Premise
The symptomatic picture of tumors of the exocrine pancreas (mainly represented by pancreatic carcinoma) differs from the symptomatic picture of endocrine pancreatic tumors.
Pancreatic Carcinoma Symptoms
Pancreatic cancer is the most common exocrine pancreatic cancer.
The characteristic symptoms and signs of this pancreatic cancer are:
- Predominantly abdominal pain;
- Jaundice;
- Dyspepsia;
- Weight loss.
Other fairly characteristic but not always present symptoms are:
- Hematemesis;
- Melena;
- Faecal occult blood;
- Diabetes;
- Depression.
ACHE
In pancreatic cancer, pain in the abdomen and surrounding areas is present in at least 70% of patients; in general, it arises quite early, especially when the neoplasm is located at the head of the organ: what causes it is the stasis of the pancreatic secretion, which struggles to flow into the duodenum, thanks to the presence of the tumor mass.
At a later stage of the disease, the painful sensation may also be due to infiltration and compression of neighboring nerves.
The precise location of pain varies according to the location of the pancreatic tumor:
- tumors in the head of the pancreas cause pain in the epigastrium (region just below the sternum) and in the right abdominal region;
- Pancreatic body tumors are responsible for a painful sensation in the region around the navel;
- tumors in the tail of the pancreas cause a painful sensation that involves the left abdominal region, the upper abdominal quadrants and part of the back (about the height of where the women attach the bra).
Pain is usually intense, annoying, continuous or almost continuous; sometimes it can be aggravated by meals, but in general it is independent of these; it is typically related to posture: in fact, the supine position (upturned belly) accentuates it, while some maneuvers - such as the bending of the trunk forward, the right lateral position or the compression of the abdomen - attenuate it.
JAUNDICE
With the term " jaundice ", doctors mean an unusual yellowish coloration of the skin, of the ocular sclerae and of the mucous membranes; this condition is triggered by the pathological elevation of the bilirubin blood values, with consequent accumulation of substances at the local level.
Jaundice is one of the most characteristic and early signs of pancreatic head carcinoma (80-90% of cases); it is, however, less frequent and later in carcinoma of the tail and body (10-40% of cases).
From the sometimes intermittent course, jaundice arises because the tumor mass invades and obstructs the bile ducts; in medicine, a jaundice with this nature is also called obstructive jaundice .
In the pancreatic cancer patient, the typical consequences of jaundice are:
- abdominal pain (which is associated with that described above),
- clear stools (because bile cannot pass from the gallbladder to the intestine),
- dark marsala-colored urine (because bilirubin, unable to access the bile ducts, returns to the blood and reaches the kidneys, which eliminate it)
- widespread skin itching (due to bile salt retention).
Physical examination
The physical examination of patients with jaundice from pancreatic carcinoma certainly shows a yellowish (sometimes tending to green) color of the skin and sclera of the eyes (in white individuals it is decidedly more evident); furthermore, it can lead to the finding of:
- A palpable mass at epigastric level . It is typical of the most advanced stages of the disease and affects 40-50% of cases of pancreatic and pancreatic body cancer;
- A significant increase in the size of the liver ( hepatomegaly ), as a result of biliary stasis (ie bile). It is more common in cases of pancreatic head cancer;
- An enlarged and palpable gallbladder . It only affects 15-40% of patients and, in particular, those with pancreatic head tumors;
- A significant increase in the size of the spleen ( splenomegaly ). It is very frequent;
- Ascites, or fluid in the peritoneum;
- Episodes of phlebitis (inflammation of blood vessel walls) with thrombus formation, which migrate to the vessels of the lower limbs ( migrating thrombophlebitis ). They affect about 10% of patients and, especially, those with tumors of the pancreas body and pancreatic tail.
In a patient every 10 carcinomas of the pancreas (ie 10%), obstructive jaundice is painless ; in other words, it is not responsible for any painful sensation.
DYSPEPSIA
In medicine, the term dyspepsia means poor digestion .
In pancreatic cancer, dyspepsia is particularly common in tumors located on the head of the organ.
Its presence is typically associated with disorders such as: anorexia (ie lack of appetite, not to be confused with anorexia nervosa), sense of weight at epigastric level immediately after a meal (especially if based on fatty foods), alternate constipation to diarrhea, air in the stomach and fatty stools ( steatorrhea ).
WEIGHT LOSS
Weight loss is progressive and significant, whatever the location of the neoplasm (head, body or tail) and is related to anorexia resulting from dyspepsia and bad nutrient absorption (which, in these cases, is a typical effect of functional pancreas deficiency).
From this point of view, pancreatic cancer represents one of the diseases that most rapidly cause a state of real physical decay.
HEMATEMES, MELENA AND BLOOD BLOOD IN THE FECI
In medicine, the terms hematemesis, melena and occult blood in the stool mean, respectively:
- I vomit with blood;
- Dark, almost black stools, due to the presence of digested blood;
- Feces with small traces of blood, not visible to the naked eye, but appreciable only with specific laboratory analyzes.
The occurrence of hematemesis, melena and occult blood in the faeces is the result of the erosion or ulceration of the mucosa of the duodenum, by the carcinoma of the pancreas during its propagation to the contiguous organs.
DIABETES
Diabetes is perhaps the best known example of a metabolic disease. To cause its appearance is a decrease in the activity of insulin, a hormone produced by the pancreas; insufficient insulin activity causes hyperglycemia, which is high concentration of glucose in the blood.
In individuals with pancreatic cancer, the onset of diabetes depends on the negative effects that the malignant tumor can have, in a medium-advanced phase, on the functionality of the organ concerned, specifically on the activity of the beta cells of the islets of Langerhans.
The presence of diabetes in the pancreatic cancer patient is typically responsible for:
- Polydipsia, or intense thirst;
- Polyuria, that is the need to urinate often;
- Exhaustion ;
- Further weight loss .
DEPRESSION
For reasons still unknown, pancreatic cancer would induce a lowering of mood, classifiable as depression, shortly after its onset.
Depression in pancreatic cancer is a concrete and fairly widespread problem, felt by patients and their relatives even before an official diagnosis (therefore, it is not a depression due to the knowledge of being suffering from a serious malignancy).
Summary of symptoms and signs of pancreatic cancer.
- Abdominal pain
- Epigastric pain
- Pain in the upper part of the abdomen
- Back pain
- Jaundice
- I made clear
- Abdominal pain
- Dark urine
- Skin itching
- Hepatomegaly
- Ascites
- splenomegaly
- Enlarged gallbladder
- Migrant phlebitis and thrombophlebitis
- Dyspepsia
- Anorexia
- Sense of weight at epigastric level after meals
- Constipation alternating with diarrhea
- Air in the stomach
- steatorrhea
- Nausea and vomit
- Weight loss
- Hematemesis, melena and occult blood in the stool
- Diabetes
- polydipsia
- Polyuria
- exhaustion
- Further weight loss
- Depression
Tumor symptoms of the endocrine pancreas
The potential symptoms of endocrine pancreatic cancer vary according to the cell, to the islets of Langerhans, from which the tumor mass originates.
This means that, when they are symptomatic, insulinoma, gastrinoma, somatostatinoma, VIPoma and glucagonoma are responsible for specific clinical manifestations.
insulinoma
Insulinoma pathologically potentiates the production of insulin by the beta cells of the Langerhans islands, establishing a condition of hypoglycemia (ie low concentration of glucose in the blood).
The state of hypoglycemia is typically responsible for: weakness, loss of energy, dizziness and drowsiness.
gastrinoma
Pancreatic gastrinomas abnormally enhance gastrin production by so-called pancreatic G cells. The resulting excess of gastrin causes peptic ulcers in the stomach and duodenum ; the typical symptoms of peptic ulcers in the stomach and duodenum are: abdominal pain, diarrhea, vomiting with blood (hematemesis), acid reflux, persistent heartburn, feeling sick in the upper part of the stomach, sense of weakness, associated weight loss to a loss of appetite, malnutrition, anemia and dark stools due to the presence of blood.
Gastrinomas are a typical consequence of a rare disease known as Zollinger-Ellison syndrome .
somatostatinoma
Somatostatinoma is a tumor that induces excessive production of the hormone somatostatin, by the delta cells of the Langerhans islands.
An excess of somatostatin causes: gallstones (and related symptoms), diabetes (and related symptoms), fatty stools (steatorrhea) and very smelly.
VIPoma
Pancreatic- based VIPomas are tumors that induce excessive production of the VIP hormone (Intestinal Vasoactive Peptide) by pancreatic cells responsible for this function.
The excess of VIP is typically responsible for: chronic and persistent watery diarrhea, hypokalemia, lethargy, muscle weakness, nausea, vomiting and abdominal cramps.
glucagonoma
Glucagonoma pathologically increases the secretion of the glucagon hormone by the alpha cells of the Langerhans islands.
An excess of glucagon in the human body causes: a particular form of erythema (known as migrant necrolytic erythema ), anemia, diarrhea, weight loss, mouth sores and low blood levels of amino acids.
Important note on endocrine pancreatic cancer
About 2/3 of cases of endocrine pancreatic cancer do not alter hormone production, so they are asymptomatic.
When should I go to the doctor?
If an individual is the subject of an unusual weight loss, associated with jaundice, abdominal pain and poor digestion - that is, the typical symptoms of pancreatic cancer - he should immediately contact his doctor to undergo tests.
See also: Pancreatic tumor symptoms
