The classic presentation form of pancreatic cancer is referred to as "silent jaundice", meaning the jaundice is not accompanied by other symptoms, as for instance pain. Jaundice is the first symptom in about half of patients with cancer in the head of the pancreas. Among patients who are radically operated, more than 70% have jaundice as one of the first symptoms.
Secondary to jaundice, pain is the most common symptom, usually localized centrally in the abdomen. When pain radiates to the back, there is reason to suspect that the tumor has already infiltrated the nerve plexus outside the gland. Pain is commonly the symptom leading the patient to go to the doctor (50–60%). The pain can be described as fatigue in the back which increases when lying on the back. Sitting slightly bent forward may relieve the pain.
Unintentional weight loss should cause suspicion of pancreatic cancer, especially if it is accompanied by fatigue and recent discomfort in the abdomen or back pain. At the time of diagnosis, almost all patients have lost 2-5 kg of weight, and more than 10 kg is not uncommon.
Newly diagnosed diabetes may be a warning signal, especially if it is observed in connection with unintentional weight loss or pain in middle-aged people. About 20% of the patients have recently developed diabetes. The connection between pancreatic cancer and diabetes is unclear.
Stomach retention may be an early sign of a tumor in the head of the pancreas compressing the duodenum.
Patients who receive the diagnosis of acute pancreatitis, without simultaneously having a triggering factor, should be assessed for cancer.
Endocrine tumors have debut symptoms which deviate from regular adenocarcinomas in the pancreas. Symptoms from functional tumors depend on the excreted hormones.
- insulinomas cause episodes of hypoglycemia due to high blood insulin
- gastrinomas can have debut with ulcer symptoms due do raised levels of gastrin
Tumors in the body and tail seldom cause early symptoms and are usually diagnosed late in the course of the disease. The tumor is therefore often larger and more advanced at the time of diagnosis.
Ascites may be a sign of advanced cancer.