Health Information

Essentials of diagnosis

• 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.

General considerations

Carcinoma is the commonest neoplasm of the pancreas. About 75% are in the head and 25% in the body and tail of the organ. Carcinomas involving the head of the pancreas, the ampulla of vater, the common bile duct, and the duodenum are considered together, because they are usually indistinguishable clinically; of these, carcinomas of the pancreas constitute over 90%. They comprise 2% of all cancers and 5% of cancer deaths.

Clinical findings

Symptoms and signs: Pain is present in over 70% of cases and is often vague, diffuse, and located in the epigastrium or left upper quadrant when the lesion is in the tail. Radiation of pain into the back is common and sometimes predominates. Sitting up and learning forward may afford some relief, and this usually indicates that the lesion has spread beyond the pancreas and is inoperable. Diarrhea, as a relatively early symptom, is seen occasionally. Migratory thrombophlebitis is a rare sign. Weight loss is a common but late finding, jaundice, which may be associated with a palpable gallbladder, is indicative of obstruction by neoplasm (Courvoisier’s law), but there are frequent exceptions. In additions, a hard, fixed, occasionally tender mass may be present.

Laboratory findings

There may be mild anemia. Glycosuria, hyperglycemia, and impaired glucose tolerance or true diabetes mellitus are found in 10-20% of cases. The serum amylase or lipase level is occasionally elevated. Liver function tests may suggest obstructive jaundice. Steatorrhea in the absence of jaundice is uncommon. Occult blood in the stool is suggestive of carcinoma of the ampulla of vater.