Symptoms of Pancreatic Cancer

Pancreatic cancer often produces few symptoms in the early stages of the disease. Many symptoms of pancreatic cancer are vague and nonspecific in the beginning, so patients may ignore them. The best information available suggests that pancreatic cancer grows slowly for years before causing any symptoms at all, making it difficult for a patient or doctor to recognize a problem.  There are several symptoms commonly associated with pancreatic cancer, but all of them are nonspecific and are more frequently caused by other conditions.

Jaundice

Obstructive jaundice develops when the bile duct is blocked and the bile backs up into the blood stream.  Patients with jaundice have dark urine, often described as “cola” colored, light stools (clay colored), yellow eyes, and darkening of the skin.  The bilirubin in the skin often causes pruritis (itching).

The most common cause, by far, of obstructive jaundice is a gallstone that has left the gallbladder and lodged in the common bile duct (the conduit from the liver and gallbladder to the small intestine).  However, a cancer in the head of the pancreas can also obstruct the common bile duct, creating jaundice.  While jaundice from a gallstone is usually associated with pain, pancreatic cancer is classically described as causing “painless jaundice.”

Although pancreatic cancer classically presents as “painless jaundice,” in fact, many patients with pancreatic cancer will experience abdominal or back pain.

Digestive Trouble

Digestive difficulties including indigestion, nausea, weight loss, a poor appetite, and diarrhea, are not uncommon in patients with pancreatic cancer and are likely due to direct involvement of a portion of the digestive tract by the tumor, or infiltration of the nerves to the digestive tract by the tumor.  If the tumor blocks the digestive tract, the patient will suffer nausea, vomiting, and pain which may worsen after eating.

The pancreas makes enzymes that are necessary to breakdown the food that we eat so that it can be absorbed by the small intestine.  Many patients with pancreatic cancer will not release enough pancreatic enzymes into the small intestine to properly digest their food, especially the fat that is eaten.  This can be either due to poor function of the pancreas, or blockage of the pancreatic duct by the tumor, preventing the release of the enzymes into the intestine.  Diarrhea results when the nutrients in food are not absorbed properly. When this occurs, stool may float due to the higher fat content, appear bulky, greasy, and unusually pale.

Just the presence of many tumors will cause weight loss, and pancreatic cancer is no exception.  In addition to this, pancreatic cancer often causes indigestion, bloating and abdominal discomfort due to the local effects on the digestive system.  Weight loss can be further exacerbated by a lack of pancreatic enzymes from obstruction or dysfunction of the pancreas.

Fluid in Abdomen (Ascites)

Patients with pancreatic cancer can develop fluid in the abdomen which is called ascites.  In patients with pancreatic cancer, the ascites has two potential causes.  In patients with locally advanced disease, the cancer can obstruct the portal vein.  In this situation, the blood draining from the intestine to the liver is blocked and the pressure that develops in the bowel causes fluid to leak into the abdomen.  The second potential cause of ascites in patients with pancreatic cancer is from tumor that has spread into the peritoneal cavity (the sac that holds all of the abdominal organs).  The fluid buildup can be massive and very uncomfortable and can even affect a patient’s breathing.  Often the fluid can be controlled with medications (diuretics), but some patients will require drainage of the fluid (paracentesis).  Although ascites can develop in patients with pancreatic cancer, there are many other causes such as cirrhosis.

New / Sudden Onset Diabetes

New onset diabetes, or difficulty in maintaining normal blood sugar in a previously well controlled diabetic, are warning signs for pancreatic cancer.  Patients with  diabetes do not make enough insulin to properly control their blood sugar.  While, for some patients the blood sugar can be reduced by adjusting the diet, many patients with diabetes will require medication, either in the form of pills (oral hypoglycemic agents) or insulin injections.  While new onset or worsening diabetes is a warning sign of pancreatic cancer, the vast majority of diabetics do not have and will never develop pancreatic cancer.