Pancreatic Cancer Symptoms & Signs
Pancreatic cancer arises when cells in the pancreas, a glandular organ behind the stomach, begin to multiply out of control and form a mass. These cancerous cells have the ability to invade other parts of the body. There are a number of types of pancreatic cancer.
The most common, pancreatic adenocarcinoma, accounts for about 85% of cases, and the term “pancreatic cancer” is sometimes used to refer only to that type. These adenocarcinomas start within the part of the pancreas which makes digestive enzymes. Several other types of cancer, which collectively represent the majority of the non-adenocarcinomas, can also arise from these cells.
One to two percent of cases of pancreatic cancer are neuroendocrine tumors, which arise from the hormone-producing cells of the pancreas. These are generally less aggressive than pancreatic adenocarcinoma.
Classic pancreatic cancer symptoms can include:
Painless jaundice (yellow skin/eyes, dark urine, itching).
This is related to bile duct obstruction
Weight loss which is significant and unexplained
Abdominal pain which is new-onset and significant
Other possible symptoms of pancreatic cancer:
Pain in the upper abdomen that radiates to the back which is new, significant and persistent that is relieved by leaning forward
Diabetes which is new-onset and not associated with weight gain
Vague indigestion (dyspepsia) or abdominal discomfort (not responding to prescribed medication)
Loss of appetite
Nausea and vomiting
Pain when eating
Steatorrhea (fatty stools that are often pale and smell foul)
Not everyone will have all of these symptoms. For example, those who have a tumour in the body or tail of the pancreas are unlikely to have painless jaundice. All of these symptoms can have other causes, and there is not yet a reliable and easy test for pancreatic cancer.
Explanation of the symptoms:
Pain in the abdomen and upper back
Approximately 70 per cent of patients with pancreatic cancer go to the doctor initially due to pain. This pain is often described as beginning in the stomach area and radiating around to the upper back (just above where a woman’s bra strap would be).
This pain is worse when lying down than sitting up.
Generally the reason for the pain is because of the tumour pressing against your abdomen and spine.
Half of patients will have yellowing of the skin and whites of the eyes, jaundice, when they first go to the doctors. This is related to the tumour blocking the bile duct which leads to a build-up of bile in the liver.
Jaundice may be more obvious in the whites of the eyes and bad jaundice can cause itching of the skin.
Many of our patients or relatives have said that they have experienced mood changes before being diagnosed.
Mild to severe depression can often present itself in the early stages of pancreatic cancer.
This is why if someone who has never suffered from a severe bout of depression before should express their concerns to their GP. It can often highlight a medical problem in the very early stages.
A tumour in the pancreas can cause bowel disturbances which means you do not absorb your food properly.
This will result in regular, large bowel movements of pale and smelly stool. This can also cause weight loss.
Diabetes is due to a deficiency in insulin, which is produced by the pancreas.
A tumour can stop the pancreas producing insulin leading to an onset of diabetes in the early stages of pancreatic cancer.
You may have diabetes if you have low energy, pass more urine than normal and feel extremely thirsty.
Risk factors for pancreatic adenocarcinoma include:
Age, gender, and ethnicity; the risk of developing pancreatic cancer increases with age. Most cases occur after age 65, while cases before age 40 are uncommon. The disease is slightly more common in men than women, and in the United States is over 1.5 times more common in African Americans, though incidence in Africa is low.
Cigarette smoking is the best-established avoidable risk factor for pancreatic cancer, approximately doubling risk among long-term smokers, the risk increasing with the number of cigarettes smoked and the years of smoking. The risk declines slowly after smoking cessation, taking some 20 years to return to almost that of non-smokers.
Obesity; a BMI greater than 35 increases relative risk by about half.
Family history; 5–10% of pancreatic cancer cases have an inherited component, where people have a family history of pancreatic cancer. The risk escalates greatly if more than one first-degree relative had the disease, and more modestly if they developed it before the age of 50.Most of the genes involved have not been identified. Hereditary pancreatitis gives a greatly increased lifetime risk of pancreatic cancer of 30–40% to the age of 70. Screening for early pancreatic cancer may be offered to individuals with hereditary pancreatitis on a research basis. Some people may choose to have their pancreas surgically removed to prevent cancer developing in the future.
Pancreatic cancer has been associated with the following other rare hereditary syndromes: Peutz–Jeghers syndrome due to mutations in the STK11 tumor suppressor gene (very rare, but a very strong risk factor); dysplastic nevus syndrome (or familial atypical multiple mole and melanoma syndrome, FAMMM-PC) due to mutations in the CDKN2A tumor suppressor gene; autosomal recessive ataxia-telangiectasia and autosomal dominantly inherited mutations in the BRCA2 gene and PALB2 gene; hereditary non-polyposis colon cancer (Lynch syndrome); and familial adenomatous polyposis. PanNETs have been associated with multiple endocrine neoplasia type 1 (MEN1) and von Hippel Lindau syndromes.
Chronic pancreatitis appears to almost triple risk, and as with diabetes, new-onset pancreatitis may be a symptom of a tumor. The risk of pancreatic cancer in individuals with familial pancreatitis is particularly high.
Diabetes mellitus is a risk factor for pancreatic cancer and (as noted in the Signs and symptoms section) new-onset diabetes may also be an early sign of the disease. People who have been diagnosed with Type 2 diabetes for longer than ten years may have a 50% increased risk, as compared with non-diabetics.
Specific types of food (as distinct from obesity) have not been clearly shown to increase the risk of pancreatic cancer. Dietary factors for which there is some evidence of slightly increased risk include processed meat, red meat, and meat cooked at very high temperatures (e.g. by frying, broiling or barbecuing).
If you regularly experience ONE OR MORE of these symptoms which are NOT NORMAL FOR YOU, DO NOT IGNORE THEM, contact your GP straight away.