title: Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage.
abstract: BACKGROUND
  The need to detect pancreatic cancer at earlier stages is undisputed. We recorded the signs and symptoms of patients presenting with exocrine pancreatic cancer and evaluated their association with clinical characteristics such as tumour site and disease stage.
  
  
  METHODS
  All patients (n = 185) with exocrine pancreatic cancer newly diagnosed at five general hospitals in Eastern Spain were prospectively recruited over 5 years. Symptoms were elicited through personal interviews and signs were recorded by the attending physician on admission.
  
  
  RESULTS
  At diagnosis, one third of tumours of the pancreas head were in stage I and another third in stage IV. None of the tumours of the body and tail were in stage I, and over 80% were in stage IV (p < 0.001) . At presentation, the most frequent symptoms were asthenia (86%), anorexia (85%), weight-loss (85%), abdominal pain (79%), and choluria (59%). Cholestatic symptoms were more common in tumours affecting only the pancreatic head (p < 0.001) . There was a clear trend toward more localized tumours with increasing numbers of cholestatic signs (p < 0.001) . Asthenia, anorexia and weight-loss were unrelated to stage. An increased symptom-to-diagnosis interval was associated with more advanced stage (p = 0.048).
  
  
  CONCLUSIONS
  Proper attention to signs and symptoms, especially cholestasis, may help identify patients with pancreatic cancer at an earlier stage. Results also provide a current picture of the semiology of pancreatic cancer which could be of use in studies on the potential of proteomic tests in the early detection of this neoplasm.
authors.affiliation: Unidad de Epidemiología Clinica y Molecular del Cáncer, Instituto Municipal de Investigación Médica, Universidad Autónoma de Barcelona, Carrer del Dr. Aiguader 80, 08005 Barcelona, Spain. Mporta@imim.es
authors.forename: Miquel
authors.initials: M
authors.lastname: Porta
authors.forename: Xavier
authors.initials: X
authors.lastname: Fabregat
authors.forename: Núria
authors.initials: N
authors.lastname: Malats
authors.forename: Luisa
authors.initials: L
authors.lastname: Guarner
authors.forename: Alfredo
authors.initials: A
authors.lastname: Carrato
authors.forename: Ana
authors.initials: A
authors.lastname: de Miguel
authors.forename: Laura
authors.initials: L
authors.lastname: Ruiz
authors.forename: Manuel
authors.initials: M
authors.lastname: Jariod
authors.forename: Sergi
authors.initials: S
authors.lastname: Costafreda
authors.forename: Susana
authors.initials: S
authors.lastname: Coll
authors.forename: Juan
authors.initials: J
authors.lastname: Alguacil
authors.forename: Josep M
authors.initials: JM
authors.lastname: Corominas
authors.forename: Ricard
authors.initials: R
authors.lastname: Solà
authors.forename: Antonio
authors.initials: A
authors.lastname: Salas
authors.forename: Francisco X
authors.initials: FX
authors.lastname: Real
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D046790:Pancreas, Exocrine / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000473:pathology*; D011446:Prospective Studies