Symptoms of pancreatic cancer

Pancreatic cancer doesn't usually cause symptoms in the early stages. As the cancer grows it can start to cause symptoms. These can include:

• pain in the tummy (abdomen) or back
• yellowing of the skin or whites of your eyes (jaundice)
• unexplained weight loss
• changes to your poo (stools)

About pancreatic cancer symptoms

The symptoms vary depending on where the cancer is in the pancreas. Pancreatic cancer can develop in the head, body or tail of the pancreas.

Most pancreatic cancers start in the cells that produce digestive juices and are called exocrine tumours. The most common type of pancreatic cancer is called ductal adenocarcinoma. 

Common symptoms

Tummy or back pain

Many people with pancreatic cancer go to their doctors because they have pain in their tummy (abdomen) or back, or both. Pain is more common in cancers of the body and tail of the pancreas. People may describe it as a dull or gnawing pain. The pain may come and go to begin with.

Pain can differ from person to person, and some people with pancreatic cancer don't have any pain. But generally the pain may begin in the upper part of the abdomen and may spread to the sides or back. The pain may be worse after eating or when lying down. 

Jaundice

Jaundice is yellowing of the skin and whites of the eyes. Your wee (urine) can be darker than normal and your stools may be lighter in colour. Jaundice is more common with cancer of the head of the pancreas because the tumour blocks the bile duct. This tube carries bile into the small bowel (duodenum). If it is blocked the bile ends up in your bloodstream. You pass it out in your urine (making it look dark) rather than through the bowel (so your stools looks lighter).

Bile contains a lot of yellow pigment so it turns the skin yellow. This may be less noticeable in black or brown skin. It is often easier to spot in the whites of the eyes rather than the skin.

Many people with pancreatic cancer have jaundice when they first go to their doctors. Most of them will have pain as well. A small number of people have no pain and jaundice. 

Jaundice is a common symptom of many liver and gallbladder diseases.

Weight loss

People diagnosed with pancreatic cancer might have recently lost a lot of weight for no apparent reason. This symptom is more common in cancers of the head of the pancreas.

Bowel changes

If your pancreatic duct blocks, you might develop a symptom called steatorrhoea. This means fatty stools. You may pass frequent, large bowel motions that are pale coloured and smelly, and are difficult to flush away. These bowel changes can mean that you are not absorbing your food properly. This can also cause weight loss.

Diarrhoea and constipation are also other possible bowel changes you can have.

Other signs or symptoms

Cancer of the pancreas can cause other signs or symptoms. These might happen before the cancer is diagnosed or might happen later. Not everyone has every symptom.

Indigestion

Indigestion causes heartburn, bloating and sickness. It is a common problem in the general population, and for most people it isn't a sign of cancer.

If it is persistent or isn't getting better with medicines, you should go back to see your doctor.

Sickness

You may feel or be sick because you have jaundice or an inflamed pancreas. Both these conditions upset the delicate chemical balance of the body.

You might also be sick if the cancer, or inflammation around it, starts to block food from passing out of the stomach and into the first part of the bowel. Due to sickness, you might have a loss of appetite which can cause weight loss.

Diabetes

Some people diagnosed with cancer of the pancreas are found to be newly diabetic. Some have been diagnosed with diabetes within the previous year. If you have diabetes you are not producing enough insulin. So there is too much sugar in your blood. The sugar passes out of the body in the urine and takes some water with it.

• thirst
• passing a lot of urine
• weakness
• weight loss and hunger

Itching

You might have itching if you have jaundice. The increased bile salts in the bloodstream cause itching in the skin.

Fever and shivering

You might have a temperature from time to time because you have jaundice or an inflamed pancreas. When your temperature is high you may feel cold and shivery.

Blood clots

Occasionally, pancreatic cancer is linked to blood clots. They may form in the deep veins of your body, usually the leg. This is called deep vein thrombosis (DVT). Or blood clots can develop in smaller veins anywhere in the body. Sometimes the clots will disappear and then develop somewhere else in the body.

Blood clots can be life threatening. Contact your healthcare team straight away if you have these symptoms:

• pain, redness and swelling around the area where the clot is
• the area around the clot might feel warm to touch
• breathlessness
• pain in your chest or upper back – dial 999 if you have chest pain
• coughing up blood

Symptoms of metastatic pancreatic cancer

Metastatic pancreatic cancer is when the cancer that started in the pancreas has spread to another part of the body, such as the liver, lungs or bones. This may also be called advanced pancreatic cancer.

The most common place for pancreatic cancer to spread to is the liver. It can also spread to the lungs, within the abdomen or to nearby lymph nodes. Rarely, it can spread to the bone.

Symptoms if cancer has spread to the liver or within the abdomen

You might have any of the following symptoms if your cancer has spread to the liver:

• discomfort or pain on the right side of your tummy (abdomen)
• feeling sick
• poor appetite and weight loss
• a swollen tummy (called ascites)
• yellowing of the skin and whites of the eyes, and itchy skin (jaundice)

Symptoms if cancer has spread to the lungs

You may have any of these symptoms if your cancer has spread into the lungs:

• a cough that doesn’t go away
• breathlessness
• ongoing chest infections
• coughing up blood
• a buildup of fluid between the chest wall and the lung (a pleural effusion)

Symptoms if cancer has spread to the bone

You might have any of the following symptoms if your cancer has spread to the bones:

• pain from breakdown of the bone – the pain is continuous and people often describe it as gnawing
• backache, which gets worse despite resting
• weaker bones – they can break more easily
• raised blood calcium (hypercalcaemia), which can cause dehydration, confusion, sickness, tummy (abdominal) pain and constipation
• low levels of blood cells – blood cells are made in the bone marrow and can be crowded out by the cancer cells, causing anaemia, increased risk of infection, bruising and bleeding

Cancer in the spinal bones can cause pressure on the spinal cord. If it isn't treated, it can lead to weakness in your legs, numbness, paralysis and loss of bladder and bowel control (incontinence). This is called spinal cord compression. It is an emergency, so if you have these symptoms contact your 24 hour advice line or healthcare team straight away. If you can't get through, contact your GP or go to your nearest accident and emergency department (A&E). 

Symptoms of pancreatic neuroendocrine tumours

Neuroendocrine tumours (NETs) are rare cancers that start in neuroendocrine cells. Neuroendocrine cells have different functions depending on where they are in the body. They control how our bodies work. You might also hear NETs called neuroendocrine neoplasms (NENs) or neuroendocrine carcinomas (NECs). 

A pancreatic NET starts in the neuroendocrine cells of the pancreas. Pancreatic NETs are rare. They are usually split into 2 groups, these are:

• cancers that don’t make hormones, or make hormones that don’t cause a set of symptoms (non functioning tumours)
• cancers that make hormones and cause a set of symptoms (functioning tumours)

The most common type are non functioning pancreatic NET.