Pancreatic Cancer Workup

Pancreatic ductal adenocarcinoma can remain clinically quiet until it obstructs a duct, invades nearby structures, or produces systemic effects. The pattern an experienced clinician notices is often a cluster rather than one isolated symptom: progressive painless cholestatic jaundice, declining weight, poor appetite, steatorrhoea, epigastric pain that may bore through to the back, or diabetes that appears suddenly or becomes difficult to control in an older adult. A tumour in the pancreatic head lies near the common bile duct, so it may produce obstruction earlier. The patient may describe tea-coloured urine, clay-coloured stool, and generalized pruritus before reporting pain. A distended, nontender gallbladder with painless jaundice supports distal malignant obstruction, but it does not establish the diagnosis. Gallstones, benign strictures, pancreatitis, and other malignancies remain possible. Tumours in the body or tail are less likely to obstruct the common bile duct early. They may therefore present with weight loss, persistent epigastric or back pain, exocrine insufficiency, or metastatic disease rather than jaundice. Steatorrhoea suggests inadequate delivery of pancreatic enzymes to the intestine; the resulting malabsorption contributes to weight loss and fat-soluble...