What are the signs of pancreatic cancer?

Signs and Symptoms of Pancreatic Cancer

The three main cardinal symptoms of pancreatic cancer are abdominal pain (often radiating to the back), weight loss, and jaundice, with other common symptoms including nausea, anorexia, malaise, and vomiting. 1, 2

Primary Symptoms

• Abdominal pain that often radiates to the back - becomes persistent as disease progresses 2, 3
• Weight loss - typically severe and rapid, associated with unresectability 1, 2
• Jaundice - often painless, particularly with tumors in the head of the pancreas 1, 3
• Nausea, anorexia, malaise, and vomiting - common accompanying symptoms 1
• New-onset diabetes mellitus - approximately 5% of pancreatic cancer patients develop diabetes within two years before diagnosis 1, 2
• Steatorrhea (fatty stools) - due to exocrine pancreatic insufficiency 2, 3
• Early satiety - feeling full quickly when eating 3

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, 3
  • Jaundice may lead to earlier detection and better resectability rates 1

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

  • Usually diagnosed at more advanced stages due to lack of early symptoms 2, 3
  • More likely to cause early back pain 4
  • Jaundice typically only occurs with hepatic or hilar metastases, indicating inoperability 1

Signs of Advanced Disease and Unresectability

• Persistent back pain - suggests retroperitoneal nerve infiltration 1, 4
• Marked and rapid weight loss - indicates aggressive disease 1, 3
• Palpable and fixed epigastric mass - sign of locally advanced disease 1, 3
• Ascites (fluid accumulation in the abdomen) - indicates advanced disease 1, 3
• Enlarged supraclavicular lymph node (Virchow's node) - indicates metastatic spread 1
• Migratory thrombophlebitis - rarely the first symptom 1, 3
• Courvoisier's sign - palpable gallbladder with jaundice 1

Warning Signs That Should Prompt Investigation

• Recent-onset diabetes mellitus in patients over 50 years without predisposing factors 1, 2
• Unexplained episode of acute or chronic pancreatitis 1
• Combination of weight loss with abdominal symptoms or back pain in individuals ≥60 years 5
• Jaundice in individuals ≥40 years (requires direct specialist referral) 5
• Appetite loss, pale stools, unusual bloating, and dark urine 6

Clinical Pitfalls in Diagnosis

• Symptoms are often vague and non-specific in early stages, leading to delayed diagnosis 3, 7
• No positive clinical features clearly identify potentially curable pancreatic cancer 1
• Initial symptoms may be intermittent and attributed to other conditions 7
• Symptoms may be present up to 6 months prior to diagnosis but misattributed to other conditions like irritable bowel syndrome 8
• Pain may be absent in up to 25% of patients at diagnosis, particularly those with head tumors 8

High-Risk Populations to Consider for Screening

• Individuals with hereditary conditions (e.g., familial pancreatic cancer, hereditary pancreatitis) 2, 8
• Patients with recent-onset diabetes mellitus, particularly when combined with weight loss in older adults 1, 8
• Overweight persons who develop new-onset diabetes may benefit from screening for early, asymptomatic pancreatic cancer 8

The high mortality rate of pancreatic cancer is largely due to late diagnosis, as symptoms typically appear when the disease is already advanced 5, 7. Early recognition of symptom patterns, particularly in high-risk individuals, is crucial for improving outcomes.