The pancreas is a part of the digestive system and produces insulin and other important enzymes and hormones that help break down foods.
It is about 6 inches long and is shaped like a thin pear lying on its side. The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail. The pancreas is located between the stomach and the spine.
It starts when abnormal cells in the pancreas grow and divide out of control and form a tumor. Cells make up all organs in the body. The cells divide to form new cells an replace old cells. Sometimes this process breaks. New cells form even when the body does not need them, or old cells do not die. These extra cells may form a mass of tissue called a tumor.
Even when cancer spreads to other areas of the body, it is still referred to as pancreatic cancer if that is where it started. Cancer cells can often spread to the liver, abdominal wall, lungs, bones and/or lymph nodes.
Pancreatic cancer is the ninth most commonly diagnosed cancer in women and the 10th most commonly diagnosed in men in the U.S.
Diagnosing Pancreatic Cancer
Pancreatic cancer is often hard to diagnose. It is often called the “silent killer” because the tumor can grow for many years before it causes pressure, pain, or other signs of illness.
Diagnosing pancreatic cancer is also made difficult because the pancreas lies deep in the abdomen behind the stomach, so tumors are not felt during a physical exam.
For these reasons, the symptoms of pancreatic cancer are seldom recognized until cancer has progressed to an advanced stage and often spread to other areas of the body.
A doctor may advise the following tests if pancreatic cancer is suspected :
- imaging tests that create pictures of the internal organs (CT scan, MRI or PET scan)
- endoscopic ultrasound (EUS)
- a biopsy
- blood tests
Pancreatic cancer signs and symptoms
Pancreatic cancer symptoms are barely noticeable in its early stages. If symptoms are present, they are often vague and can be easy to ignore or linked with other health conditions.
Having one or more of the symptoms below does not automatically mean that pancreatic cancer may be involved. In fact, many of these symptoms are more likely to be caused by other conditions. Still, if any of these symptoms are observed, it’s important to have them checked by a doctor so that the cause can be found and treated if needed.
Jaundice is the yellowing of the white of the eyes and the skin. It is a result of the buildup of bilirubin, a dark yellow-brown substance made in the liver.
In general, the liver releases a liquid called bile that contains the bilirubin. This liquid goes through the bile duct into the intestine where fat is broken down. Bile exits the body together with stool. When the bile ducts become blocked, bile doesn’t reach the intestines and the amount of bilirubin in the body builds up.
Jaundice can be a symptom of pancreatic cancer at an earlier stage. It occurs in about 50% of pancreatic cancer cases.
Pancreatic cancer can begin at the end of the pancreas where it is near the bile duct. Cancer can press on the bile duct and cause jaundice. This often leads to the tumors being detected while they are small and at an early stage.
On the other hand, pancreatic cancers that begin at the body or tail do not press on the duct until they have spread through the pancreas. By this time, cancer has often spread beyond the pancreas.
When cancer spreads, it can go to the liver which also can cause jaundice.
2. Abdominal pain that radiates to the back
This symptom is common in pancreatic cancer. It is also one of the earliest symptoms. Pain is a symptom in about 70% of pancreatic cancer cases.
Pancreatic cancer that began in the body or tail area of the pancreas can often grow fairly large. The tumor can press on other nearby organs, causing abdominal pain. It may also spread to the nerves surrounding the pancreas, which often causes back pain.
It can also press on the spine or cause a blockage in the stomach or duodenum (top part of the small intestines).
There is no fixed pattern to the pain, but often and over time, the pain of pancreatic cancer may move or radiate more through the abdomen to the back area. The pain can differ from person to person.
Pain can be worse when lying down or after eating and can often be relieved by leaning forward.
3. Weight loss
Losing a lot of weight for no particular reason can be a sign that something is wrong. Weight loss is one of the more common and early symptoms of pancreatic cancer. It can begin very early in the disease and a profound loss in weight can precede disease diagnosis by months.
Weight loss and muscle wasting (cachexia) occur in over 90% of patients with pancreatic cancer.
People may also notice a loss of appetite.
Pancreatic cancer hinders the pancreas’ ability to produce digestive enzymes that help to digest food, especially high-fat food. As a result, the body can’t digest food properly or get the nutrients it needs, leading to weight loss.
Pain is another factor why people with pancreatic cancer lose interest in food which exacerbates the rapid loss in weight.
4. Itchy skin
Progressive itching that intensifies over a few weeks and is accompanied by jaundice is also a symptom of pancreatic cancer.
Itching can occur in cases where the pancreatic tumor blocks the body’s bile duct. The obstruction of the bile ducts or the breakdown of red blood cells can both lead to the build-up of bile salts in the skin. The buildup of bilirubin in the skin causes severe itching. The bilirubin can cause the skin to itch first before it even turns yellow.
Pruritis is the medical term for itchy skin.
This symptom can be unrelenting and often debilitating. The itchiness can also make the skin feel hot and uncomfortable.
When pancreatic tumors grow larger, they can cause the belly to distend.
It can also cause digestive problems, which may cause gas and bloating. Discomfort, pressure or pain can be felt in the stomach area.
In addition, pancreatic cancer can also cause a build-up of extra fluid in the abdomen. Ascites is the troubling large collection of fluid in the abdominal cavity. Ascites also increases causes the belly to swell and stretch out.
Aside from bloating, ascites can also stretch the skin tightly across the stomach area and the belly button becomes flat or pushed out. This puts pressure on the stomach and lungs and can cause other symptoms.
6. Nausea and vomiting
Nausea and vomiting may be a problem in up to 40% of pancreatic cancer patients.
Emesis is the clinical term for vomiting. Vomiting can occur for several different reasons.
First, a tumor can block the bile duct or press on the duodenum (the first part of the small bowel), which can obstruct digestion. By this point, the tumor has grown quite large enough to block a portion of the digestive tract (usually the duodenum).
Second, the growing tumor may also cause inflammation around the pancreas. This can lead to a chemical imbalance in the body which can make people feel sick.
Lastly, tumors in the abdomen can put pressure on surrounding organs, including the stomach. This can result in nausea or a feeling of fullness even without any recent food intake. Pain tends to be worse after eating.
7. Gallbladder and liver enlargement
A swollen gallbladder is often an indicator of pancreatic cancer.
The gallbladder is an organ that stores bile, a digestive fluid produced by the liver.
The gallbladder and pancreas share a drainage duct, called the common bile duct. Pancreatic cancer can block the bile duct. This prevents the normal flow of bile triggering inflammation. The bile buildup in the gallbladder causes the enlargement.
An enlarged gallbladder can be felt like a large lump under the right side of the ribcage during a physical exam. Imaging tests can provide a clear picture of this. There may also be some upper abdominal tenderness.
Sometimes pancreatic cancer can also enlarge the liver especially if the cancer cells have already spread there.
8. Blood clots
Blood clots are formed when platelets (blood cells) and fibrin (a type of protein) clump together to stop bleeding which results from injuries.
Sometimes a blood clot can form in a vein without any bleeding happening, which isn’t normal.
Occasionally, a blood clot in a large vein can be the first clue that someone has pancreatic cancer. Substances released by cancer cells can sometimes cause blood clots to form in the veins. People with pancreatic cancer are at higher risk of a blood clot forming in a vein.
Venous thrombosis or deep vein thrombosis (DVT) is a blood clot that forms in a vein. This often happens in the lower leg, thigh, pelvis or arm. There is often pain, swelling or tenderness in one of your arms or legs.
Moreover, the skin can also feel warm and may become reddish.
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. Pulmonary embolism or PE is a blood clot in the lungs.
Pancreatic cancer may trigger sudden onset diabetes that is unrelated to weight gain or late-onset diabetes without any obvious cause.
This new onset of diabetes is often seen up to one or two years before pancreatic cancer is discovered. In cases where pancreatic cancer is diagnosed early, it is usually because it was detected by a medical imaging scan for another condition or a dubious diagnosis like diabetes.
A tumor often interrupts the pancreas from working properly. As a consequence of this, diabetes can develop.
The pancreas produces the hormone insulin which the body needs to regulate the amount of sugar in the blood. Cancer can destroy the cells that make insulin, causing blood sugar levels to rise.
A patient with a new and suspicious diabetes diagnosis should be evaluated further to rule out pancreatic cancer.
10. Light-colored stools
A grayish, light-colored, or greasy poop is another symptom of pancreatic cancer.
Bilirubin is typically excreted from the body through the stool. It also gives stools their brown color.
When the bile duct is blocked, stools might change in color due to the absence of bilirubin. The bilirubin stays inside the body instead of getting excreted through the stool.
Also, can also make it difficult for the intestines to help break down fats. Bile and pancreatic enzymes can’t get through to the intestines to help break down fats. This results in stools that can become greasy and might float in the toilet.
11. Dark-colored urine
Normal urine is clear and has a straw-yellow color. Color can vary when foods of certain types are consumed or when certain medications are taken.
Dark-colored urine could be a sign of pancreatic cancer. It can be an early sign of jaundice which is a key indicator of pancreatic cancer.
The typical warning signs of pancreatic cancer are things that could easily be ignored or misdiagnosed as other ailments. Signs like changes in urine color.
However, these symptoms could mean a bile duct is blocked, which could indicate a tumor in the pancreas. The tumor causes less bile to be excreted which can lead to bilirubin levels in the blood to increase. The excess bilirubin can make the urine to become brown in color.
Fatigue can be an early symptom of pancreatic cancer, manifesting even before the diagnosis is made.
It can be described as a loss of the usual energy levels and can even affect mental processes. Fatigue due to pancreatic cancer can be debilitating.
This cancer can disrupt how nutrients from food can be absorbed into the blood and used by the body. This means that food isn’t properly digested and the body is deprived of the nutrients and energy it needs.
Extreme tiredness may be a sign of pancreatic cancer, but it’s also a common sign of other conditions. Either way, unexplained fatigue should not be ignored.