Signs and Symptoms

Generally, most pancreatic cancers present nonspecifically and are not diagnosed until
late in the course of the disease, after the cancer has already spread to other organs. Common
symptoms include pain, unexplained weight loss, jaundice, clay-colored stools, nausea,
anorexia, malaise, fatigue, migratory thrombophlebitis (Trousseau's syndrome), and particularly
epigastric pain that radiates to the back or midepigastric or back pain.1,2,3

In some cases, patients with pancreatic cancer sometimes present with new-onset diabetes
mellitus or with signs and symptoms of chronic pancreatitis within the previous year. Depression
is common in patients with pancreatic cancer, and in some instances the diagnosis of depression
is established before the patient is found to have the cancer.1,2

Patients with pancreatic cancer had jaundice (89%), pale stools (75%), dark urine (78%), and
pruritus (41%) as late manifestations of disease. Because most patients with lesions located in
the head of the pancreas, proximal to the bile duct and ampulla, present with jaundice, these
lesions may be more likely to physically obstruct the bile duct, resulting in the presentation of
symptoms earlier than in lesions in the body or tail, more distant from the pancreatic duct.2,3
Additional characterization of jaundice also has been useful in pancreatic cancer prognosis.
Painless jaundice has been ascribed a relatively more favorable prognosis because it may be
more likely to correspond to a resectable tumor. 3 Pruritus is the patient's most distressing
symptom.2

All upper gastrointestinal symptoms, patients with pancreatic cancer commonly reported
bloating (23%), belching (23%), dyspepsia (36%), and vomiting (31%). An early gastrointestinal
symptom of pancreatic cancer arguably is generalized dyspepsia that may be attributed to
delayed gastric emptying. Dyspepsia associated with hiccups, flatulence, and regurgitation may
be early symptoms of pancreatic cancer, preceding more suggestive signs and symptoms of
pancreatic cancer by many months. The occurrence of other upper gastrointestinal symptoms has
not received as much focus as dyspepsia, Vomiting may be seen in relatively late stages when the
tumor has invaded or compressed the second portion of the duodenum, creating a partial or
complete obstruction.3
 Lower gastrointestinal symptoms are diarrhea and constipation. Both constipation and
diarrhea have been variously cited as the predominant alteration in bowel habits in carcinoma of
the pancreas. Constipation may only be important in case of a recent manifestation of pancreatic
cancer, whereas diarrhea is rare and steatorrhea is inconstant.3 Developing, advanced intra-
abdominal disease is presence of ascites, a palpable abdominal mass, hepatomegaly from liver
metastases, or splenomegaly from portal vein obstruction.2

Pain was categorized as abdominal pain at least 6 weeks in duration. Pain also was one of the
most frequent symptoms. Unrelenting pain at the nighttime pain often become a predominant
complaint.2,3 Abdominal pain was present regardless of tumor location, cancer in the body and
tail of the pancreas (90%) compared with those with cancer in the head of the pancreas (70%).3

Weight loss, fatigue, or altered ability to sleep, these are among several symptoms consistent
with locally advanced disease. Although cancer often has been associated with weight loss and/or
cachexia, weight loss in patients with pancreatic and biliary cancers also may be attributed to
gastrointestinal disruption that results in malabsorption.3

Some of the common presenting symptoms, pain, dyspepsia, and weight loss, have an
insidious onset and easily are mistaken for other illnesses or functional disorders. Abdominal
pain, jaundice, and weight loss as the primary symptoms of pancreatic cancer.2,3

1. Wolfgang, C.L. et al. (2013) Recent Progress in Pancreatic Cancer. CA: A Cancer
Journal for Clinicians. 63, (5), 318-348
2. Dragovich, T. Section of Hematology and Oncology For Pancreatic Cancer. Medscape
[serial online]. Available at http://emedicine.medscape.com/article/280605. Accessed
October 12, 2014.
3. Holly, E.A. et al. (2014) 3 Signs and Symptoms of Pancreatic Cancer: A Population-
Based Case-Control Study in the San Francisco Bay Area. Journal of Clinical
Gastroenterology and Hepatology. 2, (6), 510-517