Signs and symptoms of exocrine pancreatic cancer
Early pancreatic cancers often do not cause any signs or symptoms. By the time they do cause symptoms, they have often already grown through the pancreas or spread beyond it.• Abdominal or back pain
Pain in the abdomen (belly) or back is common in pancreatic cancer. Cancers that start in the body or tail of the pancreas can grow fairly large and start to press on other nearby organs, causing pain. The cancer may also spread to the nerves surrounding the pancreas, which often causes back pain. Of course, pain in the abdomen or back is fairly common and is most often caused by something other than pancreatic cancer.
• Blood clots
Sometimes, the first clue that someone has pancreatic cancer is the development of a blood clot in a large vein, often in the leg. This is called a deep venous thrombosis or DVT. Symptoms can include pain, swelling, redness, and warmth in the affected leg. Sometimes a piece of the clot can break off and travel to the lungs, which might make it hard to breathe or cause chest pain. A blood clot in the lungs is called a pulmonary embolism or PE.
• 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.
• Diabetes
Diabetes can develop if a tumour interferes with the pancreas working 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 over 50 has developed type 2 diabetes within the past two years, with no other explanation, their GP should consider the possibility of pancreatic cancer.
• Digestive problems
Pale, greasy stools: If cancer blocks the release of the pancreatic juice into the intestine, a person might not be able to digest fatty foods. The undigested fat can cause stools to be unusually pale, bulky, greasy, and to float in the toilet.
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.
• Fatty tissue abnormalities
Some people with pancreatic cancer develop an uneven texture of the fatty tissue underneath the skin. This is caused by the release of the pancreatic enzymes that digest fat.
• 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.
• Gallbladder enlargement
If the cancer blocks the bile duct, bile can build up in the gallbladder, which then becomes enlarged. This can sometimes be felt by a doctor (as a large lump under the right ribcage) during a physical exam. It can also be detected by imaging tests.
• Indigestion/heartburn
New, unexplained and persistent dyspepsia (indigestion/heartburn) can be a symptom of pancreatic cancer, particularly in older people.
• Jaundice and related symptoms
Jaundice is yellowing of the eyes and skin. Most people with pancreatic cancer (and virtually all people with ampullary cancer) will have jaundice as one of their first symptoms. Signs and Symptoms of Pancreatic Cancer.
Jaundice is caused by the buildup of bilirubin, a dark yellow-brown substance made in the liver. Normally, the liver excretes bilirubin as part of a liquid called bile. Bile goes through the common bile duct into the intestines, eventually leaving the body in the stool. When the common bile duct becomes blocked, bile can’t reach the intestines, and the level of bilirubin in the body builds up.
Cancers that start in the head of the pancreas are near the common bile duct. These cancers can press on the duct and cause jaundice while they are still fairly small, which may allow these tumors to be found at an early stage. But cancers that start in the body or tail of the pancreas don’t press on the duct until they have spread through the pancreas. By this time, the cancer has often spread beyond the pancreas as well.
When pancreatic cancer spreads, it often goes to the liver. This can also lead to jaundice.
- Dark urine: Sometimes, the first sign of jaundice is darkening of the urine from bilirubin. As bilirubin levels in the blood increase, the urine becomes brown in color.
- Light-colored stools: If the bile duct is blocked, bile (and bilirubin) can’t get through to the bowel. When this happens, a person might notice their stools becoming lighter in color.
- Itchy skin: When bilirubin builds up in the skin, it can start to itch as well as turning yellow.
• Weight loss and poor appetite
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, especially high fat food. This means that the body can't digest food properly or get the nutrients it needs, leading to weight loss.
Signs and symptoms of pancreatic neuroendocrine tumors
Pancreatic neuroendocrine tumors (NETs) often release excess hormones into the bloodstream. Different types of tumors make different hormones, which lead to different symptoms.• Carcinoid tumors
These tumors often make serotonin or its precursor, 5-HTP. When a pancreatic tumor makes these substances, they first travel to the liver. The liver breaks these substances down before they can reach the rest of the body and cause problems. Because of this, carcinoid tumors often don’t cause symptoms until they spread outside the pancreas.
When these tumors do spread, it is most often to the liver. There, the cancer cells can release hormones directly into the blood leaving the liver. This can cause the carcinoid syndrome, with symptoms including flushing (skin turning red with a warm feeling), diarrhea, wheezing, and a rapid heart rate. These symptoms often occur in episodes, between which the person may feel fine.
• Gastrinomas
These tumours occur in the head of the pancreas and the duodenum. They overproduce a hormone called gastrin, which can cause peptic ulcers in the stomach or duodenum. This can result in severe pain, bleeding (causing black, tarry stools) and diarrhoea. Gastrinomas are the second most common of the different functioning endocrine tumours.
Gastrinomas can be associated with a hereditary syndrome called Multiple Endocrine Neoplasia, type 1 (MEN-1) where several tumours develop in different endocrine glands, including the pancreas.
• Glucagonomas
These tumours overproduce a hormone called glucagon, which normally helps to regulate the amount of glucose (sugar) in the blood. Symptoms include a specific type of skin rash (redness, blistering and scabbing), anaemia (lack of red blood cells), weight loss and inflammation inside the cheeks and lips. Glucagonomas are most often found in the tail of the pancreas. The tumours often spread outside the pancreas (metastasise), commonly to the liver. Glucagonomas mostly affect post-menopausal women.
• Insulinomas
These tumours overproduce the hormone insulin, which can lead to symptoms of hypoglycaemia (low blood sugar), such as weakness, loss of energy, dizziness and drowsiness. They are the most common type of sporadic functioning endocrine tumours. Insulinomas tend to occur in middle age and are slightly more common in women than men. Insulinomas can occur in MEN-1 but less commonly than gastrinomas.
• Non-functioning neuroendocrine tumors
These tumors don’t make excess hormones, so they don’t cause symptoms in early stages and often grow quite large before they are found. Most of these are cancers and start to cause problems as they get larger or spread outside the pancreas. Symptoms can be like those from exocrine pancreas cancers, including jaundice (yellowing of the eyes and skin), belly pain, and weight loss.
• PPomas
These tumors make pancreatic polypeptide (PP), which helps regulate both the exocrine and endocrine pancreas. They can cause problems such as belly pain and an enlarged liver. Some patients also get watery diarrhea.
• Somatostatinomas
These tumors make somatostatin, which helps regulate other hormones. Symptoms of this type of tumor can include diarrhea, gallbladder problems, and symptoms of diabetes (feeling thirsty and hungry, and having to urinate often). The problems with the gallbladder can lead to belly pain, nausea, poor appetite, and jaundice (yellowing of the skin and eyes).
The early symptoms of a somatostatinoma tend to be mild and are more often caused by other things, so these tumors tend to be diagnosed at an advanced stage. Often, they are not found until they spread to the liver, when they cause problems like jaundice and pain.
• VIPomas
These tumours overproduce a hormone called vasoactive intestinal polypeptide (VIP). This causes a great deal of watery diarrhoea and sometimes flushing of the face. This condition is also known as watery diarrhoea and hypokalaemia achlorhydria (WDHA) or Verner-Morrison Syndrome after the doctors who discovered it. VIPomas occur most frequently in the tail of the pancreas. They are more common in women than men. Signs and Symptoms of Pancreatic Cancer