In the United States, pancreatic cancer is the third leading cause of cancer-related deaths and is projected to become the second leading cause by 2030. According to the NIH’s National Cancer Institute, there will be approximately 67,440 new cases of pancreatic cancer and 51,980 deaths from the disease this year.

The pancreas is an organ in the abdomen that helps the body digest and use the energy that comes from food. It makes enzymes that help with digestion, and it makes hormones, such as insulin, that control how our bodies store and use glucose—sugar which is the body’s main source of energy. Pancreatic cancer occurs when cells in the pancreas grow out of control and form a growth or tumor.

There are two forms of pancreatic cancer:

• Exocrine pancreatic cancer, which accounts for roughly 95% of all cases.
• Endocrine pancreatic cancer, or pancreatic neuroendocrine tumors.

Various factors can increase or decrease the risk of developing pancreatic cancer. Anything that increases your chance of developing a disease is known as a risk factor, and anything that decreases your chance of developing a disease is known as a protective factor. Knowing your risk factors can help you make choices that may lower your chances of developing pancreatic cancer.

The following risk factors may increase the risk of pancreatic cancer:

• Smoking.
• Obesity.
• A personal history of diabetes or chronic pancreatitis.
• A family history of pancreatic cancer or pancreatitis.
• Certain hereditary conditions, such as:
  • Hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome).
  • Peutz-Jeghers syndrome.
  • Hereditary breast and ovarian cancer syndrome.
  • Familial atypical multiple mole melanoma (FAMMM) syndrome.
  • Ataxia-telangiectasia.

“If you’re dealing with symptoms like ongoing back pain, trouble sleeping, depression, or unexplained weight loss, don’t brush them off,” said Nina Steele, PhD, member of the Signaling Networks & Metabolic Pathways Research Program at the Cancer Center. “These issues can have many causes, but in rare cases they may be linked to pancreatic cancer. Make sure to speak with your doctor so nothing is overlooked. Additionally, if pancreatic cancer runs in your family — whether in an immediate relative or in multiple relatives — you may want to visit a high-risk clinic for genetic testing and regular checkups.”

Nina G. Steele, PhD Assistant Professor, Department of Internal Medicine University of Cincinnati College of Medicine

In its early stages, pancreatic cancer usually doesn’t cause any obvious symptoms, making it difficult to detect. As it develops, people may notice:

• Jaundice (yellowing of the skin and whites of the eyes).
• Light-colored stools.
• Dark urine.
• Pain in the upper or middle abdomen and back.
• Weight loss for no known reason.
• Loss of appetite.
• Fatigue.

Pancreatic cancer is usually diagnosed with tests and procedures that make pictures of the pancreas and the area around it. Tests and procedures to detect, diagnose and stage pancreatic cancer are usually done at the same time. To plan treatment, it is important to know the stage of the disease and whether the pancreatic cancer can be removed by surgery.

In addition to asking about your personal and family health history and doing a physical exam, your doctor may perform the following tests and procedures:

• Blood tests to check for abnormal levels of substances like bilirubin or tumor markers (such as CA 19-9 and CEA) that may signal cancer.
• Imaging tests, including:
• MRI, CT scans, or PET scans, which create detailed pictures inside the body.
• Ultrasound, either on the abdomen or through an endoscope (EUS), to view the pancreas more closely.
• Procedures to examine the bile and pancreatic ducts, such as ERCP or PTC, especially if jaundice or a blockage is suspected.
• Laparoscopy, a minor surgery using a small camera to look inside the abdomen and take samples if needed.
• Biopsy, which removes tissue or cells from the pancreas to confirm the diagnosis under a microscope.

These tests help doctors understand the presence, extent, and stage of pancreatic cancer so they can choose the most effective treatment plan.

An Expert Perspective

“When I started working on pancreatic cancer in 2017, the five-year survival rate was 8%,” said Steele. “Now, in 2025, the five-year survival rate is still sitting around 8-9%, but for the first time in history, we now have RAS inhibitors in clinical trials, which will very likely be available for many patients in the next year. RAS is an important protein that drives pancreatic cancer cell growth in over 95% of patients, making this a groundbreaking discovery. This makes it an exciting time for patients and their family members, as well as for the entire research community.”

The RAS protein is a family of proteins that acts as a molecular switch for cell growth, differentiation and survival by cycling between an “on” (GTP-bound) and “off” (GDP-bound) state. When mutated, RAS proteins can become stuck in the "on" state, leading to uncontrolled cell proliferation and playing a key role in cancer development.

“In the future, I envision nearly all patients at some point will be on RAS inhibitors, and that this will significantly prolong survival, and possibly in some cases, be a cure, complementing the progress that has been made with surgical techniques and chemotherapies,” shared Steele. “Additionally, combination therapies against other proteins aside from RAS are in early stages of development, and in future years, this could further extend survival for this aggressive disease.”

As progress continues with new targeted drugs like RAS inhibitors, scientists like Dr. Steele are also focusing on the underlying tumor biology that influences how well these treatments work. This research helps identify which patients may benefit most and how to overcome resistance.

“My research focuses on improving outcomes for pancreatic cancer patients by studying how different cell types communicate within the tumor microenvironment (TME), which plays a major role in treatment resistance,” she said. “In the lab, I use computational tools, cell-based experiments, and animal models to explore these interactions.”

Building on these efforts to understand how tumors resist treatment, Dr. Steele’s work has expanded into large-scale projects that map the pancreas at an unprecedented level of detail. These initiatives aim to uncover the biological drivers of disease progression and disparities.

“I recently led the development of the largest single-cell RNA sequencing and spatial transcriptomics atlas of the human pancreas to date, built from more than 229 patient samples,” she shared. “This work revealed a new signaling niche involving aggressive basal-like tumor cells and CXCL10+ fibroblasts. We are also using this atlas to examine biological contributors to racial disparities in pancreatic cancer, which is especially important because Black African Americans face more than a 20% higher risk of developing the disease, even after accounting for social and economic factors.”

“I am also co-leading an exciting effort to diversify the genomics data available for research use, which is funded by the Lustgarten Foundation, with Howard Crawford, PhD, scientific director of the Henry Ford Pancreatic Cancer Center in Detroit, Michigan, as over 95% of patient samples currently are from White or Asian individuals,” she said.

Her passion for ensuring that all patients are represented in pancreatic cancer research stems from an early experience that revealed the importance — and the responsibility — of working directly with patient samples.

“A defining moment in my career came during my graduate training, when I experienced true ‘bench-to-bedside’ research,” Steele said. “Working in the lab of Yana Zavros, PhD and collaborating with Syed A. Ahmad, MD, I coordinated patient consent for tissue collection and then used those same samples to grow 3D organoids for drug testing. This dual role solidified my commitment to translational research, and I’m deeply grateful to Dr. Ahmad for encouraging that path. Most of all, the patients and families I’ve met continue to inspire, especially one gastric cancer patient who said he donated tissue to help ‘the next person with this disease.’ Seeing discoveries move from the lab to patient care remains the most meaningful part of my work.”

Dr. Steele’s dedication to advancing pancreatic cancer research goes hand in hand with her commitment to mentoring the next generation of scientists.

“Ultimately, the most rewarding part of my work is mentoring young scientists from all backgrounds,” she shared. “Over the years, I’ve worked with high school students, undergraduates, medical students, graduate students, technicians, and postdocs—and I’ve learned something from each of them. Bringing together people of all ages and perspectives to work toward improving outcomes in this deadly disease continues to inspire me, even in a challenging funding climate. I am passionate about creating educational opportunities in our community, as the mentorship I received has been essential to my own journey and success.”

Dr. Steele also took a moment to discuss her Cancer Center membership, sharing how it has opened doors for meaningful connections and collaborations that enhance both her research and the broader scientific community.

“I am absolutely thrilled to be part of the Cancer Center community,” she said. “It has opened opportunities for new collaborations with colleagues such as Andrew Waters, PhD; Krushna Patra, PhD; Daniel Starczynowski, PhD and Amanda Wasylishen, PhD, and it has allowed me to connect with a wide network of UC Health researchers and staff. I’ve already applied for a pilot grant through a team project supported by the center, and I plan to stay actively involved to help advance the effort to establish a designated cancer center in Cincinnati, which would be highly beneficial for both patients and researchers.”