical Oncology
Dean W. Lim, M.D.

Clinical Specialties

  • Medical Oncology

Radiation Oncology

Leslie E. Botnick, M.D.

Clinical Specialties

  • Radiation Oncology
Helen Chen, M.D.

Clinical Specialties

  • Radiation Oncology
Yi-Jen Chen, M.D., Ph.D.

Clinical Specialties

  • Radiation Oncology

At City of Hope, we offer access to drug, surgical and other clinical trials aimed at improving survival rates and enhancing quality of life.

We are investigating a drug called PEGPH20, which may disrupt pancreatic cancer cells' ability to fight off chemotherapy by creating a barrier around tumors.

We are comparing blood samples of healthy adults and pancreatic cancer patients to search for DNA abnormalities. The goal is to design a DNA test that detect a cancer recurrence or spread at its earliest stages.

City of Hope is working on an improved supportive care program aimed at improving quality of life and the overall care experience.

Browse through our clinical trials and research projects here.

Living with pancreatic cancer

When you come to City of Hope, you automatically gain access to an unparalleled array of support services to help you and your family cope with each challenge you come across in your pancreatic cancer journey.

We support you every step of the way, both during treatment and long after, helping you and your loved ones manage your recovery.

We can help with all of these concerns, and more:

  • Poor appetite and trouble eating/drinking
  • Managing pain, fatigue, nausea
  • Adjusting to new diet and lifestyle habits
  • Your emotional, social and spiritual well-being
  • Palliative care
  • Staying healthy and active
  • Healthy cooking and eating
  • Healing arts
  • Caregiver skills
  • Dealing with family, work and school stress
  • Navigating the health care system

Learn more about these resources at our Living with Cancer or Supportive Care Medicine sites. For more information about the supportive care programs we offer, please contact the Sheri & Les Biller Patient and Family Resource Center at 626-218-2273 (CARE).

Support the Pancreatic Cancer Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts more than 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.


Kimberly Wah Bio photo

Kimberly Wah
Senior Director of Development
Phone: 626-218-6305
Cell: 626-560-9429
Email: [email protected]

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