Pancreatic Cancer: Symptoms, Early Detection, and When to Act

Pancreatic adenocarcinoma is aggressive and often silent until advanced. Knowing subtle signs enables earlier diagnosis.

Classic Symptoms (Often Late)

• Jaundice: Painless, yellow skin/eyes, dark urine, pale stools, pruritus. Caused by bile duct obstruction (head of pancreas tumors).
• Abdominal/Back Pain: Epigastric, radiating to back; worse supine/after meals; relieved leaning forward.
• Weight Loss: Unintentional >10% body weight; anorexia, early satiety, malabsorption (steatorrhea).
• New-Onset Diabetes: Especially >50 yrs, lean, no family history. Tumor destroys islets or induces insulin resistance.
• Nausea/Vomiting: Gastric outlet obstruction or gastroparesis.
• Fatigue: Anemia, cytokines, metabolic derangement.
• Thrombosis: Migratory superficial thrombophlebitis (Trousseau’s sign).
• Depression: Paraneoplastic; may precede diagnosis.

High-Risk Groups

• Age >50 (median 70).
• Smoking (2–3× risk).
• Chronic pancreatitis.
• Family history (≥2 FDRs or 1 FDR <50).
• BRCA2, PALB2, CDKN2A, Lynch syndrome.
• New-onset diabetes + weight loss.

Screening & Diagnosis

• **No population screening.** High-risk: annual MRI/MRCP or EUS (per NCCN).
• Workup: CT pancreas protocol → CA 19-9 → EUS/FNA if mass.
• Staging: CT chest/abdomen/pelvis, PET-CT if resectable.

Treatment by Stage

• Resectable (15–20%): Whipple/distal pancreatectomy → adjuvant chemo (mFOLFIRINOX or gemcitabine/capecitabine).
• Borderline: Neoadjuvant chemo ± radiation → reassess.
• Locally advanced: Chemo (FOLFIRINOX/gem-abraxane) ± radiation.
• Metastatic: Combination chemo + targeted/immunotherapy trials.

Action

Persistent (>2 wks) epigastric/back pain + weight loss + jaundice/new diabetes → **urgent CT pancreas protocol**. Early referral to high-volume center improves resectability and survival.