Clinical symptoms of pancreatic cancer

The clinical manifestations of pancreatic cancer vary, depending on the location of the tumor, the early or late course of the disease, the presence or absence of distant metastasis, and the involvement of adjacent organs. The clinical characteristics are short course, rapid progression of the disease, and early symptoms that are often hidden and non-specific.

1. First symptoms

The first symptoms of pancreatic cancer vary, and the identification of the first symptoms is very important for early diagnosis and treatment. A group reported the first symptoms of 494 cases of pancreatic cancer, which were upper abdominal pain 42.5%, jaundice 17.8%, upper abdominal distension and discomfort 13.2%, abdominal mass 8.7%, upper abdominal dull pain 6.8%, fatigue 3.9%, back pain 2.3%, nausea and vomiting 1.2%, fever 1.2%, upper gastrointestinal bleeding 1.1%, weight loss 0.8%, diarrhea 0.4%, polydipsia and polyuria 0.2%. Abdominal pain, jaundice and upper abdominal distension and discomfort are the most common. The first symptoms of pancreatic cancer in different parts are also different. For example, jaundice is more common in pancreatic head cancer, while jaundice is rare in pancreatic body and tail cancer.

2. Common symptoms

(1) Upper abdominal pain and discomfort: Abdominal pain is a common symptom in patients with pancreatic cancer and is also a prominent symptom of pancreatic body and tail cancer. The location of abdominal pain is generally in the middle of the upper abdomen. Pancreatic head cancer may be biased to the right upper abdomen, and body and tail cancer may be biased to the left upper abdomen. Abdominal pain may also occur around the navel or the entire abdomen. The nature of the pain can be divided into three types: ① Paroxysmal severe upper abdominal pain, which may radiate to the shoulder blade, such as biliary colic, which can be induced by drinking or greasy food. It is more common in the early stages of pancreatic head cancer. It may be caused by strong contraction of the bile duct and pancreatic duct in the presence of obstruction. It accounts for about 30% of abdominal pain. ② Dull pain in the upper abdomen, which is common, accounting for about 70%, is continuous or intermittent bloating and pain, often aggravated 1 to 2 hours after a meal, and relieved or relieved after a few hours. ② Upper abdominal pain involving the lower back and back. In 1/4 of the patients, the lower back pain is more significant than the upper abdominal pain. The pain may also be like a band in the hypochondrium on both sides. It can be relieved by sitting, bending over, lying on the side, and bending the knees. It can be aggravated by lying on the back. It is more obvious at night than during the day.

(2) Weight loss: Within a short period of time after the onset of pancreatic cancer, patients will experience significant weight loss, accompanied by symptoms such as weakness and fatigue.

(3) Indigestion and loss of appetite: Pancreatic cancer often causes symptoms such as indigestion, loss of appetite, fullness, and nausea, which may be related to delayed gastric emptying. In addition, the lower end of the common bile duct and pancreatic duct are blocked by tumors, bile and pancreatic juice cannot enter the duodenum, and the exocrine function of the pancreas is impaired, which can affect appetite.

(4) Vomiting: A small number of patients may experience obstructive vomiting due to tumor invasion or compression of the duodenum and stomach.

(5) Constipation and diarrhea: About 10% of patients have severe constipation due to frequent insufficient food intake. About 15% of patients have diarrhea due to pancreatic exocrine insufficiency. Steatorrhea is a late manifestation and a symptom unique to pancreatic exocrine insufficiency, but it is relatively rare.

(6) Gastrointestinal bleeding: About 10% of cases experience upper gastrointestinal bleeding, which manifests as vomiting blood, black stools, and sometimes positive stool occult blood. It is usually caused by pancreatic cancer compressing or invading the stomach and duodenum, or by tumors invading the common bile duct or ampulla. If the invasion of the splenic vein or portal vein causes embolism, secondary portal hypertension, and can cause esophageal varicose vein rupture and massive bleeding.

(7) Fever: 10% to 30% of patients may experience fever, which may manifest as low-grade fever, high-grade fever, intermittent fever or irregular fever. Fever is the first symptom in some cases, which may be caused by endogenous pyrogens produced by tumor tissue necrosis or secondary infection of the bile duct or other parts.

(8) Others: may include symptomatic diabetes, thrombophlebitis, acute pancreatitis and mental symptoms, etc.