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

https://doi.org/10.1016/S1542-3565(04)00171-5 Get rights and content

Abstract

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.

Section snippets

Patients and methods

This signs-and-symptoms study was part of a large population-based case-control study of 532 patients with pancreatic cancer and 1701 control participants that was conducted between 1994 and 2001 in the San Francisco Bay Area.8, 9, 10, 11, 12, 13 Eligibility and methods of recruitment have been described in detail elsewhere.13 Briefly, patients with pancreatic cancer aged 21–85 years were identified by the Northern California Cancer Center’s rapid case ascertainment within 1 month of diagnosis

Results

There were slightly more men than women with pancreatic cancer (1.3:1) in our symptoms study, and this was consistent with the ratio of men to women in the main study. Controls were somewhat more educated than cases, whereas marital status and race or ethnicity were similar between groups (Table 1). Symptoms were categorized under 4 broad subgroups of bile duct obstruction, upper gastrointestinal, lower gastrointestinal, and other constitutional symptoms, and percentages by case and control

Discussion

The purpose of this study was to evaluate the signs and symptoms commonly reported by patients with pancreatic cancer in a population-based setting, with a goal toward promoting earlier diagnosis. Unlike most symptom studies, our participants were part of a larger population-based study that included a consecutive group of patients with pancreatic cancer and population-based control participants to better compare and highlight symptoms likely to define pancreatic cancer in the general

Acknowledgements

The authors thank Dr. Andrew Ko for his thoughtful suggestions.

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    Supported in part by grants no. RO1-CA59706, RO3-CA89726, and P50-CA72712 from The National Institutes of Health.

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