About 10% of pancreatic cancer is inherited. If you have a first-degree relative (mom, dad, sister, brother) with pancreatic cancer, you might be more likely to get it. Other risk factors include:

• African American or Ashkenazi Jew – people of this descent are more likely to develop pancreatic cancer
• Chronic pancreatitis, which may be due to heavy alcohol use or an inherited gene mutation
• Diabetes for a long time
• Diets high in red or processed meat or high in fat
• History of certain types of pancreatic cysts, such as mucinous cystic neoplasms and intraductal papillary mucinous neoplasms (IPMN)
• Obesity (being overweight)
• Older age
• Smoking

Most symptoms of pancreatic cancer are not noticeable. Symptoms may include:

• Nausea or vomiting
• Pain in the back or stomach area
• Recent diabetes diagnosis
• Swelling in the pancreas (pancreatitis)
• Weight loss or poor appetite
• Yellowing of the skin or eyes (jaundice)

There is a slight hereditary component to liver cancer, but it’s not very strong. Your family history can increase your odds of having conditions that lead to liver cancer. Risk factors for liver cancer include:

• Asian or African descent
• Cirrhosis – develops when liver cells are damaged and replaced by scar tissue
• Heavy alcohol use
• Obesity (being overweight) with non-alcoholic fatty liver disease (NAFLD)
• Smoking
• Type 2 diabetes
• Viral Hepatitis B or C

Signs and symptoms of liver cancer often don’t appear until the later stage of the disease. Some of the more common symptoms include:

• Easy bleeding or bruising
• Nausea or vomiting
• Swelling or pain in the liver, spleen or stomach area (near right shoulder blade), or legs
• Weight loss and loss of appetite
• Yellowing of the skin or eyes (jaundice)

People with long-term inflammation of the bile ducts have a higher risk of developing bile duct cancer. Certain conditions of the liver or bile ducts can cause this inflammation. These include bile duct stones, cirrhosis, hepatitis B or C, or primary sclerosing cholangitis (PSC). Other risk factors include:

• Diabetes
• Ethnicity – Hispanic Americans are at the highest risk
• Heavy alcohol use
• Inflammatory bowel disease
• Non-alcoholic fatty liver disease (NAFLD)
• Obesity (being overweight)
• Older age
• Smoking

Bile duct cancer is rare. Sometimes people with bile duct cancer do not have any signs and symptoms. First signs and symptoms of bile duct cancer are similar to liver cancer:

• Abdominal (belly) pain
• Dark urine and/or lighter-colored stool
• Fever
• Itching
• Nausea or vomiting
• Weight loss and loss of appetite
• Yellowing of the skin or eyes (jaundice)

Many of the risk factors for gall bladder cancer are related to irritation and swelling in the gallbladder that lasts for a long time. Other risk factors include:

• Ethnicity – Mexican Americans and Native Americans are at higher risk
• Sex – Females are at higher risk
• Gallbladder polyps or cysts
• Gallstones – the most common risk factor
• Obesity (being overweight)
• Older age (average age is 72)
• Porcelain gallbladder

Gallbladder cancer is rare. Symptoms usually appear after the tumor is large or has spread to other parts of the body. Sometimes you may notice:

• Dark urine and/or lighter-colored stool
• Lumps in the stomach area
• Nausea or vomiting
• Stomach area pain
• Yellowing of the skin or eyes (jaundice)

The pancreas is located deep inside the body. It is hard for doctors to see or feel any early pancreatic cancer signs during a physical exam. Symptoms often aren’t obvious. And you may not notice any symptoms until the cancer is very advanced. There’s no standard test to diagnose pancreatic cancer. A tumor in the pancreas is only visible with a computed tomography (CT) scan or magnetic resonance imaging (MRI).

If a specialist sees a tumor through a scan, they will take a sample of the tumor (called a biopsy). This test helps figure out what the tumor is and if it’s cancerous.

Some scans might show that you have a pancreatic cyst or pseudocyst.

• A cyst is a pocket or collection of fluid with a lining like the lining of your pancreatic ducts.
• A pseudocyst is a collection of fluid with a capsule or scar tissue surrounding it.

On imaging, cysts and pseudocysts can appear similar. They behave differently due to their lining and how they form. This allows us to differentiate between the two. Most are not cancerous and do not cause symptoms. However, some cysts can become cancerous and do require surgery or other treatment.

Pseudocysts are often the result of pancreatitis (inflammation of the pancreas). Pancreatitis is usually caused by heavy alcohol use or gallstones. A pseudocyst will never become cancer and will sometimes go away on its own. If it does not cause symptoms, it may be safely left alone. Sometimes, it will grow, get infected or cause significant symptoms, and it will need to be drained or require surgery.

These cysts contain thin, watery fluid. They generally do not become cancer or increase the risk of cancer. Surgery is occasionally recommended when they cause symptoms or when they have the appearance of a more suspicious cyst.

Both kinds of cysts contain a protein called mucin and have some risk of becoming a cancer.

• When IPMNs are in the main pancreatic duct, the risk of developing pancreatic cancer is much higher. In this case, surgery is recommended.
• When IPMNs are along smaller ducts, the risk of cancer is lower. In this case, your care team will evaluate the best treatment option.

For people who do not undergo surgery, regular screening (imaging and lab tests) is recommended. This can help to catch any possible cancer early. For cysts that are higher risk, continued screening of the pancreas is necessary, even after surgical removal.

Liver cancer (and other hepatobiliary cancers) often doesn’t have symptoms until the cancer is more advanced. But your doctor can do a blood test at your routine annual check-up to assess the general health of your liver. This simple blood test looks for any signs of inflammation or swelling in the liver that could lead to cirrhosis.

If results of a blood test are normal, there is no need for other types of liver tests. If your blood test shows first signs of liver damage, you also may need these tests:

• CT scan to look for visual signs of cirrhosis
• Biopsy to confirm diagnosis of cirrhosis or fibrosis (which leads to cirrhosis)
• Regular ultrasound screenings of your liver

People at a high risk for developing liver cancer should be screened every 6 months. Liver cancer can be avoided with preventative health screenings. People at high risk include:

• Anyone with cirrhosis from any cause; hepatitis C, hepatitis B, alcohol and fatty liver disease are the most common causes of cirrhosis in the United States.
• Persons of Asian descent with chronic hepatitis B (men aged 40 and over, women aged 50 and over).
• Persons of African descent, aged 20 and over, with chronic hepatitis B.
• Persons of any age with chronic hepatitis B and a family history of liver cancer.