Pancreatic Cancer Symptoms and Signs

November 22, 2024

This page was reviewed under our medical and editorial policy by Laleh Melstrom, M.D., M.S., associate professor of surgery and immuno-oncology, Division of Surgical Oncology, Department of Surgery, City of Hope^® Cancer Center Duarte

Pancreatic cancer is a cancer that starts in the pancreas, a gland located between the stomach and spine. Part of the digestive system, the pancreas produces enzymes that help break down food and hormones that regulate blood sugar. The majority of pancreatic cancers are pancreatic adenocarcinomas, which often start in the ducts of the pancreas.

There are no standard screening tests to detect early-stage pancreatic cancers. Patients with a family history of pancreatic cancer should talk to their doctor about their personal risk. Patients with a genetic high risk may benefit from periodic tests to check for cancer. About 10% of pancreatic cancers are hereditary, according to the National Comprehensive Cancer Network.

Pancreatic cancer usually causes few noticeable changes in its early stages. By the time a patient detects symptoms, the cancer may already have grown beyond the pancreas itself. Symptoms are things a patient notices or feels, such as fatigue or pain. Signs are things a doctor can see or measure during an exam, such as bleeding or fever.

Symptoms of Pancreatic Cancer

The following symptoms are things that patients may notice on their own.

Yellowing of the Eyes and Skin (Jaundice)

A change in skin or eye coloring caused by jaundice is often the first sign of pancreatic cancer. It happens when a tumor growing in the pancreas blocks a tube (duct) that carries bile, a digestive fluid made by the liver. When bile is unable to flow freely, a yellow-brown component in it called bilirubin may build up in the body. Too much of it causes the skin and eyes to turn yellow.

Dark-Colored Urine

Some patients with jaundice develop dark-colored urine even before eye or skin color changes. Normally, the liver breaks down bilirubin, which is then excreted in stool. When a tumor in the pancreas blocks a duct that transports bile to the intestines, however, bilirubin ends up getting excreted in urine. Urine normally does not contain bilirubin, but if it does, it may be brownish in color.  

Unexplained Weight Loss

Many people with pancreatic cancer lose weight without trying, and cancer symptoms, such as loss of appetite or nausea and vomiting, may cause them to eat less and lose weight. Symptoms that cause fluid loss, such as nausea, vomiting and diarrhea, may also lead to dehydration, another possible cause of unexplained weight loss. However, even when a patient is eating normally, pancreatic cancer may cause weight loss by interfering with digestion, causing fewer calories to be absorbed.

Itchy Skin

Itchiness is a common symptom of high levels of bilirubin in the body. When bilirubin accumulates in the skin, it breaks down into substances that cause itching over the entire body.

Belly and Back Pain

The pancreas is located deep within the torso, in between the belly and back. Although a pancreatic tumor is unable to be felt in the early stages, as it grows larger and presses on internal organs, it may cause pain in the area. Pancreatic cancer may also affect surrounding nerves, leading to back pain. 

Blood Clots

In some patients, a blood clot in a large vein may be the first symptom of pancreatic cancer. Specific symptoms depend on where the blood clot is located.

Deep vein thrombosis (DVT): If a blood clot occurs in an arm or leg, the surrounding area may become red, swollen and painful.

Pulmonary embolism (PE): Blood clots in the lungs may cause trouble breathing; fast or irregular heartbeat; or dizziness. Patients may also have chest pain and cough up blood.

Most blood clots are not caused by pancreatic cancer, but all blood clots may be life-threatening. Patients should seek emergency care if symptoms of a clot are experienced.

Nausea and Vomiting

Pancreatic tumors may put pressure on the stomach as they grow larger. If a tumor grows large enough, it may even interfere with food passing through the stomach, leading to nausea and vomiting. Patients may experience discomfort or pain after eating. 

Loss of Appetite

Patients with pancreatic cancer often lose a desire to eat, or they may want only very small amounts of food. Abdominal discomfort, nausea and vomiting are common reasons for food avoidance. Underlying body pain may also contribute to a loss of appetite. If patients become malnourished, they may feel more tired and weak.

Irregular Stool

Pancreatic cancer may cause noticeable changes in stool. Bile duct blockages prevent bile from reaching the intestines, making it harder to digest fats. A drop in pancreatic enzymes also leads to less fat absorption. If this happens, the movement of undigested fat through the gut may result in greasy-looking stools that may float in the toilet. Stool may also appear lighter in color or gray.

Signs That Pancreatic Cancer Has Spread

Pancreatic cancer often causes no symptoms until it has spread to other parts of the body (metastasized).

Symptoms of metastatic pancreatic cancer vary by location. Pancreatic cancer typically spreads to the liver, lungs or abdomen, but spread to the bone is also possible.

Spread to the Liver or Abdomen

If pancreatic cancer spreads to the liver or abdomen, patients may have symptoms for the first time or notice that existing ones are getting worse. These may include jaundice-related symptoms, such as yellowing or itchy skin. Patients may also feel more tired, weak or less interested in eating. Symptoms that may be caused by liver metastases include:

• Fever
• Ascites (swollen, hard belly)
• Leg swelling
• Pain near the liver (upper right part of the abdomen)
• Confusion
• Excessive sleepiness

Spread to the Lungs

The lungs are another common site for pancreatic cancer to metastasize. Lung-related symptoms may include:

• Coughing, or coughing up blood
• Fluid around the lungs
• Chest pain
• Trouble breathing

Spread to the Bone

Less commonly, pancreatic cancer may spread to the bone. This may happen with almost any type of cancer.

Symptoms of bone metastases may include those listed below.

Bone pain: This may initially come and go and worsen at night. Later on, pain may become constant and make it difficult to do activities.

Bone breaks during normal activities: Sudden, severe pain may be a sign.

Spinal cord compression: This may lead to back pain, lower-extremity numbness and/or bladder or bowel incontinence.

Damaged bone cells: Such damage may cause calcium levels in the blood to be higher than normal. If this happens, patients may feel achy, extra thirsty or confused. If severe, kidney failure and coma are possible.

Patients should discuss any persistent symptoms with their doctor and be evaluated to determine the cause. If symptoms are severe, including sharp, sudden pain, trouble breathing or severe vomiting, patients should seek immediate medical care.