Exocrine Pancreatic Cancer: More Common and More Symptomatic

Cancers affecting the exocrine cells are much more likely to produce symptoms than those affecting the endocrine cells. Among the most common symptoms of exocrine pancreatic cancer are those caused by a backup of bilirubin, a dark yellow-brown substance excreted by the liver as part of a digestive liquid called bile. Normally this liquid travels through the common bile duct, through the pancreas, into the intestines, and then out of the body in the stool. In pancreatic cancer, this process can go awry.

Among the symptoms related to problems with bilirubin are:

• Jaundice The majority of people with exocrine pancreatic cancer develop jaundice — a yellowing of the skin and eyes — as one of their earliest symptoms, according to the American Cancer Society (ACS). If pancreatic cancer blocks the common bile duct, it can cause bilirubin to build up, producing jaundice. Jaundice can also be a sign of pancreatic cancer that has metastasized to the liver. Although jaundice is a common pancreatic cancer sign, more common reasons for this symptom are gallstones or hepatitis.

• Dark Urine and Itchy Skin The increase in bilirubin levels can lead to a buildup of substances normally broken down in the body and excreted. The result can be symptoms such as dark urine and itchy skin.

• Stool Trouble Bilirubin gives stool its brown color; if it’s not reaching the intestine because of a blockage in the common bile duct, stool may be abnormally pale. Bilirubin also helps break down fat during digestion, so common bile-duct blockages sometimes lead to greasy-looking stool that may float in the toilet.

Other possible symptoms of exocrine pancreatic cancer include:

• Pain in the belly or back due to the cancer pressing on nearby organs or spreading to nerves
• Unintentional weight loss
• Unexplained loss of appetite
• Digestive problems, including nausea and vomiting, caused by stomach blockage
• Enlargement of the liver or the gallbladder (due to bile buildup)
• Unevenness in the fatty tissue beneath the skin due to the release of pancreatic enzymes
• Diabetes (In rare cases, pancreatic cancer may destroy the insulin-producing cells of the pancreas.)
• Deep vein thrombosis (DVT), a blood clot in a large vein, often in the leg, which can result in pain, swelling, redness, and a feeling of warmth
  

Endocrine Pancreatic Cancers — a Rarer Breed

Pancreatic neuroendocrine tumors (PNETs), or islet cell tumors, are an uncommon type of pancreatic cancer, accounting for less than 5 percent of all pancreatic cancers. This type of pancreatic cancer affects hormone-producing cells found in the pancreas.

While they can be life-threatening, pancreatic PNETs tend to be less dangerous than pancreatic exocrine cancer.

Malignant neuroendocrine cells cause the pancreas to overproduce hormones. Excesses of different types of hormones result in different kinds of symptoms.

Among the types of PNETs are:

• Gastrinomas These tumors secrete a hormone that instructs the stomach to make acid. Too much leads to pain, nausea, and appetite loss, as well as other more severe symptoms, like bleeding ulcers.
• Glucagonomas By producing a hormone that increases glucose in blood, these tumors can sometimes cause diabetes. Most people with this disease visit the doctor because of an odd, blistering rash that pops up in different places on the skin.
• Insulinomas These tumors secrete insulin, sometimes leading to low blood sugar and dizziness, weakness, confusion, sweating, and rapid heartbeat.
• VIPomas Named for the substance they secret, vasoactive intestinal peptide (VIP), these tumors can cause severe diarrhea.
• PPomas Pancreatic polypeptide (PP) is the problematic secretion here; too much can cause abdominal pain and liver enlargement.
• Carcinoid Tumors These growths make serotonin or its predecessor, 5-HTP (5-hydroxytryptophan). Symptoms include flushing, diarrhea, wheezing, and a rapid heart rate.
• Nonfunctioning Neuroendocrine Tumors These don’t make excess amounts of hormones. Symptoms resemble those of pancreatic exocrine cancer, such as jaundice. (2)

Pancreatic cancer symptoms can vary from person and person and evolve over time. Coping with pancreatic cancer symptoms — and the side effects of treatment — can be a struggle. Some patients may need assistance dealing with pain, fatigue, and nausea, for instance, while others might benefit from help grappling with the emotional aspects of the disease.

The Pancreatic Cancer Action Network (PanCAN), a leading national nonprofit, emphasizes the importance of symptom management and supportive (palliative) care at diagnosis, during and after cancer treatment, and as a focus in and of itself.

Palliative care providers include doctors, other members of the healthcare team, supportive care specialists, other medical specialists, and hospice organizations. (3)