Signs and symptoms of pancreatic cancer: a population-based case-control study in the San Francisco Bay area

Clin Gastroenterol Hepatol. 2004 Jun;2(6):510-7. doi: 10.1016/s1542-3565(04)00171-5.


Background & aims: Pancreatic cancer usually does not cause definitive symptoms until survival is severely compromised. Prevention and early detection are urgently needed. Our aim was to collect and analyze data in a population-based study on signs and symptoms of disease reported by patients with pancreatic cancer and control participants to contribute to earlier detection and better prognosis.

Methods: A supplemental symptoms questionnaire was administered to 120 consecutive patients with pancreatic cancer who were part of a larger population-based case-control study conducted in the San Francisco Bay Area between 1994 and 2001. One hundred eighty age- and sex-matched population-based control participants also were queried about the same symptoms reported by at least 5% of patients with pancreatic cancer.

Results: Most signs and symptoms occurred within 3 years before diagnosis with pancreatic cancer (cases) and interview (controls). Many signs and symptoms were more likely to have been reported by patients compared with control participants and included appetite loss (odds ratio [OR], 41; 95% confidence interval [CI], 14-120), pale stools (OR, 31; 95% CI, 7.3-134), abdominal pain (OR, 30; 95% CI, 9.1-101), jaundice (OR, 20; 95% CI, 8.0-49), unusual bloating (OR, 20; 95% CI, 5.9-67), unusual belching (OR, 17; 95% CI, 3.9-75), weight loss (OR, 12; 95% CI, 5.2-28), dark urine (OR, 10; 95% CI, 2.9-36), constipation (OR, 7.3; 95% CI, 2.0-26), diarrhea (OR, 5.6; 95% CI, 2.0-16), itching (OR, 5.0; 95% CI, 2.3-11), fatigue (OR, 3.8; 95% CI, 2.0-7.3), altered ability to sleep (OR, 2.9; 95% CI, 1.3-6.3), and unusual heartburn (OR, 2.3; 95% CI, 1.2-4.5).

Conclusions: Our results show that signs and symptoms likely to be indicators of pancreatic cancer occur substantially more often among patients with pancreatic cancer than among population-based controls. The large magnitude of the risk estimates indicate that common gastrointestinal symptoms may assist clinicians in earlier diagnosis of pancreatic cancer and perhaps affect survival.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Abdominal Pain / etiology
  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Cholestasis / etiology*
  • Early Diagnosis
  • Fatigue / etiology
  • Feeding and Eating Disorders / etiology
  • Female
  • Gastrointestinal Diseases / etiology*
  • Humans
  • Male
  • Middle Aged
  • Pancreatic Neoplasms / complications*
  • Pancreatic Neoplasms / diagnosis
  • San Francisco
  • Sleep Wake Disorders / etiology
  • Surveys and Questionnaires
  • Time Factors
  • Weight Loss