Survival rates are better when the disease is detected and treated early, but early symptoms tend to be subtle. Which ones do you need to know?
Pancreatic cancer affects the pancreas, a small organ located between the stomach and the spine. It is notoriously difficult to detect at an early stage because its more visible symptoms, such as jaundice, usually do not appear until late in the disease. Pancreatic cancer has a five-year survival rate of 11.5%. One of the reasons for this high mortality rate is that the disease is often only diagnosed after it has spread outside the pancreas. Treatment options for advanced pancreatic cancer are limited and less likely to be successful. The lack of specific signs and symptoms of pancreatic cancer in the early stages of the disease, especially symptoms that can be distinguished from those of other more common diseases, makes ongoing scientific efforts to develop a reliable detection test particularly essential.
Two parts of the pancreas commonly affected by cancer
The pancreas is made up of two main parts. The first, called the exocrine component, is made up of ducts and small sacs at the end of the ducts. These produce enzymes that help the body digest food, especially fats. The other part of the pancreas is the endocrine component. These are small clumps of cells located throughout the pancreas that secrete hormones like insulin, which help control blood sugar. Symptoms of pancreatic cancer vary depending on which part of the pancreas has developed the cancer.
Exocrine pancreatic cancer: More frequent and more symptomatic
Cancers affecting exocrine cells are much more likely to produce symptoms than those affecting endocrine cells. Among the most common symptoms of exocrine pancreatic cancer are those caused by a buildup of bilirubin, a dark yellow-brown substance excreted by the liver as part of a digestive fluid called bile. Normally, this fluid passes through the common bile duct, passes through the pancreas, travels to the intestines, and then is eliminated from the body in the stool. In the case of pancreatic cancer, this process can go wrong.
Symptoms related to bilirubin problems include:
The majority of people with exocrine pancreatic cancer develop jaundice (yellowing of the skin and eyes) as one of their first symptoms. If pancreatic cancer blocks the common bile duct, it can cause a buildup of bilirubin, which produces jaundice. Jaundice can also be a sign of pancreatic cancer that has metastasized to the liver. Although jaundice is a common sign of pancreatic cancer, the most common reasons for this symptom are gallstones or hepatitis.
Dark and itchy urine
Increased bilirubin levels can lead to a buildup of substances normally broken down in the body and excreted. This can result in symptoms such as dark urine and itchy skin.
Bilirubin gives stools their brown color; if it does not reach the intestine due to a blocked bile duct, the stools may be abnormally pale. Bilirubin also helps break down fat during digestion, so blockages in the common bile duct sometimes result in greasy-looking stools that can float down the toilet.
Other possible symptoms of exocrine pancreatic cancer include:
Pain in the stomach or back due to the pressure exerted by the cancer on nearby organs or its spread to the nerves.
Unintentional weight loss
Unexplained loss of appetite
Digestive problems, including nausea and vomiting, caused by stomach blockage.
Enlargement of the liver or gallbladder (due to an accumulation of bile).
irregularity of fatty tissue under the skin due to the release of pancreatic enzymes.
Diabetes (in rare cases, pancreatic cancer can destroy insulin-producing cells in the pancreas).
Deep vein thrombosis (DVT), a blood clot in a large vein, often in the leg, which can cause pain, swelling, redness and a feeling of warmth.
Pancreatic endocrine cancers: a rarer type
Pancreatic neuroendocrine tumors (PNETs), or islet tumors, are an uncommon type of pancreatic cancer, accounting for less than 5% of all pancreatic cancers. This type of pancreatic cancer affects the hormone-producing cells located in the pancreas. Although they can be life-threatening, pancreatic PNETs tend to be less dangerous than pancreatic exocrine cancer.
Malignant neuroendocrine cells cause the pancreas to overproduce hormones. Excesses of different types of hormones cause different types of symptoms.
Types of PNETs include:
These tumors secrete a hormone that tells the stomach to produce acid. Too much causes pain, nausea and loss of appetite, along with other more serious symptoms, such as bleeding ulcers.
By producing a hormone that raises blood glucose, these tumors can sometimes cause diabetes. Most people with this condition visit the doctor because of a strange, blistering rash that appears in different places on the skin.
These tumors secrete insulin, which sometimes causes low blood sugar and dizziness, weakness, confusion, sweating, and rapid heartbeat.
Non-functional neuroendocrine tumors
They do not produce excessive amounts of hormones. Symptoms resemble those of exocrine pancreatic cancer, such as jaundice.
Symptom management: Essential to all care
Symptoms of pancreatic cancer can vary from person to person and change over time. Coping with the symptoms of pancreatic cancer, and the side effects of treatment, can be a struggle. Some patients may need help coping with pain, fatigue and nausea, for example, while others may benefit from help coping with the emotional aspects of the illness.