Pancreatic Cancer: Early Symptoms You Should Not Ignore

Why pancreatic cancer is noticed late

The pancreas lies deep, behind the stomach, and a small tumor in it causes no symptoms for a long time. When symptoms do appear, they are often vague: abdominal discomfort, nausea, weakness. Such complaints occur in many common conditions, so they are easy to overlook.

The stage at which the tumor is found decides whether it can be removed. Whether surgery can be done straight away depends on how the tumor relates to the major veins and arteries and whether there are distant metastases. If the tumor is in contact with blood vessels, chemotherapy is often given first, after which surgery becomes possible for some patients^[1]. For stages and treatment, see the page on pancreatic cancer.

Early symptoms that should raise concern

The symptoms depend on where exactly the tumor is. A tumor in the head of the pancreas blocks the bile duct early, so the first sign is often jaundice. Tumors of the body and tail stay silent longer and are more often found at a later stage^[1].

• Painless jaundice. The whites of the eyes and the skin turn yellow, the urine darkens, the stools become pale, and itching may appear^[2].
• Unexplained weight loss. You lose weight although you have not changed your diet or tried to slim down.
• Pain in the upper abdomen or in the back that does not go away.
• Nausea and vomiting^[2].
• Pale, fatty, foul-smelling stools that are hard to flush. This happens when the pancreas produces too few enzymes to digest fat.
• Diabetes that first appears after 50, especially together with weight loss, or worsening of existing diabetes^[1].

A large study of UK family doctors’ patient records found nine features linked to pancreatic cancer in the year before diagnosis: jaundice, weight loss, abdominal pain, nausea and vomiting, back pain, constipation, diarrhea, malaise and new-onset diabetes. The most common was abdominal pain, in about 4 in 10 patients, followed by jaundice and new diabetes. Weight loss was less common, in about 1 in 10, but alongside jaundice it was the strongest signal^[2].

Does such a symptom mean cancer?

Usually not. In the same study, among patients aged 60 and over, a single symptom such as abdominal pain or weight loss meant pancreatic cancer in fewer than 1 in 100 cases. The exception was jaundice: at this age it turned out to be caused by pancreatic cancer in about 1 in 5. A combination of several symptoms raised the likelihood^[2].

So the conclusion is simple: abdominal pain, nausea or weight loss on its own is a reason to see a doctor in the usual way, not to think about cancer. But jaundice, or several warning symptoms together, needs tests without delay.

Diabetes after 50: when to pay attention

In some people, diabetes appears as one of the first signs of pancreatic cancer^[1]. In a study of people aged 50 and over who were newly diagnosed with diabetes, about 1 in 100 were found to have pancreatic cancer within three years. In more than half of them, the cancer was diagnosed within the first six months after the diabetes^[3].

In other words, for most people new diabetes is simply diabetes. But researchers noticed that the risk is higher when diabetes appears together with weight loss and a rapid rise in blood sugar, and the older the person is when it is diagnosed^[4]. If diabetes has appeared after 50 and you are losing weight at the same time, tell your doctor and discuss testing of the pancreas.

Symptoms you should not wait with

Unexplained weight loss, pain in the abdomen or back, or new diabetes after 50 is a reason to see a doctor. If several of these signs appear at once, tests should not be put off. I explain how the causes of jaundice are told apart in the article is obstructive jaundice always cancer?

Which test is needed

If pancreatic cancer is suspected, the main test is a contrast-enhanced CT scan with a pancreatic protocol^[1]. It shows the tumor and its relationship to the major blood vessels, which is what decides whether surgery is possible.

The CA 19-9 tumor marker is not suitable for detecting pancreatic cancer: in some people with the cancer it stays normal. It is used once the diagnosis has been made, to assess the extent of the disease and to monitor treatment^[1].

If the CT shows a tumor, a multidisciplinary team decides whether to operate straight away or to start with chemotherapy. Before chemotherapy, the diagnosis has to be confirmed by a biopsy, preferably during endoscopic ultrasound. If surgery is planned straight away, a biopsy is usually not done^[1]. For tumors in contact with major blood vessels, see the page on borderline resectable pancreatic cancer.

What to do if you have warning symptoms

1. Tell your doctor about all your symptoms togetherWeight loss, pain, changes in your stools, new diabetes: on their own they may seem minor, but together they matter more.
2. Know the warning signsJaundice with a fever: go to a hospital within 1–2 hours; jaundice without a fever: see a doctor the same day. Confusion, severe dizziness or fainting: call 103.
3. If a tumor is suspectedA contrast-enhanced CT scan with a pancreatic protocol is needed. A CA 19-9 test does not replace it.
4. Show your results to a surgeonSend your CT or MRI: the online consultation is free. We discuss a treatment plan after a full work-up and a multidisciplinary team review.

Sources

1. Conroy T, Pfeiffer P, Vilgrain V, et al. Pancreatic cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2023;34(11):987–1002. PMID 37678671
2. Stapley S, Peters TJ, Neal RD, et al. The risk of pancreatic cancer in symptomatic patients in primary care: a large case-control study using electronic records. Br J Cancer. 2012;106(12):1940–1944. PMID 22617126
3. Chari ST, Leibson CL, Rabe KG, et al. Probability of pancreatic cancer following diabetes: a population-based study. Gastroenterology. 2005;129(2):504–511. PMID 16083707
4. Sharma A, Kandlakunta H, Nagpal SJS, et al. Model to Determine Risk of Pancreatic Cancer in Patients With New-Onset Diabetes. Gastroenterology. 2018;155(3):730–739.e3. PMID 29775599

This article is for general information and does not replace a consultation: the cause of symptoms is determined after examination and tests.