Pancreatic Cancer Symptoms: An Overview

Pancreatic Cancer Symptoms: An Overview Pancreatic cancer often goes undetected until its advanced and difficult to treat. In the vast majority of cases, symptoms only develop after pancreatic cancer has grown and begun to spread. Because more than 95% of pancreatic cancer is the adenocarcinoma type, well describe those symptoms first, followed by symptoms of rare forms of pancreatic cancer. Recommended Related to Pancreatic Cancer Understanding Pancreatic Cancer the Basics The pancreas is an organ located behind your stomach next to the top of the small intestine. It is about six inches long but is less than 2 inches wide and functions as two separate organs. It has two big manufacturing jobs in the body: It makes digestive juices that help the intestines break down food. It produces hormones including insulin that regulate the bodys use of sugars and starches. The pancreas is divided into three sections: the head, the body, and the tail. The Pancreatic Cancer Symptoms: Location Matters Initially, pancreatic cancer tends to be silent and painless as it grows. By the time its large enough to cause symptoms, pancreatic cancer has generally grown outside the pancreas. At this point, symptoms depend on the cancers location within the pancreas: Pancreatic cancer in the head of the pancreas tends to cause symptoms such as weight loss, jaundice (yellow skin), dark urine, light stool color, itching, nausea, vomiting, abdominal pain, back pain, enlarged lymph nodes in the neck. Pancreatic cancer in the body or tail of the pancreas usually causes belly and/or back pain and weight loss. In general, symptoms appear earlier from cancers in the head of the pancreas, compared to those in the body and tail. Pancreatic Cancer: Gastrointestinal Symptoms Because pancreatic cancer grows around important areas of the digestive system, gastrointestinal symptoms often predominate: Abdominal pain. More than 80% of people with pancreatic cancer eventually experience some abdominal pain as the tumor grows. Pancreatic cancer can cause a dull ache in the upper abdomen radiating to the back. The pain may come and go. Bloating. Some people with pancreatic cancer have a sense of early fullness with meals (satiety) or an uncomfortable swelling in the abdomen. Nausea Diarrhea Pale-colored stools. If the duct draining bile into the intestine is blocked by pancreatic cancer, the stools may lose their brown color and become pale or clay-colored. Urine may become darker. Pancreatic Cancer: Constitutional (Whole-Body) Symptoms As it grows and spreads, pancreatic cancer affects the whole body. Constitutional symptoms can include: Weight loss Malaise Loss of appetite Elevated blood sugars. Some people with pancreatic cancer develop diabetes as the cancer impairs the pancreas ability to produce insulin. (However, the vast majority of people with a new diagnosis of diabetes do not have pancreatic cancer.) Pancreatic Cancer: Skin Symptoms Jaundice: As pancreatic cancer blocks the duct that releases bile into the intestine (common bile duct), the ingredients of bile build up in the blood. This turns the skin and the eyes yellow, a condition called jaundice. The same blockage causes dark urine and light-colored stools. Itching: People with pancreatic cancer sometimes report itching all over. Blockage of the bile ducts is often responsible. Symptoms of Rare Pancreatic Cancers Islet cell tumors, also called neuroendocrine tumors, arise from the cells in the pancreas that make hormones. Islet cell tumors account for only 1.5% of all pancreas tumors. Like pancreatic adenocarcinoma, islet cell tumors may cause abdominal pain, weight loss, nausea, and vomiting. Hormones released by an islet cell tumor can also cause symptoms: Insulinomas (excess insulin): sweating, anxiety, lightheadedness, and fainting from low blood sugar. Glucagonomas (excess glucagon): diarrhea, excessive thirst or urination, weight loss. Gastrinomas (excess gastrin): abdominal pain, nonhealing stomach ulcers, reflux, weight loss. Somatostatinomas (excess somatostatin): diarrhea, weight loss, abdominal pain, foul-smelling fatty stools. VIPomas (excess vasoactive intestinal peptide): abdominal cramping, watery diarrhea, facial flushing. Pancreatic Cancers Sneaky Symptoms In a very small number of people with pancreatic cancer, early symptoms might be present that could lead to an earlier diagnosis. Unfortunately, researchers have been unable to identify any predictable pattern. One study that surveyed 305 people with pancreatic cancer illustrated the challenge: About 4% reported having a sudden disgust for preferred tastes (like coffee, smoking, or wine) that preceded other symptoms by more than six months. 5% of people had loss of appetite, a feeling of early fullness with meals, or profound weakness, more than six months before more obvious symptoms developed. 1% of people had attacks of acute pancreatitis more than six months before their diagnosis with pancreatic cancer. The rarity and vagueness of these situations points out the difficulty of using early symptoms to catch pancreatic cancer at an earlier stage. That said, symptoms like weight loss, persistent loss of appetite, yellowing of the eyes or skin, dark urine, or light-colored stools should always prompt concern. Consistent or worsening discomfort, nausea, vomiting, or diarrhea are also disconcerting. If you feel somethings not right, see your doctor. MedicineNet, 2013 What are the symptoms and signs of pancreatic cancer? Because the pancreas lies deep in the belly in front of the spine, pancreatic cancer often grows silently for months before it is discovered. Early symptoms can be absent or quite subtle. More easily identifiable symptoms develop once the tumor grows large enough to press on other nearby structures such as nerves (which causes pain), the intestines (which affects appetite and causes nausea along with weight loss), or the bile ducts (which causes jaundice or a yellowing of the skin and can cause loss of appetite and itching). Symptoms in women rarely differ from those in men. Once the tumor sheds cancer cells into the blood and lymph systems and metastasizes, more symptoms usually arise depending on the location of the metastasis. Frequent sites of metastasis for pancreatic cancer include the liver, the lymph nodes, and the lining of the abdomen (called the peritoneum). Unfortunately, most pancreatic cancers are found after the cancer has grown beyond the pancreas or has metastasized to other places. 2013 Pancreatic Cancer UK Signs and symptoms Signs and symptoms are diagnostic tools that help doctors to work out what is wrong with someone and make a diagnosis. Symptoms are the things that you are experiencing, e.g. pain or loss of appetite that you will tell your doctor about. Signs are what the doctor can see when they examine someone, e.g. someone wincing when they touch a painful area. Signs and symptoms of pancreatic cancer Pancreatic cancer doesnt usually give rise to any symptoms or signs in the early stages. This is the main reason it can be so difficult to detect and diagnose. As the cancer grows the symptoms it causes will depend on the type of pancreatic cancerand where it is in the pancreas. Any symptoms people do have can be quite vague and may come and go at first. An example is abdominal pain, which may start off as occasional discomfort before becoming more painful and more frequent. The symptoms can also be a sign of other more common, less serious illnesses. This means that people may end up seeing their GP several times or being sent for a number of different testsbefore pancreatic cancer is even considered. It is important to remember that any of the symptoms described here are common for lots of illnesses and may not be a sign of pancreatic cancer. But if you have persistent unexplained symptoms its important for your GP to refer you for tests to explore what is causing them. It can help to note down the frequency of your symptoms and mention anything unusual you are experiencing, even if it seems unrelated. If your symptoms get worse or you develop any new symptoms suddenly you should always get in touch with your GP. Most common symptoms of pancreatic cancer Most pancreatic cancers are exocrine tumours (90%). Their symptoms can be very vague and depend on whether the tumour is in the head, body or tail of the pancreas. à ¯Ã‚ »Ã‚ ¿Abdominal pain Pain is a symptom in about 70% of pancreatic cancer cases. It often starts as general discomfort or pain in the abdomen (tummy) which can spread to the back. It can be worse after eating or when you are lying down. Sitting forward can sometimes relieve the pain. At first the pain may come and go, but over time it may become more constant. If any of the organs (pancreas, liver or gall bladder) in your abdomen are inflamed or enlarged the area may also be tender to touch. Pain is caused by the cancer affecting nerves or organs near the pancreas. It can also be a result of a tumour causing a blockage in the stomach or duodenum (top part of the small intestines). Jaundice Jaundice occurs in about 50% of pancreatic cancer cases. Its an illness where the skin and the whites of the eyes turn yellow. Other signs of jaundice include dark urine, pale stools and itchy skin. Jaundice develops when there is a build-up in the blood of a chemical called bilirubin. This chemical is always present in the blood. It usually gets removed from the body in the bile fluid produced by the liver which empties into the small intestines through the bile duct. Cancer growing in the pancreas can block the bile duct so that bile and bilirubin keep building up in the body. This is known as obstructive jaundice. Jaundice can be caused by other non-cancerous conditions, such as a gallstone blocking the bile duct, so its important for all the obvious causes to be explored. Weight loss Losing a lot of weight for no particular reason can be a sign that something is wrong. People may also notice a loss of appetite or changes in what they feel like eating. Pancreatic cancer can affect the ability of the pancreas to produce digestive enzymes that help to digest food. This means that the body cant digest food properly or get the nutrients it needs, leading to weight loss. Weight loss is more common with cancers in the head of the pancreas. Other common symptoms of pancreatic cancer These symptoms are also common, though not everyone will have every symptom. People may have these symptoms before a diagnosis, develop them later on, or perhaps not get them at all. Bowel problems A condition called steatorrhoea (stools that are large, pale, oily, floating and smelly) is a common symptom of diseases of the pancreas. It happens because the cancer affects the production of the enzymes needed to digest food, particularly high fat food. Undigested food passing quickly through the body can also cause diarrhoea and subsequent weight loss. Nausea and vomiting Nausea (feeling sick) and sickness can occur for several different reasons. A tumour can block the bile duct or press on the duodenum, which obstructs digestion. It may also cause inflammation around it in the pancreas, or jaundice. Both of these can lead to a chemical imbalance in the body which can make people feel sick. Fever and shivering If the pancreas is inflamed or the ducts are blocked because of the tumour, this can cause a high temperature and shivering. Diabetes Diabetes can develop if a tumour stops the pancreas from functioning properly. This is because the pancreas produces the hormone insulin which the body needs to regulate the amount of sugar in the blood. People with diabetes often feel extremely thirsty, pass more urine than normal, lose weight and feel weak and lacking in energy. Diabetes is particularly associated with pancreatic cancer in older people. If someone develops late onset diabetes with no other explanation their GP should consider the possibility of pancreatic cancer. Symptoms of endocrine pancreatic tumours Less than 5% of all pancreatic cancers are endocrine tumours, which develop in the hormone producing cells of the pancreas. They are divided into functioning and non-functioning tumours, depending on whether or not they overproduce hormones and cause a chemical syndrome. Most endocrine tumours do not produce a clinical syndrome (non-functioning) so they do not cause specific symptoms. As they grow or spread they may cause pain, jaundice or a lump that can be felt in the abdomen. Some endocrine tumours overproduce hormones and cause a clinical syndrome (functioning). These give rise to different symptoms depending on the type of tumour and the hormone it produces. Gastrinomas overproduce gastrin, which causes peptic ulcers in the stomach or duodenum. Symptoms include severe pain, black tarry stools and diarrhoea. Glucagonomas overproduce glucagon. Symptoms include a specific type of skin rash (redness, ulceration and scabbing), anaemia (lack of red blood cells), weight loss and inflammation inside the cheeks and lips. Insulinomas overproduce insulin, leading to hypoglycaemia (low blood sugar levels). Symptoms may include weakness, drowsiness, dizziness or lack of energy. Somatostatinomasoverproduce somatostatin, which causes gall stones, diabetes, diarrhoea and steatorrhoea. VIPomas overproduce a hormone called vasoactive intestinal peptide (VIP). Symptoms include watery diarrhoea, high blood pressure and flushing of the face. 2009, Nick James and the late Sally Tweddle Pancreatic cancer symptoms This page has information on the symptoms of pancreatic cancer. You can find the following information A quick guide to whats on this page Early symptoms Other symptoms of pancreatic cancer Symptoms from endocrine pancreatic tumours More information Open box A quick guide to whats on this page Pancreatic cancer symptoms The most common type of cancer of the pancreas are exocrine tumours. The symptoms can be quite vague. And they vary depending on where the cancer is in your pancreas in the head, body or tail. Early symptoms can include weight loss, pain in the stomach area, back pain and jaundice. More than half of patients have jaundice when they first go to their doctor. Jaundice without pain is the most common reason for first going to the doctor in patients who have pancreatic cancer that can be removed with surgery. Symptoms of jaundice can include yellowing of the skin and whites of the eyes, severe itching, darkened urine, and pale coloured stools (bowel motions). Other symptoms There are other symptoms that you can have with cancer of the pancreas. These include diabetes, itching, sickness, change in bowel motions, fever and shivering. There is an uncommon group of pancreatic tumours called neuroendocrine tumours. About a third of these produce hormones. The symptoms are different for each type, depending on the hormone the tumour makes. You can view and print the quick guides for all the pages in the about pancreatic cancer section. Back to top Early symptoms The commonest types of cancer of the pancreas are exocrine tumours. The symptoms can be quite vague. And they vary depending on where the cancer is in your pancreas in the head, body or tail. Early symptoms can include Weight loss Pain in the stomach area Jaundice More early symptoms Weight loss People diagnosed with pancreatic cancer may have recently lost a lot of weight (at least 10% of their total body weight) for no apparent reason. This symptom is more common in cancers of the head of the pancreas. Pain in the stomach area About 7 out of 10 people with pancreatic cancer first go to their doctors because they have pain. Pain is more common in cancers of the body and tail of the pancreas. People describe it as a dull pain that feels as if it is boring into you. It can begin in the stomach area and spread around to the back. The pain is worse when you lie down and is better if you sit forward. It can be worse after meals. Your abdomen may also be generally tender or painful if your liver, pancreas or gallbladder are inflamed or enlarged. Jaundice More than half of patients have jaundice when they first go to their doctors. Jaundice is yellowing of the skin and whites of the eyes. The urine is darker than normal and bowel motions may be lighter in colour. Jaundice is more common with cancer of the head of the pancreas because the tumour blocks the bile duct. This tube carries bile into the duodenum. If it is blocked the bile ends up in your bloodstream instead. Bile contains a lot of yellow pigments so it turns the skin yellow. Jaundice is a common symptom of many liver and gallbladder diseases. It is often easier to spot in the whites of the eyes rather than the skin. More early symptoms Other early symptoms might include loss of appetite and back pain. Back to top Other symptoms of pancreatic cancer There are other symptoms that you can have with cancer of the pancreas. You may have any of these symptoms from before you are diagnosed. Or you may develop them later. Of course, you may not have all of them. Not everyone has every symptom. But these non specific symptoms are common in pancreatic cancer. You may have Diabetes Itching Sickness Bowel changes Fever and shivering Diabetes Some people diagnosed with cancer of the pancreas are found to be newly diabetic. Some have been diagnosed with diabetes within the previous year. If you have diabetes you are not producing enough insulin. So there is too much sugar in your blood. The sugar is passed out of the body in the urine and takes a great deal of water with it. This causes Thirst Passing a lot of urine Weakness Weight loss and hunger Itching You may have itching if you have bad jaundice. The bile salts in the bloodstream cause itching in the skin. Sickness You may feel or be sick because you have jaundice or an inflamed pancreas. Both these conditions upset the delicate chemical balance of the body, which can make you sick. You may also be sick if the cancer, or inflammation around it, is beginning to block the duodenum. This will stop digested food from passing through to the small bowel. Bowel changes Again, if you have jaundice you may develop a symptom called steatorrhoea. This means fatty stools. You may pass frequent, large bowel motions that are pale coloured and smelly. These bowel disturbances can mean that you are not absorbing your food properly. So this may be a cause of weight loss. Fever and shivering You may have a temperature from time to time because you have jaundice or an inflamed pancreas. When your temperature is high you may feel cold and shivery. Back to top Symptoms from endocrine pancreatic tumours Endocrine pancreatic tumours are uncommon. They are also called neuroendocrine tumours. About a third of these pancreatic tumours produce hormones (functional tumours). The symptoms are different for each type, depending on the hormone the tumour produces. They are Insulinoma Gastrinoma Somatostatinoma VIPoma Glucagonoma Insulinomas Insulinomas produce too much insulin, causing weakness, loss of energy, dizziness and drowsiness. Gastrinomas Gastrinomas produce too much gastrin, causing peptic ulcers in the stomach or duodenum. This leads to severe pain, bleeding causing black tarry stools (faeces), and diarrhoea. Somatostatinomas Somatostatinomas produce too much of a hormone called somatostatin. This causes gallstones, diabetes and diarrhoea with bulky fatty and smelly stools (steatorrhoea). VIPomas VIPomas produce too much of a hormone called VIP. This causes a great deal of watery diarrhoea, flushing of the face, and high blood pressure. Glucagonomas Glucagonomas produce too much of a hormone called glucagon. This causes a very specific type of skin rash (redness, ulceration and scabbing), anaemia, mouth ulcers and diarrhoea. About two thirds of pancreatic neuroendocrine tumours do not produce hormones and so do not cause specific symptoms. As these tumours get larger or spread they may cause symptoms such as pain, a lump in the abdomen or jaundice. The average general health article on pancreatic cancer states flatly that there are no early symptoms of pancreatic cancer. People diagnosed with pancreatic cancer are typically already in the advanced stage of the disease by the time its caught, and the typical prognosis is death within five years. With pancreatic cancer much on everyones mind due to the untimely death of Steve Jobs, it seems like a good time to ask the question thats on all of our minds:Are there any early warning signs of pancreatic cancer? The answer is yes, there are. But to understand these signs and symptoms of pancreatic cancer, its important to understand where the pancreas is, and what it does. Located deep inside the abdomen, the pancreas is only 4 to 6 inches long and shaped like a tadpole. In the tail of the pancreas are cells that produce insulin, and tumors at this end are usually endocrine tumors. Theyre easier to diagnose, but are much rarer. At the other end, the head of the pancreas, are cells that produce digestive enzymes, and tumors at this end are called exocrine tumors. These are by far the most common, and are much more difficult to detect. However, the idea that a pancreatic tumor is asymptomatic is a bit of a myth. Dig deep into journal articles and ask patients what they remember and the result is a long list of odd signs and symptoms of pancreatic cancer to watch out for. Taken one by one, these symptoms could mean many things. But if you find yourself experiencing two or three of these early warning signs of pancreatic cancer, call your doctor and ask for a scan. Imaging techniques such as MRIs can detect pancreatic cancer some of the time, depending on the location of the tumor. Early Warning Signs of Pancreatic Cancer Diabetes, especially if it comes on suddenly. Recently, the Mayo Clinic published startling research showing that 40 percent of pancreatic cancer patients had been diagnosed with diabetes one to two years before discovering they had a pancreatic tumor. Researchers believe the diabetes is caused by tumors that simply havent been detected yet. The problem is, diabetes is very common, and the majority of diabetes isnt pancreatic cancer, so doctors are trying to develop screening tools to tell the difference. Right now, they say family history is an important clue. If youre diagnosed with diabetes that seems to come on suddenly and you have no family history of diabetes, bring this to your doctors attention and ask for further screening for pancreatic cancer. Yellowing of the eyes or skin. Even a small pancreatic tumor can block the bile duct in the head of the pancreas, causing bile to build up. This causes jaundice. Itchy skin, palms, and soles of feet. A little-known side-effect of jaundice is itchy hands and feet. Its due to a skin reaction to the bilirubin, the yellowish brown liver chemical that causes jaundice. Lack of appetite. An Italian study found that six to eight months before being diagnosed with pancreatic tumors, patients reported a sudden drop in their appetite and a tendency to feel full after eating very little. Changes in taste. In the same Italian study, some of the patients surveyed said theyd suddenly lost their taste for coffee, wine, and smoking. In fact, they said, they felt disgust for the smell and taste of coffee and alcohol. Abdominal pain. Pancreatic cancer sufferers remember this pain as a gnawing pain, rather than a sharp cramp or ache, and it radiates toward the back. A characteristic clue: the pain goes away when you lean forward. An enlarged gall bladder. The same blockage of the bile duct that causes jaundice can also cause an enlarged gallbladder, as the bile builds up behind the duct. The good news is that an enlarged gallbladder can be seen on imaging tests, and it may even be possible for a doctor to feel it during a physical exam. Pale, floating, smelly stools. If a pancreatic tumor prevents digestive enzymes from reaching the intestine, the result is an inability to digest fatty foods. So you end up with loose, smelly floaters as a result of the excess fat. Doctors say this symptom, in particular, can be an early clue and is too often overlooked. Dark, tarry stools. Bleeding in the upper intestines causes this symptom. Sudden, unexplained weight loss. Weight loss is not always, as many people mistakenly believe, a sign of advanced cancer thats spread to the liver. It can also happen because a lack of pancreatic enzymes is causing fat to pass through the body undigested. What do you do if youre worried about any of these symptoms? Document all symptoms, and report them to your doctor in as much detail as possible. If your doctor is convinced you have legitimate concerns (and remember, you may have to do some convincing) tests such as an ultrasound, a CT scan, and an endoscopy followed by a biopsy can be used to search for a pancreatic tumor. Theres also a blood test for a biomarker called CA-19-9 that can be used in conjunction with other tests to diagnose pancreatic cancer early. While tragic early deaths like Steve Jobs are the hard reality of pancreatic cancer, there are also people living productive lives thanks to an early diagnosis of pancreatic cancer. Such was the case with Supreme Court Justice Ruth Bader Ginsburg, whos still practicing after having a tiny pancreatic tumor surgically removed. Yes, she got lucky, as she put it but she also got a CT scan, which is how the tumor was found. Further Reading: Islet Cell Tumors (Endocrine Pancreas) Treatment (PDQ ®) Pancreatic Islet Cell Transplantation for Diabetes-Topic Overview Pancreatic Islet Cell Transplantation for Diabetes-Related Information Pancreatic Islet Cell Tumor Islet Cell Carcinoma (Endocrine Pancreas) Islet Cell Carcinoma (Endocrine Pancreas) Islet Cell Carcinoma (Endocrine Pancreas) See All Islet Cell Tumors Topics