Clinical features

It is unusual for the common exocrine type of pancreatic cancer to cause warning symptoms in the early stages and even with advanced disease there may be a period of mild, non-specific or vague ill health which is not severe enough for medical attention. People with pancreatic cancer tend to be diagnosed when the disease is very advanced and mild symptoms have suddenly turned into rapidly deteriorating poor health, profound fatigue and rapid weight loss. They are likely to have at least one if not several of the symptoms listed below:

• Weight loss – rapid weight loss for no obvious reason
• Loss of appetite (anorexia)
• Upper abdominal pain which may go through to the back, may be worse after meals and be difficult to control with pain relieving drugs
• Back pain
• Jaundice
• New onset diabetes mellitus
• Itchy skin – often because of jaundice, this can be very difficult to control and disturbs sleep
• Nausea and vomiting – if as a result of gastric outflow obstruction this is likely to be severe, associated with extreme tiredness, abdominal pain and bloating and regular vomiting of vast quantities of foul smelling undigested food and gastric juices, mobility will be restricted
• Steatorrhoea – fatty stools - because fat is not absorbed by the gut when a person is jaundiced it is passed out with the stools, they may have frequent diarrhoea
• Repeated acute episodes of infection by bacteria of bile in the blocked bile duct requiring emergency admission to hospital for treatment

Clinical Features of the rare hormone producing Pancreatic Cancers

These tumours of the pancreas present when the tumour is small because of the symptoms caused by the excess hormone production and not with the symptoms of advanced disease described above, sometimes it may be difficult to locate the tumour because it is so small. They are named either for the hormone they produce or simply called ‘islet tumours’.

Insulinomas produce too much insulin causing weakness and loss of energy, there may be repeated hypoglycaemic attacks.

Gastrinomas produce too much of a hormone called gastrin. Gastrin stimulates acid production by the stomach and too much of this hormone leads to over production of gastric acid which leads to very severe gastric and duodenal ulceration, these cause pain, nausea and may lead to significant bleeding from the ulcers in the gut requiring emergency admission to hospital for treatment of blood loss. Severe ulceration due to over production of gastrin is called the Zollinger-Ellison Syndrome.

Somatostatinomas produce too much of a hormone called somatostatin which prevents the release of insulin and enzymes of the exocrine pancreas. Excess somatostatin therefore causes diabetes and steatorrhoea.

VIPomas produce too VIP hormone (vasoactive intestinal peptide hormone). The symptoms are profuse watery diarrhoea, flushing and high blood pressure.

Glucagonomas are usually cancerous, they cause diabetes mellitus and a distinctive rash called necrolytic migratory erythema.

Amended November 2008