Case history
Case history #1
A 70-year-old man who smokes heavily presents with a 6-month history of intermittent abdominal pain and nausea. He has lost 10 kg of weight in the past 2 months, which he thinks is due to a decreased appetite, and he complains of pruritus. On physical examination there is icterus in the conjunctival sclerae and epigastric tenderness but no abdominal mass or lymphadenopathy. Blood tests demonstrate elevated bilirubin and alkaline phosphatase; the rest of the blood tests are within the normal range.
Case history #2
A 45-year-old woman presents to her physician with vague upper abdominal (epigastric) pain. After treatment with proton-pump inhibitors, analgesics, and antacids over a period of 3 months, which were ineffective, the patient also started to experience back pain. This prompted an initial upper gastrointestinal endoscopy, which was normal. Nearly 4 months after initial presentation, an upper abdominal ultrasound reveals a pancreatic mass with liver metastases.
Other presentations
Because there are no specific symptoms or early warning signs for pancreatic cancer, the clinical diagnosis is difficult and patients usually present with advanced disease. Pancreatic cancer should be considered in patients aged 50 years or older with new-onset diabetes mellitus but without a positive family history or other risk factors for diabetes.[5] An unexplained episode of acute pancreatitis can also be a first presentation of pancreatic cancer.[6] Because patients with pancreatic cancer have an increased risk of thromboembolic disease, venous thrombosis or migratory thrombophlebitis (Trousseau's sign) could also be a first presentation of pancreatic cancer.[7][Figure caption and citation for the preceding image starts]: Trousseau's sign in a patient with pancreatic adenocarcinomaPunithakumar EJ et al. Trousseau syndrome in pancreatic carcinoma. Surgery. 2021;169(2):E3-4; used with permission [Citation ends].
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