According to the American Cancer Society, more than 62,000 Americans will be diagnosed with pancreatic cancer in 2022 and almost 50,000 people will die of it.  “Pancreatic cancer is hard to diagnose early because there’s no standard screening test for it,” says medical oncologist and associate director of clinical research Maged Khalil, MD. “People experience symptoms before ever being checked for it. Stage for stage, pancreatic cancer is associated with lower survival rates than many other cancers.” 

The most significant risk factors for getting pancreatic cancer are smoking, being overweight, having diabetes or chronic pancreatitis, and exposure to toxic chemicals. Family history, gender, race, and genetics also play a role in getting pancreatic cancer. While symptoms of pancreatic cancer can be hard to spot, there are certain things doctors see again and again when diagnosing the disease—and these symptoms should never be ignored.

“If you have unexplained symptoms, constant abdominal pain or weight loss, unintended weight loss, new onset problems with your glucose and insulin management, those might be symptoms for one to think about pancreas cancer,” says Dr. Curtis Wray, surgical oncologist with UT Physicians and UTHealth. “Getting in to see a primary care physician earlier is always helpful. Too many of us don’t see their physician on a regular basis, and obviously with the COVID-19 pandemic, that’s made routine medical care a lot more challenging over the last 10 months.” Here are five key pancreatic cancer warning signs doctors want you to know about. Read on—and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.

Yellowing of the skin and eyes is one of the most common signs of pancreatic cancer, doctors warn. According to the American Cancer Society, jaundice is often the earliest sign of illness, especially if the cancer has spread from the pancreas to the liver.6254a4d1642c605c54bf1cab17d50f1e

“The most common single symptom is jaundice, and most patients will present to their regular doctor with jaundice or to the emergency room, and they’ll be evaluated and chances are they’ll have a scan and may get a scope to help relieve the jaundice,” says Matthew Walsh, MD, chairman of the department of general surgery at Cleveland Clinic. “And that’ll give them either a clear diagnosis, because you can do a type of brush biopsy of a bile duct in someone who has jaundice, and jaundice is just blockage of the bile duct in this case that causes yellowing of the skin and eyes, and often very irritating itching.”

Digestive issues could be a warning sign of pancreatic cancer, doctors say. “Diarrhea results when the nutrients in food are not absorbed properly,” according to the Pancreas Center at Columbia University’s Department of Surgery. “When this occurs, stool can become loose, watery, oily and foul-smelling. Pancreatic enzymes are responsible for digesting fatty foods. If a tumor blocks the pancreatic duct, insufficient pancreatic juices in the intestines can lead to poor absorption and diarrhea, as the undigested food passes quickly through the digestive tract. If this happens, stool may float due to the higher fat content, appear bulky, greasy, and unusually pale.”

“If pancreatic juices don’t flow, digestion is not complete, which can cause bloating, lack of appetite and weight loss, when you’re not trying to shed pounds,” says Heinz-Josef Lenz, MD, an oncologist at USC Norris Comprehensive Cancer Center. If a tumor is pressing on the stomach, you may also experience nausea and vomiting.”

Diabetes is strongly associated with pancreatic cancer—but experts are still unsure of the direct link, and how one affects the other. “It is possible that, in some patients, diabetes leads to development of pancreatic cancer. It is also possible pancreatic cancer leads to development of diabetes,” says Max Petrov, MD, PhD, MPH, professor of pancreatology at The University of Auckland School of Medicine. 

“Factors such as inflammation or altered immune markers might play a role,” says Mark O. Goodarzi, MD, PhD, FACP, director of the division of endocrinology, diabetes and metabolism and Eris M. Field chair in diabetes research at Cedars-Sinai. “As far as longstanding diabetes, obesity may be a key contributor. People who are obese and have diabetes often have high insulin levels, and insulin can stimulate cell division. Over time, high levels of insulin could promote tumor formation. This is not proven, but it is a theory. The concept with new-onset diabetes is that the pancreatic cancer cells themselves might be producing some factor that causes diabetes.”

Abdominal pain could be a sign of pancreatic cancer, possibly because the tumor is pressing on the spine and causing severe discomfort. “As tumors on the pancreas grow, they often push against these other body parts, which can be very painful,” says pancreatic cancer researcher Shubham Pant, MD.

“Almost 7 out of 10 people (70%) with pancreatic cancer go to their doctors because they have pain,” explains Cancer Research UK. “Pain is more common in cancers of the body and tail of the pancreas. People describe it as a dull pain that feels as if it is boring into you. It can begin in the stomach area and spread around to the back. The pain is worse when you lie down and is better if you sit forward. It can be worse after meals.”

Smoking is a major risk factor for many concerning health conditions, and pancreatic cancer is one of them. “Multiple clinical studies have shown that smoking tobacco, particularly cigarettes, elevates the risk for developing pancreatic diseases such as pancreatitis and cancer, say Mouad Edderkaoui, PhD, and Edwin Thrower, PhD. “Furthermore, risk increases as a function of the amount of tobacco consumed.  Smoking tobacco has often been linked as a co-factor with alcohol abuse in predisposing to pancreatic disorders. However, the inclusion of smokers that do not drink alcohol in some of these studies has highlighted that cigarette smoking can also be considered an independent risk factor.”

“People who smoke are two times more likely to develop pancreatic cancer compared to those who don’t,” says Joseph Herman, MD, MSc, a member of the Scientific and Medical Advisory Board at the Pancreatic Cancer Action Network (PanCAN). “About 20 to 30% of exocrine pancreatic cancer cases – the most common kind of pancreatic cancer – are thought to be attributable to smoking.”