Pancreas Cancer Symptoms

Pancreas Cancer Symptoms

This article describes the symptoms that may occur with pancreatic cancer. Pancreatic cancer is a common cancer and is the 10th most common among men and women in the United States. Pancreatic cancer is difficult to treat and many people already have spread of tumor cells outside of the pancreas by the time they are diagnosed. Pancreatic cancer is the fourth most common cause of death from cancer in the United States for both men and women. There are several different types of pancreatic cancer; the most common is ductal adenocarcinoma. The emphasis with symptom description will be towards pancreatic ductal adenocarcinoma in the head of the pancreas. This location typically has the earliest presentation and the best potential for cure compared with other sites.

Treatment options for pancreas cancer are fairly limited. Some cancers, such as breast cancer, have numerous treatment options often with similar survival and long-term outcomes. On the other hand, pancreas cancer often has a relatively small window for cure and almost always involves surgery to remove the tumor. There are several effective assistant therapies (notably gemcitabine) which can help control the tumors growth but are not curative.

The symptoms of pancreas cancer can be understood by having an appreciation of the anatomy and basic function of the pancreas. The important structures that are in proximity to the pancreas include intestine (duodenum, pylorus), blood vessels (superior mesenteric artery and vein), nerves (celiac ganglion), multiple lymphatic channels and nodes, bile ducts and drainage of the liver, and the functional units of the pancreas supply both endocrine and exocrine products.

The frequency of symptoms with pancreatic cancer varies based upon the location of the tumor. The tumors that cause symptoms earlier are those that arise in the head of the pancreas because of their proximity to so many key structures. Tumors of the tail of the pancreas may grow for some time before they are noticed. Common symptoms seen with tumors of the head of the pancreas include the following:

  • Weight Loss 92%
  • Abdominal Pain 72%
  • Jaundice 82%
  • Changes in stool/urine color 63%
  • Loss of appetite 64%
  • Nausea 35%
  • Fatigue and weakness 35%
  • Vomiting 35%
  • Itching and skin rash 25%

Tumors of the body or tail of the pancreas cause a similar set of symptoms with the notable exception that jaundice is not as frequent.

Weight Loss: Weight loss is often the earliest and most concerning symptom. An unintentional weight loss of more than 10% should prompt some type of investigation as to the cause. There are many causes for weight loss that are not cancer such as overactive thyroid gland. Many cancers cause weight loss. The reason for this weight loss is complex is from a combination of; 1) high amounts of calories burned by the tumor, 2) secreted hormones that take away appetite, and 3) blockage of the intestine causing malabsorption or obstruction.

Depression: For a variety of reasons, likely related to hormone production by the tumor, depression seems to occur with pancreatic cancer. Having a bad cancer is often depressing but the depression often occurs before the person knows about the diagnosis. Certainly depression is not specific for cancer and the vast majority of people with depression do not have cancer.

Blockage of the ducts as well as invasion of the liver with pancreatic cancer causes liver failure. Liver failure is responsible for many of the late symptoms of pancreatic cancer such as jaundice as well as being one of the causes of death.

Jaundice: Jaundice is the most common symptom that causes someone to seek medical attention despite weight loss being more common. Jaundice refers to a yellow or orange discoloration of the skin, mucus membranes and eyes. This occurs when bile is blocked from emptying from the liver. Bile is a key component of the digestion of dietary fats. Bile acts as a soap to emulsify fats and assist in digestion. Enzymes from the pancreas such as lipase then help to break the fats down in order to be digested. In addition to problems with digestion, difficulty in fat absorption causes vitamin deficiency in the fat soluble vitamins (i.e. Vitamins D, E, A, and K). When jaundice is severe it causes severe rash and skin itching which can be unbearable. Blockage of bile can occasionally cause a buildup of bacteria within the bile ducts. Infection of the bile ducts is known as cholangitis and can create serious illness or death if not relieved. Bile is responsible for the brown color of stool. Without bile, the stools become pale or white and fatty. A buildup of bile in the body causes it to stain the urine dark brown. Both of these changes in elimination can be very concerning for the patient.

Nausea and Vomiting: Tumors of the head of the pancreas can compress or grow into the first portion of the small intestine. As the outlet of the stomach is blocked, nausea and dehydration can occur. With severe dehydration, kidney failure develops. Continuous vomiting also causes dangerous electrolyte disorders. Weight loss and lack of appetite further compound the weight loss. Importantly, weight loss and vomiting cause depletion of body protein can cause severe malnutrition. A person with severe malnutrition will not be fit enough to undergo a major operation to cure a pancreatic cancer. This places the person in a very difficult position. The appearance of weight loss, nausea or jaundice should prompt notification of a physician to investigate as to the cause of it.

With the appearance of some or all of the above symptoms, the usual steps involve examination and blood work to assess the function of the liver, pancreas and kidneys. Some type of imaging is required if pancreas cancer is suspected. This is most commonly a CAT scan. Pancreas cancer is unusual in that a sample of cells is not required to make the diagnosis or to establish a treatment plan. The important point is that the above symptoms should be investigated quickly and not ignored.

REFERENCES:

  1. Townsend Jr, CM; Beauchamp RD; Evers BM; Mattox KL. (2008) Townsend: Sabiston Textbook of Surgery, 18th ed. Chapter . New York, NY: Saunders.
  2. www.cancer.gov/cancertopics/types/pancreatic
  3. seer.cancer.gov/statfacts/html/pancreas.html
  4. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.