Pancreatic cancer

Last reviewed: 5 Jan 2023
Last updated: 11 Nov 2022



History and exam

Key diagnostic factors

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

Other diagnostic factors

  • age 65 to 75 years
  • steatorrhoea
  • thirst, polyuria, nocturia, and weight loss
  • nausea, vomiting, and early satiety
  • unexplained acute pancreatitis
  • hepatomegaly
  • epigastric abdominal mass
  • positive Courvoisier's sign
  • petechiae, purpura, bruising
  • Trousseau's sign (migratory thrombophlebitis)
Other diagnostic factors

Risk factors

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

Diagnostic investigations

1st investigations to order

  • pancreatic protocol CT
  • abdominal ultrasound
  • LFTs
More 1st investigations to order

Investigations to consider

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

Emerging tests

  • genomic testing

Treatment algorithm


resectable (stages I and II)

locally advanced unresectable (stage III)

metastatic (stage IV)



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 and Bristol-Myers Squibb, 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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