What are the symptoms of pancreatic tumors?

Symptoms of Pancreatic Tumors

The main symptoms of pancreatic tumors include abdominal pain (often radiating to the back), weight loss, and jaundice, with presentation varying based on tumor location and type. 1

Common Presenting Symptoms

General Symptoms

• Abdominal pain, which often radiates to the back, is one of the three cardinal symptoms and becomes persistent as disease progresses 1, 2
• Weight loss, typically severe and rapid, commonly indicates advanced disease 1, 3
• Jaundice, particularly painless jaundice, occurs with tumors in the head of the pancreas due to bile duct obstruction 1, 3
• New-onset diabetes mellitus, especially in older patients without predisposing factors, can be an early warning sign 1, 2
• Nausea and vomiting, often due to tumor effects or general disease progression 1
• Anorexia and malaise, manifesting as loss of appetite and general unwellness 1
• Steatorrhea (fatty stools) due to exocrine pancreatic insufficiency 1, 3
• Early satiety, particularly in cases with gastric outlet or duodenal obstruction 1, 2

Symptoms Based on Tumor Location

• Head of pancreas tumors (60-70% of cases):

  • More likely to cause early jaundice due to bile duct compression 3
  • May have less pain initially compared to body-tail tumors 2
  • Can cause duodenal obstruction as they grow locally 3

• Body and tail tumors (20-25% of cases):

  • Usually diagnosed at more advanced stages due to lack of early symptoms 3
  • More likely to cause early back pain 4
  • Jaundice typically only occurs with metastatic disease to the liver 1

Signs of Advanced Disease

• Persistent back pain suggests retroperitoneal nerve infiltration 4, 1
• Marked and rapid weight loss indicates aggressive disease 1
• Palpable and fixed epigastric mass signifies locally advanced disease 1
• Ascites (fluid accumulation in the abdomen) 1
• Enlarged supraclavicular lymph node (Virchow's node) indicates metastatic spread 1
• Migratory thrombophlebitis, though rare as an initial symptom 1

Symptoms Specific to Neuroendocrine Pancreatic Tumors

Neuroendocrine tumors (NETs) may present with specific hormone-related syndromes 3, 5:

• Insulinoma: Confusion, sweating, dizziness, weakness, unconsciousness, relief with eating 3
• Gastrinoma: Zollinger-Ellison syndrome with severe peptic ulceration and diarrhea 3, 5
• Glucagonoma: Necrolytic migratory erythema, weight loss, diabetes mellitus, stomatitis, diarrhea 3
• VIPoma: Werner-Morrison syndrome with profuse watery diarrhea and marked hypokalemia 3
• Somatostatinoma: Cholelithiasis, weight loss, diarrhea, steatorrhea, diabetes mellitus 3
• Non-syndromic pancreatic NETs: Symptoms from pancreatic mass and/or liver metastases 3

Clinical Pitfalls in Diagnosis

• Symptoms are often vague and non-specific in early stages, leading to delayed diagnosis 1
• Symptoms may be erroneously attributed to other conditions like irritable bowel syndrome 2
• Approximately 25% of patients with pancreatic cancer may have no pain at diagnosis 2
• Contrary to common belief that pancreatic cancer patients are lean, many are actually overweight prior to symptom onset 2

Warning Signs That Should Prompt Investigation

• Recent-onset diabetes mellitus in patients over 50 years of age, particularly when combined with weight loss 1, 2
• Unexplained persistent back pain, especially in older adults 4
• Painless jaundice in adults 3, 1
• Persistent upper abdominal discomfort that radiates to the back 1, 4