Pankreas Kanserinin Ilk Bulgulari...

The most common presenting sign of periampullary cancer is progressive obstructive jaundice (75%). Early on, patients may note dark urine and pale stools, followed by scleral icterus and yellow skin pigmentation. Pruritis secondary to the deposition of bile salts in the skin is common. Patients may also complain of anorexia, pain, and weight loss. Occasionally, the initial symptoms may be quite vague and may include upper GI discomfort, dyspepsia, and maldigestion or steatorrhea due to pancreatic exocrine insufficiency. Other nonspecific symptoms that may occur include nausea, early satiety, abdominal fullness, discomfort, malaise, weakness, fevers, and night sweats. A new diagnosis of adult onset diabetes is noted in a minority of patients. Those patients with ampullary or duodenal adenocarcinoma may have heme-positive stools or a microcytic anemia at their initial visit, given the tendency for these tumors to bleed. Patients often complain of a dull and constant midepigastric abdominal pain that radiates to the back and is the result of chronic biliary or pancreatic duct obstruction. The presence of more severe pain that responds poorly to analgesics may reflect neural invasion of the peripancreatic autonomic plexus, which portends a poorer prognosis.

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