Pancreatic Cancer

Signs and symptoms of pancreatic cancer

Most cancers of the pancreas are adenocarcinomas. Early cancer of the pancreas may cause no symptoms. When symptoms occur, they are often vague at first and may depend on where in the pancreas the cancer is. The commonest symptoms are pain typically in the upper central abdomen but can be any part of the abdomen, back pain, loss of appetite and loss of weight and steatorrhoea (see below). The symptoms experienced with other forms of pancreatic cancer may be different.

The pain often starts as general discomfort or pain in the abdomen (tummy) which can spread to the back. Early on the pain may come and go but it can become persistent as the disease develops. Pain is often described as getting worse after meals or by lying down. Some patients have pain at night and disturbed sleep. Sometimes they report pain as a pulled muscle or as joint or bone pain.

The most common sign of this type of pancreatic cancer is jaundice. This is most likely to occur when the cancer is in the head of the pancreas. People with jaundice may have yellow skin, yellow eyes, dark urine, pale stools and an itchy skin. Other symptoms can include nausea and sickness and changes to bowel habit. There may be general abdominal discomfort.

Pancreatic cancer can be difficult to diagnose because most pain in the abdomen is due to other things. Initially doctors may suspect pancreatitis, a stomach or duodenal ulcer, a pulled muscle, irritable bowel syndrome (IBS), a hiatus hernia or gall stones.

Although many people had noticed pain under their ribs or in the upper abdomen, some had had pain in other areas of the body too.

Some people recalled that they (or a family member later diagnosed with pancreatic cancer) had initially developed jaundice. Jaundice is caused by a blockage in the biliary system, which is the drainage system of the gallbladder, liver, and pancreas. The blockage causes yellow coloured bile to leak into the bloodstream leading to itching, a yellowish pigmentation of the skin and the whites of the eyes and darkened urine and pale stools. The blockage will also stop digested food from passing into the small bowel, sometimes causing symptoms of indigestion, nausea and vomiting after eating, particularly at night.

Jaundice maybe noticed by a doctor before the patient is aware of it. Having jaundice without other symptoms may not be a diagnosis of pancreatic cancer but always needs further investigation. NICE – The National Institute of Health and Care Excellence issued guidance in June 2015 (updated July 2017) and doctors should: “Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for pancreatic cancer if they are aged 40 and over and have jaundice.”

When William developed jaundice both his GP and a consultant first thought that he had had an allergic reaction to penicillin and his jaundice was identified by a blood test before he became yellow. 
Some people we talked to noticed that their bowel habits had changed or that their faeces had become pale, floated in the lavatory pan and were hard to flush away. The latter occurs when the faeces contain undigested fat, a condition called steatorrhoea. This may result from a blockage in the pancreas or bile duct. A few also commented that their faeces had been unusually smelly. Sometimes patients report taste changes. Some people we interviewed had had a strange metallic taste in their mouth.

Weight loss is a common symptom of pancreatic cancer. This may be because of poor absorption of food, poor appetite, nausea, and sickness. Other symptoms can be indigestion and bloating of the stomach, particularly after meals. People may also feel very tired. This may be due to loss of muscle strength.

A tumour in the pancreas can cause diabetes. Diabetes may be diagnosed at the same time as the pancreatic cancer or beforehand. Common symptoms of diabetes are hunger, thirst and weight loss. Steve noticed that his vision had deteriorated. He also had leg cramps at night and he was very thirsty. He had recently had his eyes tested so was perplexed. He went to another optician, who referred him to an ophthalmologist. Meanwhile, Steve decided to have a blood test and a doctor diagnosed diabetes. Then Steve developed jaundice, and his skin became itchy. He had an ultrasound scan, which revealed that a tumour in his pancreas had caused his diabetes.

NICE’s June 2015 guidance says that doctors should now “Consider an urgent direct access CT scan (to be performed within 2 weeks), or an urgent ultrasound scan if CT is not available, to assess for pancreatic cancer in people aged 60 and over with weight loss and any of the following:

  • diarrhoea
  • back pain
  • abdominal pain
  • nausea
  • vomiting
  • constipation
  • new onset diabetes.”

Other people we talked to remembered more unusual symptoms. Michael said that after drinking wine he would wake in the night with indigestion and ‘the shivers’ and that he would sweat for the next 12 hours. Maureen said that she felt as though she had ‘an alien’ just under her ribs. Davinder and Ben had other unusual symptoms.

There are less common types of pancreatic cancer, such as the neuroendoncrine tumours, which produce an excess of hormones, such as insulin. This may lead to weak or dizzy feelings, chills, muscle spasms, or diarrhoea. Others (non-functioning islet cell tumours) do not produce excessive amounts of hormones in the blood, and can grow for a long time before doctors make a diagnosis.

Some people tried to treat their symptoms with over-the-counter remedies or by altering their diet without success before seeing a doctor. Most consulted their GP, some on more than one occasion, and a few whose symptoms became severe out-of-hours went straight to hospital. Because the symptoms can be so vague and non-specific it often took a long time to reach a diagnosis of pancreatic cancer. Some people had their symptoms treated for a while before any tests were done. Referrals to hospital, or specific tests, were not always requested urgently if the doctor didn’t suspect cancer. Some people said that with hindsight they felt upset or frustrated by these diagnostic delays and wondered whether an earlier diagnosis might have offered them different treatment options.

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Last reviewed September 2018.
Last updated September 2018.


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