In the early stages of pancreatic cancer, many people don't notice any symptoms or complications. Noticeable symptoms usually start after the cancer begins to affect how the pancreas functions or when it spreads to other organs.
Complications can also vary depending on the tumor location. For example, if the cancer grows in the head of the pancreas, it's more likely to cause noticeable symptoms like jaundice before the disease progresses. If it's in the body or tail of the pancreas, pain and weight loss are more likely to happen first and often don't begin until the cancer has spread.
Learn more about what the complications of pancreatic cancer may look like, and what next steps you and your doctor may decide to take to manage them.
Screen for Complications Early
Jose Trevino, MD, Geoffrey R. Shudtz chair in pancreatic cancer research and chief of surgery at VCU Massey Comprehensive Cancer Center, says when pancreatic cancer is diagnosed at an earlier stage, it's much easier to treat. But diagnosis can be difficult because there are no universal screening programs in place to detect it as there are for more common cancers.
Until there's a universal screening program, he emphasizes the importance of familiarizing yourself with the signs and symptoms of pancreatic cancer if you think you may be at risk.
"There are early signs and changes that can be very impactful," Trevino says. These include:
- Early or sudden start of diabetes or prediabetes
- Pancreatitis
- Oily or light-colored stool
- Dark urine
- Yellow-tinted skin
How do you know if you're at risk? Trevino says there are certain risk factors that he looks for in his clinic. These include gene mutations, a strong family history of pancreatic cancer, and premalignant cysts, which are cysts that may eventually turn into a cancer.
Treating symptoms by targeting the cancer
If pancreatic cancer is causing complications, doctors will likely focus on treating the cancer itself to remove the root cause. Pancreatic cancer treatment options can include:
- Surgery
- Radiation therapy
- Chemotherapy
- Chemoradiation therapy
- Targeted therapy
- Immunotherapy
There are options to help relieve symptoms and improve your quality of life before or during treatment, but they are specific to the complications you have and your long-term treatment plan.
The following are complications that can occur in people with pancreatic cancer.
Jaundice
Many people who are diagnosed with pancreatic cancer cite jaundice as one of their earliest symptoms. It's marked by a yellow tint to the skin or eyes, but it can also cause other symptoms, including dark urine, itchy skin or changes to stool.
Also called hyperbilirubinemia, jaundice can happen when there is too much bilirubin in your bloodstream. Bilirubin is a yellow chemical in hemoglobin, the substance that carries oxygen in your red blood cells. Bilirubin is also in bile, a liquid your liver releases to help you digest food. Bile then travels through the common bile duct into the intestines, eventually being discarded in stool.
If your bile duct doesn't work well, as is common in pancreatic cancer, bilirubin will build up in your body, and your skin or eyes may be tinted yellow. These symptoms can lead to earlier diagnosis and treatment than other types of pancreatic cancer that begin in the body or tail of the pancreas. By the time the cancer reaches the common bile duct and causes jaundice, it is likely to have spread through or beyond the pancreas.
If the cancer does spread beyond the pancreas, it will likely spread to the liver. If your liver is affected and it can't release bilirubin through bile, this can also cause jaundice.
If pancreatic cancer is the cause of jaundice, doctors will likely focus on treating the cancer itself to remove the root cause.
Digestive Distress
Digestion issues can happen if a tumor or inflammation keeps the pancreas from functioning or blocks the pancreatic duct.
Gastrointestinal issues due to pancreatic cancer can include:
Indigestion. This can include heartburn, bloating, and sickness.
Diarrhea/abnormal bowel movements. Your stool may float and appear bulky, greasy, and unusually pale.
Nausea. If a tumor or cyst presses on the stomach or small intestine or causes a block, this can cause nausea or pain that gets worse after eating.
Poor appetite. If tumors or inflammation from the cancer keeps food from passing out of the stomach into the first part of the bowel, this could cause a loss of appetite.
If digestive issues persist, they can lead to weight loss and malnutrition. To prevent worsening digestive issues and maintain a healthy weight, you can:
- Monitor your weight.
- Stay hydrated.
- Eat frequently in small amounts.
- Prioritize high-protein foods that are easy to digest.
- Consider liquid shakes or supplements.
- Add healthy fats to your diet.
- Limit added sugars and sweets.
- Maintain an active lifestyle.
Weight Loss and Malnutrition
All types of cancer can cause weight loss or poor appetite, but these symptoms are more common in people with pancreatic cancer – up to 85% will have it by the time they are diagnosed.
If you are having unexplained weight loss or signs of malnutrition, contact your doctor right away, as it could be a sign of pancreatic cancer.
Besides larger treatments like chemotherapy, radiation, or surgery that targets the cancer itself, your doctor may prescribe a pancreatic enzyme replacement therapy – a treatment made from digestive enzymes from pigs. These can help the small intestine replace enzymes that the pancreas can't make and help your body absorb nutrients.
Weight loss due to pancreatic cancer has three main causes.
Anorexia
Anorexia is defined as the loss of the desire to eat. Tumors release inflammatory cytokines and appetite-suppressing proteins, which can affect your body's ability to interpret hunger cues and energy signals. Food aversion can also be a side effect of treatments like chemotherapy.
Other symptoms that are linked to anorexia include:
- Pain
- Fatigue
- Depression
- Dysmotility (impaired motor function in the digestive tract)
- Constipation
- Changes in smell and taste
- Vomiting
- Early satiety (getting full easily)
Pancreatic exocrine insufficiency
A common symptom in people with pancreatic cancer, pancreatic exocrine insufficiency happens when the pancreas can't secrete the enzymes needed for the digestive tract to work well due to a tumor blockage. This can make it difficult for your body to absorb nutrients from food. Symptoms include:
- Increased abdominal (belly) bloating or discomfort
- Excessive gas
- Indigestion
- Nausea
- Delayed gastric emptying/early satiety
- Changes in bowel movements
- Weight loss despite meeting caloric needs
Cachexia and sarcopenia
Cachexia refers to widespread inflammation and metabolic imbalances, which can cause muscles to weaken and break down. This can lead to sarcopenia, also known as muscle loss.
There are three stages of cachexia:
- Precachexia: Weight loss of less than 5% of your body weight
- Cachexia: Weight loss of more than 5% of your body weight or weight loss of more than 2% of your body weight and a BMI less than 20 kg/m
- Refractory cachexia: Weight loss of more than 20% of your body weight and a BMI of less than 27 kg/m
Only some people will progress through each stage, and it is difficult to predict the progression of each person. Though over 80% of people with pancreatic cancer get cachexia, there is no established treatment specifically for this complication.
Abdominal and Back Pain
Some people with pancreatic cancer may have pain in the upper abdomen (belly area) and/or middle or upper back. It is often caused by a tumor in the pancreas that presses on the spine or irritates a bundle of nerves behind the pancreas called the celiac plexus.
This type of pain often starts in the abdomen and travels into the back. The pain might feel worse when you lie down and better when you lean forward.
Pancreatic cancer can also cause other pain syndromes, including:
- Hepatic distention syndrome from liver metastases (right upper quadrant pain)
- Pancreatic duct compression (pain after meals)
- Digestive tract obstruction (pain with colicky cramps or vomiting)
- Abdominal tightness
- Midline retroperitoneal syndrome, in which it is painful to lie flat
If you are in pain due to pancreatic cancer, your doctor may recommend:
Medication. Options include:
- Opioids
- Narcotics
- Acetaminophen
- Nonsteroidal anti-inflammatory drugs
Surgery. Surgical options include:
- Celiac plexus nerve block with neurolysis. Surgeons inject a local anesthetic into the treatment site and either alcohol or phenol into the celiac plexus nerves that carry pain signals. The injections can be performed through an abdominal approach or during an endoscopic ultrasound procedure.
- Thoracoscopic splanchnicectomy: This is a minimally invasive procedure that includes cutting specific nerve branches.
- External beam radiation therapy: A radiation beam targets the tumor and may relieve pain.
Nondrug options. There are other options that can work in place of or alongside medication or surgery, including physical therapy, massages, and guided imagery.
Bowel Blockages
Bowel blockages or obstructions are more common in pancreatic cancer than other cancers due to how close the pancreas is to the bowels. You may have a bowel obstruction if you have the following symptoms:
- Abdominal cramping or intermittent pain
- Bloating
- Appetite loss
- Constipation
- Vomiting
- Inability to pass gas
- Fever
- Dehydration
There are two common causes of bowel obstructions:
A tumor. If a tumor presses on the nerves or blocks the bowels, this can cause an obstruction.
Advanced cancer. This is diagnosed when cancer has spread to the bowels from another location.
There are several treatment options for bowel blockages:
- Bowel rest. Avoid eating or drinking to avoid worsening the obstruction and allow the bowel to rest
- Nasogastric tube. Inserted through the nose into the stomach to remove fluid and gas and help clear the blockage
- Gastrostomy tube. Placed through the abdominal wall into the stomach to drain fluid and air
- Stent. A tube placed inside the intestine to open the blocked area
- Surgery. Used if there is a total blockage or if the blockage does not improve with other treatments
- Gastrostomy tube. Placed through the abdominal wall into the stomach to drain fluid and air
- Antibiotics. Used if a tear in the intestine allows fluid to leak into the abdomen and risk sepsis
- Anti-nausea and pain medicines. Used to control symptoms caused by the obstruction
Bile Duct Blockages
Tumors in the head of the pancreas are close to the common bile duct, and even small tumors can press on or block the duct, causing bilirubin to build up and eventually leading to jaundice. This is known as biliary duct compression and can be painful, depending on where the tumor sits.
Depending on your symptoms and disease stage, your doctor may recommend different treatments like chemotherapy to shrink the cancer or surgery to remove it. If these methods aren't an option or if you need symptom relief right away, your doctor may recommend one of three treatment options:
A stent. This is a small tube placed inside the duct to keep it open.
Biliary bypass surgery. If you can't have a stent placed or need a longer-term solution, your doctor may recommend biliary bypass surgery, which redirects the flow of bile from the common bile duct to the small intestine, leaving the pancreas out of the process entirely. This procedure can take longer to recover from than a stent but can provide longer-lasting results.
Whipple surgery. Recommended for people whose cancer has not spread outside the pancreas, this surgery removes any cancer that may be blocking the bile duct. The surgeon removes the head of the pancreas, the first part of the small intestine, the gallbladder, the bile duct, and sometimes, part of the stomach or nearby lymph nodes. They then join the remaining organs back together to allow the digestive system to work properly again.
Diabetes Type 3c
If your pancreas becomes too damaged to make insulin or has been removed, you may develop type 3c diabetes.
Symptoms can include:
- Increased thirst and dry mouth
- Frequent urination
- Fatigue
- Blurred vision
- Unexplained weight loss
- Numbness or tingling in your hands or feet
- Slow-healing sores or cuts
- Frequent skin and/or vaginal yeast infections
People with Type 3c diabetes also usually have symptoms linked to exocrine pancreatic insufficiency.
Treatments for Type 3c diabetes include:
- Diabetes medications like metformin
- Treatment with insulin
- Blood sugar monitoring
- Healthy diet and meal planning
- Exercise
Blood Clots
Sometimes, the first symptom of pancreatic cancer is a deep vein thrombosis – a blood clot in a large vein. It's most common in the leg.
Symptoms in the affected area can include:
- Pain
- Swelling
- Redness
- Warmth
A piece of the blood clot can also break off and travel to the lungs, also known as a pulmonary embolism. Symptoms of this can include chest pain or a hard time breathing.
Both conditions are treated with blood thinners, also known as anticoagulants, that prevent clots from forming or spreading. These are given alongside cancer treatment.
Pulmonary embolisms usually dissolve with blood thinners, but deep vein thrombosis often heals more slowly, as the body covers it with fresh layers of cells. Walking and wearing over-the-counter compression stockings can also help the leg vein heal.
Ascites
Malignant ascites is when advanced cancer causes fluid to build up in the peritoneal cavity, the space in the abdomen (belly area) and pelvis that is lined by the smooth membrane called the peritoneum.
Ascites symptoms can include:
- Weight gain
- Nausea
- Vomiting
- Discomfort/distension of the abdomen
- Shortness of breath
Along with treating the cancer, treatment for ascites includes draining the fluid by inserting a hollow needle into the abdomen connected to a bottle.
Less Common Complications
Less common complications of pancreatic cancer can include:
Gallbladder or liver enlargement
If the cancer blocks the bile duct, bile can build up in the gallbladder, making it bigger. The liver can also become enlarged, which is more likely if the cancer has spread there. A doctor may diagnose either of these with a physical exam or imaging tests.
Hypercalcemia
This happens when there is too much calcium in the blood. It can be caused by cancer spreading to the bones or a tumor produces a parathyroid hormone-related peptide that tells the body to raise calcium levels. Treatment includes lots of IV fluids, medicines to reduce calcium levels, and dialysis for kidney failure.
Gastrointestinal bleeding
Gastrointestinal bleeding is a leading cause of intensive care unit admission in pancreatic cancer. The most common cause of GI bleeding is a tumor tearing the duodenum, the first part of the small intestine next to the pancreas. Treatments include endoscopic interventions, in which a doctor inserts a thin tube with a camera into the GI tract, embolization procedures that block the blood vessels, and surgery.
Gastric outlet obstruction
This can happen if a tumor blocks the passage between the stomach and small intestine. Symptoms can include nausea, vomiting, abdominal pain, getting full early, and weight loss. It can be treated with a balloon enteroscopy, in which a balloon catheter is placed to open the passage. Surgical options include minimally invasive and open surgery.
Pancreatic neuroendocrine tumors
Pancreatic neuroendocrine tumors (NETs) form when the cells of the pancreas that make hormones multiply too rapidly and make up less than 5% of new pancreatic cancers. Their symptoms, diagnosis, and treatment are different from symptoms of pancreatic adenocarcinomas, which are more common.
These tumors can be functional or non-functional. Functional NETs produce very high amounts of hormones and cause noticeable symptoms, like gut upset and changes to blood sugar. Non-functional NETs are more common and are harder to detect, as they don't often cause noticeable symptoms. The best treatment option for these types of tumors is surgery.
Paraneoplastic syndromes
The term “paraneoplastic” means associated with cancer. These types of complications happen when hormones produced by the tumor or antibodies produced by the immune system begin circulating in the bloodstream.
There are two main treatment options. The first is treating the cancer itself by targeting the tumors. The second is immunosuppression, which can include intravenous immunoglobulin, plasma exchange, and drugs that suppress the immune system.
Takeaways
The complications and symptoms you have will vary, depending on the type of cancer you have and how advanced it is. If you have any of the above symptoms, please contact your doctor right away so you can give yourself the best chance of early diagnosis and treatment.
Pancreatic Cancer Complication FAQs
What are the symptoms of the last stage of pancreatic cancer (stage IV)?
The most common symptoms of advanced pancreatic cancer are fatigue, lack of appetite, dry mouth, pain, feeling drowsy, and feeling sad.
When is it time for hospice with pancreatic cancer?
Hospice services can be considered when someone has a prognosis of 6 months or less if their disease runs its natural course. These services are also recommended for those who don't want to receive therapies that are primarily intended to prolong life or that treat the underlying disease with no symptom benefit.
What's the most symptomatic stage of pancreatic cancer?
Every patient's experience with pancreatic cancer will differ, and some people may have a harder time in different stages. Stage IV is the most advanced stage, and it means the cancer has spread to nearby areas like the liver, bones, lining of the abdominal cavity, or lungs.
