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Essentials of Diagnosis
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Obstructive jaundice (may be painless)
Enlarged gallbladder (may be painful)
Upper abdominal pain with radiation to back, weight loss, and thrombophlebitis are usually late manifestations
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General Considerations
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The incidence of pancreatic cancer is increasing, and over the next two decades it is expected to surpass colorectal cancer as the second leading cause of cancer-related deaths in the United States
Risk factors for pancreatic carcinoma
Age
Obesity
Tobacco use (thought to cause 20–25% of cases)
Heavy alcohol use
Chronic pancreatitis
Diabetes mellitus
Prior abdominal radiation
Family history
Gallstones, gastric ulcer (possibly)
Exposure to arsenic, cadmium
~7% of pancreatic cancer patients have a first-degree relative with pancreatic cancer, compared with 0.6% of control subjects
In 10–15% of patients, pancreatic cancer occurs as part of a hereditary syndrome, including
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Pain
Present in > 70%
Often vague and diffuse
Located in the epigastrium or, when the lesion is in the tail, located in the left upper quadrant of the abdomen
Radiation into the back is common and sometimes predominates
Sitting up and leaning forward may afford some relief, which usually indicates extrapancreatic spread and inoperability
Diarrhea, perhaps from maldigestion, is an occasional early symptom
Hyperglycemia and decreases in subcutaneous abdominal fat and serum lipid levels have been reported to precede a diagnosis of pancreatic cancer
Weight loss is common and may be associated with ...