Pancreatic cancer often presents with vague and nonspecific symptoms; therefore, it can be difficult to know when to refer. A-typical symptom presentations are common. Being aware of the symptoms and your high-risk patients’ groups can guide your decision making.
Information for you
If a patient presents to you with these symptoms, then consider pancreatic cancer. NICE guidelines for referral can identify patients whose referral is urgent.
- Treatment resistant dyspepsia (indigestion symptoms that are not responding to PPI’s)
- New onset type 2 diabetes mellitus in patients who are under or normal weight or where there is no other associated metabolic condition or family history of diabetes.
- Back and/or epigastric pain or discomfort that radiates dorsally and can be relieved by leaning forwards. Patients may complain of pain being approximately where a bra strap would sit.
- New onset IBS like symptoms in those over 45 years of age. This is a common misdiagnosis of pancreatic cancer. If a patient has never had IBS like symptoms (bloating, flatulence and change of bowel habit) before, it is important to rule out pancreatic cancer.
- Painless obstructive jaundice presenting as yellowing of the skin and whites of the eyes, pruritus or dark urine.
- Altered bowel movements such as increased frequency, offensive smelling stools, loose bowels and steatorrhea.
- Unexplained weight loss
- Nausea and vomiting
- Loss of appetite and anorexia
Pancreatic cancer is often initially misdiagnosed. Common misdiagnosis includes gallstones, irritable bowel syndrome, pancreatitis, peptic ulcer, hepatitis and gastrointestinal reflux disease (GORD).
Studies have found that up to 31% of pancreatic cancer is initially misdiagnosed. Partially due to misdiagnosis, patients often require repeated primary care visits before diagnosis. If you see a patient with persistent symptoms, being treated for any of these conditions, consider pancreatic cancer.
Resources for your patient
If you are concerned about a patient, you may want to provide them with our symptoms diary to allow them to record their symptoms and whether or not any intervention you are trying is working. Your patient may remember their symptoms better if they can write them down and you can use the diary to establish a pattern of symptoms to guide diagnostics. This may also be helpful if your patient visits a number of different GPs in your practice.