Pancreatic Cancer Symptoms

What Is Pancreatic Cancer?

When cancer starts in the pancreas, it is known as pancreatic cancer. It is a disease in which malignant cells or cancer cells start developing in the tissues of the pancreas. Pancreatic cancer is also called exocrine cancer. [¹]

Pancreas is an organ deep within the abdomen, which makes certain enzymes that aid in digestion and hormones that control sugar levels in the blood. When abnormal cells grow and divide beyond control in the pancreas, they form a malignant tumor which is known as cancer.

Cancer can invade other organs and tissues of the body. However, it is still called pancreatic cancer since it starts in the pancreas.

Areas where pancreatic cancer can spread include:

Abdominal wall.
Liver.
Bones.
Lungs.
Lymph nodes.

According to the cancer stat facts by SEER Cancer, [²] the rate of pancreatic cancer new cases was 13.3 out of 100,000 people each year. The death rate of this cancer was 11.1 out of every 100,000 cases each year. In 2019, approximately 89,248 people in the USA were living with pancreatic cancer.

Pancreatic cancer is broadly divided into two categories:

Exocrine Pancreatic Cancer: This category accounts for 90% of pancreatic cancers, and the tumor develops in the exocrine components of the pancreas, including pancreas ducts and acini.
Neuroendocrine Pancreatic cancer: Neuroendocrine tumors develop from cells in the endocrine components of the pancreas. This category of pancreatic cancer accounts for less than 10% of tumors.

Both categories of pancreatic cancer have many types, which vary in their signs, symptoms, and prognosis. The poor survival of pancreatic cancer patients is due to the highly aggressive nature of cancer and the failure to diagnose it at an early stage. [4]

Pancreatic cancer is diagnosed using blood tests and special imaging scans like MRI, PET, or CT scans.

Biopsy and laparoscopy are also advanced techniques to collect samples and check the inside of the abdomen for the presence of cancerous cells.

Pancreatic cancer is divided into stages IA, IB, IIA, IIA, III, and IV according to the TNM classification.

Types of Pancreatic Cancer

The types of pancreatic cancer depend on where the cancer began.

Exocrine Pancreatic Cancer

The exocrine pancreatic cancers include:

Adenocarcinoma

Adenocarcinomas account for 90% of pancreatic cancers. It is also known as ductal carcinoma, as it arises in the lining of the ducts.

Adenocarcinoma can also develop from cells in the pancreas that create enzymes, in which case they are called acinar cell carcinoma. [³]

Squamous Cell Carcinoma

This is a rare type of pancreatic cancer that forms in pancreatic ducts. Only a few cases of this type of pancreatic cancer have been reported, which makes its prognosis difficult to understand. [⁵]

Colloid Carcinoma

Colloid carcinoma is again a rare type of cancer in the pancreas. It accounts for 1 to 3 percent of exocrine pancreas cases. Colloid carcinoma shares clinical manifestations of the disease with adenocarcinoma but has different clinical and pathological characteristics. [⁶]

Neuroendocrine Pancreatic Cancer

Pancreatic neuroendocrine tumors, or PNETs, develop from endocrine gland cells, which are responsible for insulin and glucagon secretion in the blood. This type of pancreatic cancer is also known as islet cell tumors, and it accounts for 7% of all pancreatic cancer cases. [⁷]

The functioning neuroendocrine tumors include:

Insulinoma
Gastrinoma
Glucagonoma, etc.

How Is Pancreatic Cancer Diagnosed?

Doctors often use biopsy results to confirm the diagnosis of a cancer type, but biopsies of the pancreas are difficult to perform because of the organ's location. Furthermore, the smaller size and "diffused" nature of the pancreatic tumors also make diagnosis difficult. [⁸]

If a person is suspected of having developed pancreatic cancer, the doctor first inquires about the medical and family history. Afterward, signs and symptoms of the disease are examined, and then certain diagnostic tests are performed, including:

Physical Examination
Blood Tests
PET-CT Scan
ERCP
Ultrasound
Biopsy

Pancreatic Cancer Staging

The TNM staging system classifies pancreatic cancer on 3 factors:

T: Size and location of the tumor, and how far has it grown into nearby structures?
N: Has cancer spread to the lymph nodes?
M: This tells if cancer has spread to distant organs and lymph nodes of the body.

Is Pancreatic Cancer Hereditary?

It is safe to assume that a small percentage of pancreatic cancer may be hereditary and run in families, which is called familial pancreatic cancer. [¹¹] The cancer is linked with certain genetic conditions that place an individual at a higher risk for pancreatic cancer.

Up to 10% of pancreatic adenocarcinomas are believed to appear because of an underlying genetic disposition. [¹²]

Pancreatic Cancer Symptoms

Since more than 90% of all pancreatic cancer diagnoses are adenocarcinomas, the general signs and symptoms of this disease are typical for adenocarcinoma. [³]

General symptoms associated with pancreatic cancer include

Jaundice
Itchy skin
Pale faces
Dark urine
Loss of appetite and weight
Fatigue
Fever
Pain in the upper part of the abdomen and back

What Are the Symptoms of Pancreatic Cancer?

Pancreatic cancer doesn't exhibit symptoms until cancer has grown to an advanced stage. And since the early warning symptoms of pancreatic cancer may resemble those produced by other digestive disorders, like IBS or pancreatitis, the appearance of one or more of these symptoms doesn't lead to a definite diagnosis. However, it is important to have yourself checked by a doctor if the symptoms worsen or persist for a long time so that any early cancer is promptly found.

Different types of pancreatic cancer have different clinical manifestations. For example, the symptoms of acinar cell carcinoma are similar to those of adenocarcinoma and include:

Nausea
Weight Loss
Abdominal pain
Skin rashes
Joint pain. [³]

As pancreatic cancer grows, the following symptoms start appearing.

Jaundice

Jaundice is the first symptom of pancreatic cancer that appears in most cases. The blockage in the common bile duct causes a buildup of bilirubin in the body. Pancreatic cancers can press on and block the duct even when they are small in size, so jaundice is an indication that can help the cancer is found at an early stage.

However, if cancer starts in the body or tail of the pancreas instead of the head, jaundice signs do not appear until the cancer spreads beyond the pancreas.

Signs of jaundice include:

Dark urine: The darker color of urine is due to increased levels of bilirubin in the blood.
Paler stools: The blockage of the bile duct doesn't let bile and pancreatic enzymes reach the intestines, which results in greasy and light-colored stools.
Itchy skin: Itching and yellowing of the skin is caused by a buildup of bilirubin in the skin.

Digestive Issues

Nausea and vomiting are symptoms that appear when cancer presses on the stomach and doesn't allow for food to get through.

The pain in the stomach worsens after eating, and pancreatic cancer also causes weight loss and loss of appetite in the patients.

Abdomen Pain

Pain in the back or abdomen is also a common indication of pancreatic cancer. Cancer, which starts in the pancreas, can grow and press on nearby organs, which causes pain. When the enlarged tumor presses on nerves around the pancreas, it causes back pain.

What Are Some Signs of Pancreatic Cancer?

Many diagnostic tests are run for the detection of the size and location of pancreatic tumors. The following observable test results confirm the diagnosis of pancreatic cancer.

Blood Tests

Blood tests may also indicate the presence of an abnormality. These include:

Liver Function Tests

A doctor orders liver function tests because of the development of jaundice in a patient. The blood test results show higher bilirubin levels, which are indicative of pancreatic cancer.

Tumor Markers

Tumor markers are important biomarkers released by the tumor in the blood.

Higher than normal levels of CA19-9 (carbohydrate antigen 19-9) protein in the blood indicate the presence of cancer in the pancreas.

Elevated carcinoembryonic antigen (CEA) levels also point toward pancreatic cancer.

CT Scan Results

CT scan is an initial diagnostic imaging test that can detect the tumor staging of pancreatic cancer.

Non-contrast CT scans have poor sensitivity for pancreatic tumors as they are hypovascular.

CT scans using intravenous contrast provide higher-resolution images of the pancreas, which allows the doctor to better visualize the pancreatic tumors. Pancreatic ductal adenocarcinomas are hypovascular, which is why they enhance poorly on a CT scan as compared to surrounding parenchyma. So the adenocarcinoma appears as a hypoattenuating area.

MRI results

MRI scans are used to identify pancreatic cancers when the lesions are not clearly identified on CT scans. MRI better characterizes cystic lesions in the pancreas and provides radiological evidence that confirms the diagnosis of pancreatic cancer.

ERCP Results

Endoscopic Retrograde Cholangiopancreatography can improve sensitivity for diagnosing pancreatic cancer to up to 77%. However, this test doesn't help a lot with the staging of pancreatic cancer. [¹³]

Biopsy Test Results

During a biopsy, a sample of pancreatic cells is removed to examine under a microscope. This procedure can confirm the diagnosis of cancer. It also helps doctors determine the kind of pancreatic cancer. Biopsy for the pancreas may be done in one of the three following ways.

Fine needle aspiration biopsy.
Brush biopsy.
Laparoscopy. [¹⁴]

Symptoms of Pancreatic Cancer in Women vs. Symptoms of Pancreatic Cancer in Men

The sex-based and gender-related factors are responsible for differences in incidence rates of pancreatic cancer among men and women.1 [¹⁵]

1 Note that here, we are using the terms "women" and "men" to refer to female and male biological sex at birth, respectively.

Pancreatic cancer symptoms are similar in all patients, yet the probability of developing pancreatic ductal adenocarcinoma is 30 percent greater in males as compared to females. [⁴]

Here are the symptoms of pancreatic cancer that commonly appear in women:

Yellowing of eyes and skin.
Feeling nauseous.
Pain in the abdomen after eating.
Losing weight.
Extreme bloating.
Constant lower back pain that resembles menstrual cramps.
Fever and fatigue.

Here are the symptoms of pancreatic cancer that commonly appear in men:

Dull but constant back pain that feels like you've pulled your back.
A lump appears right under the ribcage.
Swelling and pain in legs.
New-onset diabetes. [¹⁶]

Risk Factors for Pancreatic Cancer

The following risk factors can raise the chances of developing pancreatic cancer in an individual:

Smoking
Obesity
Alcohol consumption
Family history
Diabetes
Chronic pancreatitis
Hepatitis B infection
Cirrhosis. [¹⁷]

Pancreatic Cancer Prevention

There is no way to prevent cancer development in the pancreas, but protecting oneself and staying away from the risk factors are good preventative measures.

Pancreatic Cancer Prognosis and Treatment

The prognosis of pancreatic cancer depends on the size of the tumor, its metastasis, and lymph node involvement. Pancreatic cancer has a lower five-year survival rate as compared to other types of cancers because early-stage diagnosis is often impossible.

Pancreatic cancer doesn't show its signs and symptoms unless cancer has metastasized to an advanced stage, which leads to difficult treatment procedures and a greater risk of death due to cancer.

The Pancreatic Cancer Survival Rate

The five-year relative survival rate of pancreatic cancer, according to SEER cancer, is 11.5%. [²]

Pancreatic Cancer Treatment Options

Treatment options for pancreatic cancer include:

Surgery
Chemotherapy
Radiotherapy

Conclusion

Takeaway

Pancreatic cancer is difficult to diagnose and detect early. But if you notice any symptom that indicates any abnormality in your body, it is essential to contact a healthcare professional immediately. This practice is essential to catch any possible cancer development before it starts to spread.