What are the symptoms of pancreatic cancer?

Symptoms of Pancreatic Cancer

The primary symptoms of pancreatic cancer include abdominal pain often radiating to the back, weight loss, and painless jaundice (in tumors of the pancreatic head), with late diagnosis common due to the lack of early specific symptoms. 1

Common Presenting Symptoms

• Abdominal pain that often radiates to the back is one of the three cardinal symptoms and becomes persistent as the disease progresses 2, 1
• Weight loss, typically severe and rapid, is common and usually associated with unresectability 1, 3
• Painless jaundice occurs with tumors in the head of the pancreas due to bile duct compression 2, 1
• New-onset diabetes mellitus, particularly in patients over 50 years of age, can be an early warning sign (about 5% of pancreatic cancer patients develop diabetes within two years before diagnosis) 1, 3
• Nausea and vomiting may occur due to tumor effects or as part of general disease progression 1
• Anorexia and malaise (general feeling of unwellness) are frequently reported 1
• Steatorrhea (fatty stools) due to exocrine pancreatic insufficiency 2, 1
• Early satiety, particularly in cases with gastric outlet or duodenal obstruction 1

Symptoms Based on Tumor Location

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

  • More likely to cause early jaundice due to bile duct compression 2, 1
  • Patients often present with painless jaundice as the first symptom 2

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

  • Usually diagnosed at more advanced stages due to lack of early symptoms 2, 1
  • More likely to cause early back pain than tumors in the head 4
  • Jaundice typically only occurs with metastatic disease to the liver 1

Signs of Advanced Disease

• Persistent back pain suggests retroperitoneal nerve infiltration 1, 4
• Marked and rapid weight loss indicates aggressive disease 1
• Palpable and fixed epigastric mass is a sign of locally advanced disease 1
• Ascites (fluid accumulation in the abdomen) indicates advanced disease 1
• Enlarged supraclavicular lymph node (Virchow's node) indicates metastatic spread 1
• Migratory thrombophlebitis, though rare as a first symptom, can be associated with pancreatic cancer 1

Clinical Pitfalls in Diagnosis

• Symptoms are often vague and non-specific in early stages, leading to delayed diagnosis 1, 5
• Up to 25% of patients may have symptoms compatible with upper abdominal disease up to 6 months prior to diagnosis, which may be erroneously attributed to other conditions like irritable bowel syndrome 5
• Approximately 25% of patients with pancreatic cancer may have no pain at diagnosis, particularly those with pancreatic head tumors 5
• The high mortality rate is due to late diagnosis, early metastasis, and poor response to chemo- and radiotherapy in most cases 2

High-Risk Populations to Consider for Screening

• Individuals with hereditary conditions (e.g., familial pancreatic cancer, hereditary pancreatitis) 2, 5
• Patients with chronic pancreatitis 5
• Patients with recent-onset diabetes mellitus, particularly when combined with weight loss in older adults 3, 5
• Overweight individuals who develop new-onset diabetes may be at higher risk for pancreatic cancer 5

For high-risk populations, regular endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) are recommended for early detection 2.