Last reviewed: 6 Nov 2021
Last updated: 15 Oct 2020



History and exam

Key diagnostic factors

  • presence of risk factors
  • jaundice
  • non-specific upper abdominal pain or discomfort
  • weight loss and anorexia

Other diagnostic factors

  • age: 65 to 75 years
  • steatorrhoea
  • thirst, polyuria, nocturia, and weight loss
  • nausea, vomiting, anorexia, and mid-epigastric pain
  • hepatomegaly
  • epigastric abdominal mass
  • positive Courvoisier's sign
  • petechiae, purpura, bruising
  • Trousseau's sign

Risk factors

  • smoking
  • family history of pancreatic cancer
  • other hereditary cancer syndromes
  • chronic sporadic pancreatitis
  • diabetes mellitus
  • obesity
  • dietary factors

Diagnostic investigations

1st investigations to order

  • abdominal ultrasound
  • pancreatic protocol CT
  • LFTs

Investigations to consider

  • prothrombin time (PT)
  • FBC
  • cancer antigen (CA)19-9 biomarker
  • positron emission tomography
  • endoscopic retrograde cholangiopancreatography (ERCP)
  • magnetic resonance cholangiopancreatography
  • endoscopic ultrasound
  • staging laparoscopy (with laparoscopic ultrasound)
  • biopsy

Treatment algorithm



Hemant M. Kocher, MBBS, MS, MD, FRCS

Professor of Liver and Pancreas Surgery

Barts Cancer Institute

Barts and The London School of Medicine and Dentistry




HMK is an author of a number of references cited in this topic. HMK has received trial funding from Celgene, advisory board honorarium from Baxalta Inc., and educational grants from Mylan, Celgene, Ethicon, and Medtronic.


Dr Hemant M. Kocher wishes to gratefully acknowledge Dr Fieke E.M. Froeling, a previous contributor to this topic. FEMF is an author of a reference cited in this topic.

Peer reviewers

Ross Carter, FRCS

Consultant Pancreatic Surgeon

West of Scotland Pancreatic Unit

Glasgow Royal Infirmary




Not disclosed.

Nikhil I. Khushalani, MD

Assistant Professor of Oncology

Roswell Park Cancer Institute




NIK has received funding for the conduction of clinical trials and associated translational studies from Merck, Pfizer, and Astra-Zeneca. NIK has a grant from the National Comprehensive Cancer Network (from research support by Roche).

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