Symptoms and Diagnosis of Pancreatic Cancer
Pancreatic cancer can be a debilitating condition, as it often goes undetected until it's advanced and therefore difficult to treat. The majority of pancreatic cancers are the adenocarcinoma type wherein the location of the cancer plays a critical role. The symptoms of pancreatic cancer appear earlier if the cancer is in the head of the pancreas as compared to the body or the tail and are manifested by:
- Abdominal pain
- Nausea and vomiting
- Fat in the stool
- Pale-coloured stools
As the cancer grows and spreads, it affects the whole body leading to:
- Weight loss
- Loss of appetite
- Elevated blood sugars leading to Diabetes.
- Jaundice (yellowing of the skin and eyes due to bile build up in the blood)
Rare Islet cell tumours from the cells in the pancreas that make hormones can cause abdominal pain, weight loss, nausea, and vomiting. Excessive amounts of hormones released by an islet cell tumour can lead to:
- Insulinomas (excess insulin): sweating, anxiety, light-headedness, and fainting from low blood sugar.
- Glucagonomas (excess glucagon): diarrhoea, excessive thirst or urination, weight loss.
- Gastrinomas (excess gastrin): abdominal pain, non-healing stomach ulcers, reflux, and weight loss.
- Somatostatinomas (excess somatostatin): weight loss, abdominal pain, foul-smelling fatty stools.
- VIPomas (excess vasoactive intestinal peptide): abdominal cramping, watery diarrhoea, facial flushing.
Pancreatic Cancer Diagnosis
Very few symptoms manifest themselves in the initial stages of pancreatic cancer and a tumour may grow significantly before it causes any obvious recognized symptoms.
Symptoms can be quite vague and non-specific too - and may also be associated with other more common and less serious conditions. There is currently no test for early detection and diagnosis can be delayed as other conditions including hepatitis, pancreatitis, gallstones, irritable bowel syndrome or even stress need to be ruled out.
Additionally, not everyone has every symptom, for e.g., jaundice can be an early sign of a tumour in the head of the pancreas affecting the bile duct - and back pain can be a late sign of a tumour in the body or tail of the pancreas possibly affecting the nerves and spine. On the other hand, jaundice may also be a late sign of a tumour that has developed initially further away from the bile duct and then grown or spread until it causes obstruction of the bile duct.
There are two markers that can relate to pancreatic cancer - CEA and CA19-9. However these can show up in a number of other conditions and not everyone with pancreatic cancer produces them. So these blood tests are usually used alongside results from other tests including:
- Ultrasound scan of the abdomen
- CT Scan
- EUS - Endoluminal ultrasound
- ERCP - Endoscopic Retrograde Cholangio-Pancreatography
Pancreatic Cancer Stages
Tests and procedures to stage pancreatic cancer are usually done at the same time as diagnosis. The following stages are used for pancreatic cancer:
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the lining of the pancreas. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
In stage I, cancer has formed and is found in the pancreas only. Stage I is divided into stage IA and stage IB, based on the size of the tumour.
- Stage IA: The tumour is 2 centimetres or smaller.
- Stage IB: The tumour is larger than 2 centimetres.
In stage II, cancer may have spread to nearby tissue and organs, and may have spread to lymph nodes near the pancreas. Stage II is divided into stage IIA and stage IIB, based on where the cancer has spread.
- Stage IIA: Cancer has spread to nearby tissue and organs but has not spread to nearby lymph nodes.
- Stage IIB: Cancer has spread to nearby lymph nodes and may have spread to nearby tissue and organs.
In stage III, cancer has spread to the major blood vessels near the pancreas and may have spread to nearby lymph nodes.
In stage IV, cancer may be of any size and has spread to distant organs, such as the liver, lung, and peritoneal cavity. It may have also spread to organs and tissues near the pancreas or to lymph nodes.