Pancreatic cancer rarely presents in the early stages. Almost 50% of the patients presents to the emergency department with non specific abdominal pain or jaundice or both (1).
Presenting features of pancreatic carcinoma include:
- abdominal pain
- most common presenting feature and seen in up to two thirds of cases
- typically patients complian of a deep epigastric pain, which in 60% of cases, radiates to the back
- it is a very hard pain to treat.
- jaundice with pruritus if tumour affects head of the pancreas and obstructs the biliary system; occurs in 50%
- 46% will present with both pain and jaundice
- pateints with painless jaundice have a better prognosis than patients who with pain alone
- jaundice in association with body or tail tumours usually represents advanced disease (2)
- unexplained weight loss - due to anorexia or malabsorption
- ascites with a knobbly liver in 30%
- nausea, vomitin gand early satiety
- palpable gallbladder - Courvoisier's law
Any of the above symptoms together with late onset diabetes should strongly alert the clinician about the possibility of pancreatic cancer (1)
Less common presentations:
- steatorrhoea
- thrombophlebitis migrans: may also occur in glucagonomas
- acute pancreatitis
- gastric outlet obstruction, causing pyloric stenosis
- gastrointestinal haemorrhage due to duodenal erosion
- symptoms of hypoglycaemia may occur if the tumour is an insulinoma - very rare
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