Early clinical manifestations of pancreatic cancer

Pancreatic cancer mainly refers to malignant tumors of the exocrine pancreas. The incidence rate has increased significantly in recent years. It is highly malignant, develops rapidly, and has a good prognosis. Clinically, it mainly manifests as abdominal pain, lack of appetite, weight loss, and jaundice. The age of onset is most common between 45 and 65 years old, and the male-to-female ratio is 1.58:1. It ranks 6th to 7th among malignant tumors. Early diagnosis is very difficult, and the treatment effect is not ideal. The mortality rate is very high. Statistics from various countries show that the 5-year survival rate is only 2%-10%.

1. Digestive system symptoms

(1) Abdominal pain: Abdominal pain is a common symptom, which occurs in more than 3/4 of patients. The pain is mild at first and gradually worsens. In the early stage, the pain is widespread and difficult to locate, and is characterized by vague fullness, distending pain, dull pain, or dull pain. Patients with acute onset have abdominal cramps or dull pain in a clear location. Cancer of the head of the pancreas can cause right upper abdominal pain, and cancer of the tail of the pancreas can cause left upper abdominal pain. Severe back pain is often caused by the metastasis of the tumor along the nerve sheath to the posterior abdominal nerve plexus. The mass of pancreatic cancer can compress the posterior abdominal nerve when lying on the back, often aggravating abdominal pain. Therefore, typical pancreatic cancer pain is caused by lying on the back, or the pain is aggravated, especially at night, forcing the patient to sit up or bend forward to seek relief. The pain has nothing to do with eating, defecation, or passing gas.

In addition to upper abdominal pain, a few cases complain of pain in the left or right lower abdomen, around the umbilicus, or the entire abdomen, or even testicular pain, which can be easily confused with other diseases. The pain can radiate to the middle back, front chest, and scapula.

(2) Digestive tract symptoms: Digestive system symptoms of this disease include diarrhea, nausea, vomiting, constipation, gastrointestinal distension, etc. Nausea and vomiting may be temporary or only occur when there is abdominal pain; if the tumor erodes the gastrointestinal tract, it may cause vomiting blood and black stool. In pancreatic body and pancreatic tail cancer, irregular, very hard and fixed masses of varying sizes may be palpated. 90% of patients with pancreatic head cancer may have an enlarged gallbladder.

2. Systemic symptoms

(1) Weight loss: Weight loss is one of the important clinical manifestations of this disease. 90% of patients experience rapid and significant weight loss. Some patients also experience weight loss as the first symptom, especially those with pancreatic tail cancer and pancreatic body cancer. The cause of weight loss may be related to factors such as decreased appetite, insufficient pancreatic secretion, and poor digestion and absorption.

(2) Jaundice: Jaundice is one of the main symptoms for diagnosing pancreatic cancer. Jaundice may occur to varying degrees depending on the characteristics of the tumor site. 100% of duodenal papillae and ampullae cancers will have jaundice, even in the early stages. There is no jaundice in the early stages of pancreatic body and tail cancers, but in the late stages, when the cancer spreads to the head of the pancreas or metastasizes to the common bile duct, lymph nodes, and liver, causing extrahepatic or intrahepatic bile duct obstruction, jaundice may occur. The nature of jaundice is obstructive and gradually deepens, becoming dark yellow with green, accompanied by strong tea-like urine, clay stools, and itchy skin. Once jaundice occurs, it often does not subside. However, in some cases, jaundice may be temporarily alleviated or subsided due to factors such as inflammatory changes in the tumor, temporary subsidence of edema, formation of bile-intestinal fistula, and necrosis and shedding of cancer tissue.

(3) Others: About 10% of pancreatic cancer patients may experience fever during the course of the disease, which may be high, low, intermittent or irregular. In addition, this disease may also cause symptomatic diabetes, thrombophlebitis, anxiety, depression, insomnia and other mental symptoms.

3. Metastatic symptoms Pancreatic cancer can directly infiltrate the wall of the common bile duct, or cause obstructive jaundice due to cancer compression in the early stage; as the tumor develops, the cancer adheres to the stomach, duodenum, large intestine and inferior vena cava, or infiltrates into organs, and then infiltrates the superior mesenteric artery and portal vein, leading to portal hypertension and symptoms such as ascites; cancer in the body and tail of the pancreas obviously develops into the retroperitoneum and compresses the splenic artery, often causing splenomegaly and esophageal varices; the cancer extends posteriorly, compressing or eroding the celiac plexus, causing low back pain, and occasionally complicated by pancreatitis; bone metastasis of cancer can cause severe and continuous pain; metastasis to the lungs and mediastinum can cause chest pain, cough, dyspnea and other symptoms; bile stasis or metastasis to the liver can cause hepatomegaly, and clavicle, axillary or inguinal lymph nodes can also swell and harden due to cancer metastasis.