Introduction. The need to detect pancreatic cancer at earlier stages is undisputed. We recorded the signs and symptoms of patients presenting with exocrine pancreatic cancer and evaluated their association with clinical characteristics such as tumour site and disease stage.
Patients and methods. All patients (n=185) with exocrine pancreatic cancer newly diagnosed at five general hospitals in Eastern Spain were prospectively recruited over 3 years. Symptoms were elicited through personal interviews and signs were recorded by the attending physician on admission.
Results. At diagnosis, one third of tumours of the pancreas head were in stage I and another third in stage IV. None of the tumours of the body and tail were in stage I, and over 80% were in stage IV (p<0.001). At presentation, the most frequent symptoms were asthenia (86%), anorexia (83%), weight-loss (85%), abdominal pain (79%), and choluria (59%). Cholestatic symptoms were more common in tumours affecting only the pancreatic head (p<0.001). There was a clear trend towards more localized tumours with increasing numbers of cholestatic signs (p<0.001). Asthenia, anorexia and weight-loss were unrelated to stage. An increased symptom-to-diagnosis interval was associated with more advanced stage (p=0.048).
Conclusions. Proper attention to signs and symptoms, especially cholestasis, may help identify patients with pancreatic cancer at an earlier stage. Results also provide a current picture of the semiology of pancreatic cancer which could be of use in studies on the potential of proteomic tests in the early detection of this neoplasm.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Porta M, Malats N, Jariod M, et al. Serum concentrations of organochlorine compounds and K-ras mutations in exocrine pancreatic cancer. Lancet. 1999;354:2125–9.
Li D, Xie K, Wolff R, Abbruzzese JL. Pancreatic cancer. Lancet. 2004;363:1049–57.
Weiderpass E, Partanen T, Kaaks R, et al. Pancreatic cancer: Occurrence, trends, and environmental etiology. A review. Scand J Work Environ Health. 1999;24:165–74.
Ekbom A, Hunter D. Pancreatic cancer. In: Adami HO, Hunter D, Trichopoulos D, editors. Textbook of Cancer Epidemiology. New York: Oxford University Press; 2002. p. 233–47.
Anderson KE, Potter JD, Mack TM. Pancreatic cancer. In: Schottenfeld D, Fraumeni JF Jr, editors. Cancer Epidemiology and Prevention. New York: Oxford University Press; 1996. p. 725–71.
Lowenfels AB, Maisonneuve P. Pancreatic cancer: development of a unifying etiologic concept. In: Löhr JM, Colcher D, Hallingswirth MA, Liebe S. Cell and molecular biology of pancreatic carcinoma. Recent developments in research and experimental therapy. Ann New York Acad Sci. 1999;880:191–200.
Hart AR. Pancreatic cancer: any prospects for prevention? Postgrad Med J. 1999;75:521–6.
Trede M, Carter DC. Clinical evaluation and preoperative assessment. In: Trede M, Carter DC, editors. Surgery of the pancreas. New York: Churchill Livingstone; 1997. p. 459–70.
Fearon KCH, Wigmore SJ, Carter DC. Chemotherapy and radiotherapy in the treatment of pancreatic cancer. In: Trede M, Carter DC, editors. Surgery of the pancreas. New York: Churchill Livingstone; 1997. p. 551–62.
DiMagno EP, Reber HA, Tempero MA (American Gastroenterological Association Clinical Practice and Practice Economics Committee). American Gastroenterological Association medical position statement: epidemiology, diagnosis, and treatment of pancreatic ductal adenocarcinoma. Gastroenterology. 1999;117:1463–84.
Rothenberg ML, Abbruzzese JL, Moore M, Portenoy RK, Robertson JM, Wanebo HJ. A rationale for expanding the endpoints for clinical trials in advanced pancreatic carcinoma. Cancer. 1996;78 Suppl 3:627–32.
Levin B. An overview of preventive strategies for pancreatic cancer. Ann Oncol. 1999;10 Suppl 4:S193–6.
Anonymous. Early diagnosis and screening for pancreatic cancer [editorial]. Lancet. 1986;2:783–4.
DiMagno EP. Pancreatic cancer: clinical presentation, pitfalls and early clues. Ann Oncol. 1999;10 Supl 4:140–2.
Gullo L, Tomassetti P, Migliori M, Casadei R, Marrano D. Do early symptoms of pancreatic cancer exist that can allow an earlier diagnosis? Pancreas. 2001;22:210–3.
Beger HG, Warshaw AL, Büchler MW, et al, editors. The pancreas. Oxford: Blackwell; 1998.
Howard JM, Idezuki Y, Ihse I, Prinz RA, editors. Surgical diseases of the pancreas. 3rd. ed. Baltimore: Williams and Wilkins; 1998.
Neoptolemos J, Lemoine NR, editors. Pancreatic cancer. Molecular and clinical advances. Oxford: Blackwell; 1996.
Go VLW, DiMagno EP, Gardner JD, Lebenthal E, Reber HA, Scheele GA, editors. The pancreas. Biology, pathobiology, and disease. 2nd. ed. New York: Raven; 1993.
Falk J, Keidan R, Rigo PK, Dmuchowski C. Adenocarcinoma of the pancreatic head: a community teaching hospital’s experience from 1982 to 1992. Am Surg. 1999;65:15–8.
Faivre J, Forman D, Estève J, Obradovic M, San M and the EUROCARE Working Group. Survival of patients with primary liver cancer, pancreatic cancer and biliary tract cancer in Europe. Eur J Cancer. 1998;34:2184–90.
Gudjonsson B. Carcinoma of the pancreas: critical analysis of costs, results of resections, and the need for standardized reporting. J Am Coll Surg. 1995;181:483–503.
Gordon TA, Burleyson GP, Tielsch JM, Cameron JL. The effects of regionalization on cost and outcome for one general high-risk surgical procedure. Ann Surg. 1995;221:43–9.
Real FX. A “catastrophic hypothesis” for pancreas cancer progression. Gastroenterology. 2003;124:1958–64.
Maguire A, Porta M, Malats N, Gallén M, Piñol JL, Fernández E. Cancer survival and the duration of symptoms. An analysis of possible forms of the risk function. Eur J Cancer. 1994;30A:785–92.
Richter JM. Clinical assessment of pancreatic cancer. In: Beger HG, Warshaw AL, Büchler MW, et al, editors. The pancreas. Vol. 2. Oxford: Blackwell; 1998. p. 950–2.
Modolell I, Guarner L, Malagelada JR. Vagaries of clinical presentation of pancreatic and biliary tract cancer. Ann Oncol. 1999;10 Supl 4:82–4.
Lankisch PG. Clinical evaluation. En: Beger HG, Warshaw AL, Büchler MW, et al, editors. The pancreas. Vol. 1. Oxford: Blackwell; 1998. p. 163–8.
Casper ES. Pancreatic cancer: How can we progress? [editorial]. Eur J Cancer. 1993;29A:171–2.
Gapstur SM, Gann P. Is pancreatic cancer a preventable disease? [editorial]. JAMA. 2001;286:967–8.
Zeiderman MR, Wyman A, Euinton HA, Simms JM, Rogers K. Diagnostic difficulties in patients with a pancreatic mass. BMJ. 1991;302:1395–6.
Cancer of the Pancreas Task Force. Staging of cancer of the pancreas. Cancer. 1981;47:1631–7.
Bakkevold KE, Arnesjo B, Kambestad B. Carcinoma of the pancreas and papilla of Vater: presenting symptoms, signs, and diagnosis related to stage and tumour site. A prospective multicentre trial in 472 patients. Norwegian Pancreatic Cancer Trial. Scand J Gastroenterol. 1992;27:317–25.
Maringhini A, Ciambra M, Raimondo M, et al. Clinical presentation and ultrasonography in the diagnosis of pancreatic cancer. Pancreas. 1993;8:146–50.
Ridder GJ, Klempnauer J. Back pain in patients with ductal pancreatic cancer. Its impact on resectability and prognosis after resection. Scand J Gastroenterol. 1995;30:1216–20.
Kelsen DP, Portenoy RK, Thaler HT, et al. Pain and depression in patients with newly diagnosed pancreas cancer. J Clin Oncol. 1995;13:748–55.
Halder SL, McBeth J, Silman AJ, Thompson DG, Macfarlane GJ. Psychosocial risk factors for the onset of abdominal pain. Results from a large prospective population-based study. Int J Epidemiol. 2002;31:1219–25.
Fernández E, Porta M, Malats N, Belloc J, Gallén M. Symptom to diagnosis interval and survival in cancers of the digestive tract. Dig Dis Sci. 2002;47:2434–40.
Tishelman C, Taube A, Sachs L. Self-reported symptom distress in cancer patients: reflections of disease, illness or sickness? Soc Sci Med. 1991;33:1229–40.
Petricoin EF, Zoon KC, Kohn EC, Barrett JC, Liotta LA. Clinical proteomics: translating benchside promise into bedside reality. Nat Rev Drug Discov. 2002;1:683–95.
Wulfkuhle JD, Liotta LA, Petricoin EF. Early detection: Proteomic applications for the early detection of cancer. Nat Rev Cancer. 2003;3:267–75.
Petricoin EF, Liotta LA. SELDI-TOF-based serum proteomic pattern diagnostics for early detection of cancer. Curr Opin Biotechnol. 2004;15:24–30.
Porta M, Fernández E, Alguacil J. Semiology, proteomics and the early detection of symptomatic cancer. J Clin Epidemiol. 2003;56:815–9.
Diamandis EP. Analysis of serum proteomic patterns for early cancer diagnosis: drawing attention to potential problems. J Natl Cancer Inst. 2004;96:353–6.
Ransohoff DF. Rules of evidence for cancer molecular-marker discovery and validation. Nat Rev Cancer. 2004;4:309–14.
Feinstein AR. Misguided efforts and future challenges for research on “diagnostic tests”. J Epidemiol Community Health. 2002;56:330–2.
Rockhill B. Proteomic patterns in serum and identification of ovarian cancer. Lancet. 2002;360:169.
Porta M, Malats N, Guarner L, et al. Association between coffee drinking and K-ras mutations in exocrine pancreatic cancer. J Epidemiol Community Health. 1999;53:702–9.
Porta M, Jariod M, Malats N, et al. Prevalence of K-ras mutations at diagnosis and serum levels of DDT, DDE, PCBs and other organochlorine compounds in exocrine pancreatic cancer. In: Gress TM, editor. Molecular pathogenesis of pancreatic cancer. Amsterdam: IOS Press; 2000. p. 37–44.
Porta M, Costafreda S, Malats N, et al. Validity of the hospital discharge diagnosis in epidemiologic studies of biliopancreatic pathology. Eur J Epidemiol. 2000;16:533–41.
Soler M, Malats N, Porta M, et al. Medical conditions in patients with pancreatic and biliary diseases: validity and agreement between data from questionnaires and medical records. Dig Dis Sci. 1999;44:2469–77.
Alguacil J, Porta M, Benavides FG, et al. Occupation and pancreatic cancer in Spain: a case-control study based on job titles. Int J Epidemiol. 2000;29:1004–13.
Alguacil J, Kauppinen T, Porta M, et al. Risk of pancreatic cancer and occupational exposures in Spain. Ann Occupat Hyg. 2000;44:391–403.
Malats N, Casals T, Porta M, Guarner L, Estivill X, Real FX. The cystic fibrosis transmembrane regulator (CFTR) DF508 mutation and 5T allele in patients with chronic pancreatitis and exocrine pancreas cancer. Gut. 2001;48:70–4.
Real FX, Malats N, Lesca G, et al. Family history of cancer and germline BRCA2 mutations in sporadic exocrine pancreas cancer. Gut. 2002;50:653–7.
Alguacil J, Porta M, Malats N, et al. Occupational exposure to organic solvents and K-ras mutations in exocrine pancreatic cancer. Carcinogenesis. 2002;23:101–6.
Alguacil J, Porta M, Kauppinen T, Malats N, Kogevinas M, Carrato A. Occupational exposure to dyes, metals, polycyclic aromatic hydrocarbons and other agents and K-ras activation in human exocrine pancreatic cancer. Int J Cancer. 2003;107:635–41.
Gavaldà L, Porta M, Malats N, et al. Agreement between information supplied by the patient and a family member on medical history, consumption of tobacco, alcohol and coffee, and diet in cancer of the exocrine pancreas and extrahepatic biliary system. Gac Sanit. 1995;9:334–42.
International Classification of Diseases, Clinical Modification. 9th revision. Ann Arbor, MI: Commission on Professional and Hospital Activities; 1980.
International Union Against Cancer. TNM classification of malignant tumours. 4th ed., 2nd revision. Berlin: Springer; 1992.
American Joint Committee on Cancer, TNM Committee of the International Union Against Cancer. Handbook for staging of cancer from the Manual for Staging of Cancer. 4th ed. Philadelphia: J.B. Lippincott; 1993.
World Health Organization. International Classification of Diseases for Oncology (ICD-O-2). 2nd ed. Geneva: World Health Organization; 1990.
Berg JW. Morphologic classification of human cancer. In: Schottenfeld D, Fraumeni JF Jr, editors. Cancer Epidemiology and Prevention. 2nd ed. New York: Oxford University Press; 1996. p. 28–44.
Armitage P, Berry G. Statistical Methods in Medical Research. 2nd ed. Oxford: Blackwell; 1987. p. 125–32, 205–9.
Schlesselman JJ, Stolley PD. Case-control Studies. New York: Oxford University Press; 1982. p. 174–7.
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research. Belmont, CA: Lifetime Learning Publications; 1982. p. 343.
Bland M. An Introduction to Medical Statistics. Oxford: Oxford Medical Publications; 1987. p. 241–65.
Okusaka T, Okada S, Ueno H, et al. Abdominal pain in patients with resectable pancreatic cancer with reference to clinicopathologic findings. Pancreas. 2001;22:279–84.
Passik SD, Breitbart WS. Depression in patients with pancreatic carcinoma: Diagnostic and treatment issues. Cancer. 1996;78:615–26.
Porta M. Role of organochlorine compounds in the etiology of pancreatic cancer: A proposal to develop methodological standards. Epidemiology. 2001;12:272–6.
Porta M, Zumeta E, Ruiz L, et al. Persistent toxic substances and public health in Spain. Int J Occupat Environ Health. 2003;9:112–7.
Porta M, Kogevinas M, Zumeta E, et al. Concentraciones de compuestos tóxicos persistentes en la población española: el rompecabezas sin piezas y la protección de la salud pública. Gac Sanit. 2002;16:257–66.
Porta M, Malats N, Belloc J, Gallén M, Fernández E. Do we believe what patients say about their neoplastic symptoms? An analysis of factors that influence the interviewer’s judgement. Eur J Epidemiol. 1996;12:553–62.
Malats N, Belloc J, Gallén M, Porta M. Disagreement between hospital medical records and a structured patient interview on the type and date of the first symptom in cancers of the digestive tract. Rev Épidémiol Santé Publique. 1995;43:533–40.
Nebril BA, Filgueira LT, Calvo AP, et al. Importance of surgical staging in patients with cancer of the exocrine pancreas. Rev Esp Enferm Dig. 1993;83:447–52.
Cubiella J, Castells A, Fondevila C, et al. Prognostic factors in nonresectable pancreatic adenocarcinoma: A rationale to design therapeutic trials. Am J Gastroenterol. 1999;94:1271–8.
Sáenz A, Kuriansky J, Salvador L, et al. Thoracoscopic splanchnicectomy for pain control in patients with unresectable carcinoma of the pancreas. Surg Endosc. 2000;14:717–20.
Mercadante S, Catala E, Arcuri E, et al. Celiac plexus block for pancreatic cancer pain: Factors influencing pain, symptoms and quality of life. J Pain Symptom Manage. 2003;26:1140–7.
Members of the Multicentre Prospective Study on the Role of the Kras and other Genetic Alterations in the Diagnosis, Prognosis and Etiology of Pancreatic and Biliary Diseases (PANKRAS II) Study Group are mentioned in previous publications.
About this article
Cite this article
Porta, M., Fabregat, X., Malats, N. et al. Exocrine pancreatic cancer: Symptoms at presentation and their relation to tumour site and stage. Clin Transl Oncol 7, 189–197 (2005). https://doi.org/10.1007/BF02712816
- pancreatic neoplasms/diagnosis
- pancreatic neoplasms/epidemiology
- signs and symptoms
- constitutional syndrome
- epigastric mass