Cancer of the pancreas -- a thin fish-shaped organ deep within the upper abdomen -- is the 4th most common cause of cancer death in the United States, states the Centers for Disease Control and Prevention (CDC). By far the most common type of pancreatic cancer -- responsible for 95 percent of these tumors -- is pancreatic adenocarcinoma, according to the American Cancer Society. There are a number of less common types of pancreatic cancer, some of which produce hormones.
Pancreatic cancer usually produces no symptoms when it first appears. One of the major problems with pancreatic cancer is that by the time symptoms become severe enough to alert a person to make a doctor's appointment, the tumor has already progressed to an advanced stage. MD Anderson Cancer Center notes that only about 20 percent of pancreatic cancers are diagnosed at an early stage, when they are most likely to be treatable.
One of the most common symptoms of pancreatic cancer is pain or discomfort in the abdomen. Abdominal pain occurs in up to 85 percent of people with pancreatic cancer, according to "Pancreatic Cancer: Pathogenesis, Diagnosis, and Treatment." Pain caused by pancreatic cancer often begins as a dull ache in the upper abdomen, which later becomes more severe and extends through to the back. The pain may resemble indigestion, but typical indigestion medications, such as antacids, will not help. Sometimes back pain occurs alone, without obvious abdominal pain.
Nausea and Vomiting
Nausea and vomiting occur in about 30 to 40 percent of people with pancreatic cancer, according to "Pancreatic Cancer: Pathogenesis, Diagnosis, and Treatment." Numerous factors contribute to these symptoms, including the pancreas being located next to the stomach. Sometimes a tumor in the head of the pancreas -- the rightmost part of the pancreas -- will compress and block the small intestine located next to it, producing a small bowel obstruction. This leads to severe nausea, vomiting and abdominal pain.
The pancreas lies close to the common bile duct, which is the tube transporting bile from the liver to the small intestine. As a pancreatic cancer enlarges, it may block the flow of bile through the duct, causing bilirubin -- a component of bile -- to accumulate in the blood. The bilirubin will then collect in tissues, causing the skin and whites of the eyes to take on a yellowish color -- known as jaundice. The accumulation of bilirubin may cause generalized skin itchiness.
Jaundice is one of the first signs of pancreatic cancer in the head of the pancreas, as this is the part located closest to the common bile duct. It may even occur before the onset of abdominal pain and the presence of painless jaundice is an important clue to diagnosing this cancer.
Stool and Urine Changes
When pancreatic cancer blocks the common bile duct, bile does not reach the intestines. As bilirubin is responsible for the dark color of stool, the stools will become lighter -- typically clay-colored or even white. Pancreatic cancer may also interfere with the production of digestive enzymes in the pancreas, preventing the normal break down of fat in the stool. This can produce pale stools that appear oily, bulky and excessively foul-smelling.
With blockage of the common bile duct, excessive bilirubin in the blood enters the kidneys, where it exits the body through the urine. This causes the urine to appear dark yellow or tea-colored.
The pancreas is responsible for the production of insulin. This hormone is necessary to help sugar in the blood enter cells throughout the body. Without adequate amounts of insulin, sugar accumulates in the blood, elevating blood glucose levels and producing diabetes. As insulin-producing cells are located in the tail -- the leftmost part -- of the pancreas, diabetes appears earlier when cancer begins in this region. The onset of diabetes occurs later with pancreatic cancer that begins in the head of the pancreas.
Weight loss is extremely common in pancreatic cancer, occurring in up to 90 percent of people, according to "Pancreatic Cancer: Pathogenesis, Diagnosis, and Treatment." Nausea, vomiting and loss of appetite are common causes. Another cause is early satiety -- feeling full after eating only a small amount of food. This develops when pancreatic cancer compresses the stomach. Weight loss also occurs because tumor cells require energy to grow, which diverts nutrients and calories from the rest of the body.
Weakness and fatigue are common with all types of cancers, including pancreatic cancer. Other possible signs include depression, muscle spasms and dizziness. The American Cancer Society notes that sometimes the first sign of pancreatic cancer is a blood clot, often in a leg vein.
Reviewed and revised by Mary D. Daley, M.D.
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