New symptoms associated to pancreatic cancer
A recent investigation carried out in Oxford University in U. K (1) has released some information about the #symptoms associated to #pancreatic cancer. As we know, pancreatic cancer (PC) is one of the most lethal ones and its diagnosis is very difficult as its symptoms are not very specific (2). Due to this, its diagnosis is usually made in advanced phases of the disease (3). Thus, all efforts driven to know more about which symptoms should make us think on this diagnosis are of key importance.
Pancreatic cancer presentation can happen in many ways. Apart from jaundice (yellowing of the skin or white of eyes), that is a symptom consistently reported in medical literature with pancreatic or biliary tract cancer, most of the symptoms are nonspecific and cannot be easily linked to pancreatic cancer diagnosis. This prompts a challenge to general doctors in clinical practice as they have to discriminate which symptoms must be taken into account for #earlydiagnosis.
In this investigation, the authors carried out a nested case-control study in a primary care setting using a large database with data from 2000 to 2019. They included 23640 patients with diagnosis of pancreatic adenocarcinoma (PADC), 596 with pancreatic neuroendocrine tumors (PNT) and 230024 healthy controls to compare.
23 symptoms were significantly associated to PADC and 9 to PNT. The two alarm symptoms associated to both types of cancers were jaundice and gastrointestinal bleeding. Besides, they identified two new symptoms associated to PADC which are thirst and dark urine. Other symptoms identified 3 months before the diagnosis were persistent abdominal pain, diarrhoea, weight of loss and indigestion. Risk factors for developing PC identified were older age, smoking habit, excess alcohol intake, chronic pancreatitis, and type 2 diabetes mellitus.
One of the important things in this study is that the authors used a very large database including a long period of time and representative data from patients with PC. Symptoms as jaundice and bleeding have been usually associated to severe diseases, particularly pancreatic cancer. However, they reported two new symptoms that were not consistently reported in other studies. They also give information about which symptoms are more strongly associated to PC, which is very important as these problems are very unspecific and can be easily overlooked by general doctors. Besides, all this information could be further used in risk prediction models that help identify patients with PC in primary care.
One of the main limitations of the study is that it was carried out retrospectively and relying in the information recorded by general doctors in their records.
This kind of investigations that gives information about which are the most important symptoms associated to pancreatic cancer can really help to raise #awareness about this disease and help doctors identify patients with initially mild symptoms in whom this disease must be suspected.
1. Liao W, Clift A, Patone M et al. Identifying symptoms associated with diagnosis of pancreatic exocrine and neuroendocrine neoplasms: a nested case-control study of the UK primary care population. Br J Gen Pract 2021; DOI: https://doi.org/10.3399/BJGP.2021.0153
2. Rawla P, Sunkara T, Gaduputi V. Epidemiology of pancreatic cancer: global trends, etiology and risk factors. World J Oncol 2019; 10(1): 10–27
3. Lopez Serrano A. Risk factors and early diagnosis of pancreatic cancer. Gastroenterol Hepatol 2010 382-390