CARCINOMA OF THE PANCREAS - Clinical Manifestations



The clinical manifes­tations tend to be nonspecific and are often in­sidious in onset, so that the malignancy reaches an advanced stage by the time diagnosis is made. The cardinal manifestations are epigastric pain and weight loss. The pain is usually persistent, dull, and noncolicky and may radiate to the back but can be individually variable. Anorexia, nau­sea, and vomiting occur frequently, sometimes in association with a strange aversion to meat. Emo­tional disturbances (anxiety, depression) have been described as occurring more frequently and earlier than in other malignancies. Obstructive jaundice results commonly from carcinoma of the head of the pancreas, sometimes in association with a large, palpable gallbladder. A number of other abnormalities can accompany the illness: migratory thrombophlebitis (Trousseau’s sign), acute pancreatitis, diabetes mellitus, paraneo­plastic endocrine syndromes (Cushing’s syn­drome, hypercalcemia), upper gastrointestinal bleeding (direct invasion of stomach or duo­denum, involvement of the splenic vein with pro­duction of varices), or an abdominal mass. Rarely, with adenocarcinoma of acinar cells, fat necrosis may produce painful nodules subcutaneously or bone pain from intramedullary involvement.