clinical features

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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


Last reviewed 12/2020