In most cases, there are no early symptoms. Initial warning signs may include:
- Painless icterus (jaundice) (periampullary carcinoma: pancreatic tumors in the head not infrequently compress the ampulla hepatopancreatica).
- New onset type 2 diabetes
- Annular back pain without orthopedic cause
The combination of a palpable, painlessly enlarged bulging elastic gallbladder under the right costal arch and occlusive icterus (jaundice due to biliary obstruction caused by a drainage obstruction) is called Courvoisier’s sign. The most common cause is chronic tumor-related choledochal obstruction (common bile duct) due to distal cholangiocellular carcinoma (CCC, cholangiocarcinoma, bile duct carcinoma, bile duct cancer) or pancreatic head carcinoma (pancreatic head cancer). If ductal obstruction has occurred acutely, for example, because of choledocholithiasis (bile duct stone disease), the gallbladder is painfully enlarged.
The following symptoms and complaints may indicate late-stage pancreatic cancer (pancreatic head cancer):
Associated symptoms
- Abdominal discomfort (abdominal pain) – radiating primarily to the right flank, back, or left shoulder blade
- Anorexia (loss of appetite).
- Diarrhea (diarrhea)
- Darkening of the urine
- Gastrointestinal bleeding – bleeding in the gastrointestinal tract.
- Weight loss/cachexia; including preclinical tumor cachexia (without evidence of tumor) → think: pancreatic ductal adenocarcinoma (increase in plasma branched-chain amino acids: valine, leucine, and isoleucine; 2 to 5 years prior to diagnosis)
- Icterus (jaundice)
- Meteorism (flatulence)
- Fatigue
- Upper abdominal pain – radiating mainly to the right flank, back or left shoulder blade.
- Pancreatitis (inflammation of the pancreas) (about 1.5% of cases).
- Pruritus (itching)
- Rapid feeling of satiety
- Splenomegaly (enlargement of the spleen)
- Stool discoloration
- Glucose tolerance disorders/diabetes mellitus; at the time of diagnosis, 45-65% already have diabetes mellitus
- Thrombophlebitis – inflammation of superficial veins.
- Thrombosis
- Nausea/vomiting
