Pancreatic cancer usually has no symptoms in its early stages, and symptoms often begin only once the disease has advanced [1]. The main symptoms are jaundice (yellowing of the skin and the whites of the eyes, with dark urine, pale stools or itching), unexplained weight loss and loss of appetite, pain in the upper or middle abdomen that spreads to the back, tiredness, nausea and new diabetes in someone with no risk factors for diabetes [1]. Most of the time these symptoms have a simpler cause; but always show jaundice to a doctor promptly, even when there is no pain [3].
Key points
- Pancreatic cancer usually causes no symptoms at first; this is why most patients are diagnosed once the disease has advanced or spread [1, 2].
- Jaundice is the most important warning sign: in a large UK study, about 1 in 5 people aged 60 or over who saw their GP with jaundice had pancreatic cancer [6].
- New diabetes after the age of 50 is sometimes the first sign: about 1 in 100 of these people are diagnosed with pancreatic cancer within 3 years [4].
- Screening is not recommended for people without symptoms who are at average risk [8]; but if several close relatives have had pancreatic cancer, or an inherited mutation runs in your family, ask for genetic counselling [2].
Symptoms of pancreatic cancer
| Symptom | What it may mean | What to do |
|---|---|---|
| Yellowing of the skin and the whites of the eyes, even without pain | A tumour in the head of the pancreas narrows the bile duct; most pancreatic tumours are in this part [2] | Do not wait; see a doctor within the next few days [3] |
| Dark urine, pale stools and itchy skin | Signs of a blocked bile duct that come with jaundice [1, 2] | As with jaundice, see a doctor soon |
| Unexplained weight loss and loss of appetite | Among the most common symptoms [1]; in a study of people referred for tests, it was seen more than twice as often in patients with pancreatic cancer as in the others [7] | If you are losing weight without trying, see a doctor |
| Pain in the upper or middle abdomen that spreads to the back | Especially with tumours in the body and tail of the pancreas [2] | New, persistent pain, particularly with weight loss, should be checked [3] |
| New diabetes, or blood sugar suddenly getting worse | Sometimes the first sign, especially after the age of 50 and in someone with no risk factors for diabetes [1, 2, 4] | If it comes with weight loss, talk to your doctor about checking the pancreas [3, 5] |
| Nausea, vomiting, bloating or a lot of wind | Vague digestive symptoms [1] | If they last several weeks or come with weight loss, see a doctor [3] |
| Diarrhoea, or fatty, foul-smelling stools | Sometimes because the pancreas makes fewer digestive enzymes [2] | With weight loss: see a doctor [3] |
| Severe, unexplained tiredness | A common symptom [1]; in patients with pancreatic cancer it was seen about twice as often as in the others [7] | If it persists and the cause is not clear, have it checked |
| A swollen, painful leg, or sudden shortness of breath | Advanced pancreatic cancer makes the blood clot more easily [1] | Sudden shortness of breath: emergency; a swollen, painful leg: seek care urgently |
This table does not replace an examination by a doctor; in most people these symptoms have another cause.
New diabetes and pancreatic cancer
Most people who develop diabetes in middle age never get pancreatic cancer [1, 4]. But pancreatic cancer sometimes disrupts the production of insulin, and diabetes becomes its first sign [1]. In a US study, about 1 in 100 people aged 50 or over with new diabetes were diagnosed with pancreatic cancer within 3 years; more than half of them within the first 6 months [4].
These signs make it more likely and are worth discussing with your doctor [1, 2, 5]:
- unexplained weight loss at the same time as rising blood sugar
- none of the usual risk factors for diabetes, such as obesity, heart disease or a family history of diabetes
- worsening blood sugar control in someone whose diabetes was previously well controlled
Researchers have built a tool that uses age, weight change and blood sugar change to find the people at highest risk in this group; but it still needs to be tested in more studies [5].
When should I call my doctor?
Most abdominal pain and indigestion has a simple cause. But in these situations do not wait; see a doctor within the next few days:
- yellowing of the skin or the whites of the eyes, even if you have no pain; especially with dark urine, pale stools or itching [1, 3]
- unexplained weight loss with abdominal or back pain, nausea, vomiting, diarrhoea or constipation, especially after the age of 60 [3]
- new diabetes after the age of 50, especially with weight loss [4, 5]
Jaundice with fever and shivering, sudden severe abdominal pain, repeated vomiting, a painful swollen leg or sudden shortness of breath needs urgent care at an emergency department.
Who is at higher risk?
The risk of pancreatic cancer rises with age; almost 2 in 3 patients are 65 or older [9]. Other risk factors [9]:
- smoking: one of the main risk factors that you can change
- obesity and diabetes
- long-term inflammation of the pancreas (chronic pancreatitis); heavy drinking is one of its causes
- a family history of pancreatic cancer and inherited mutations such as BRCA1, BRCA2, PALB2, ATM and the Lynch syndrome genes; up to 1 in 10 patients have an inherited cause
For people without symptoms who are at average risk, screening for pancreatic cancer is not recommended, because its benefit has not been shown and it can cause harm [8]. But if two or more of your first-degree relatives (parent, brother, sister or child) have had pancreatic cancer, one of them was diagnosed before the age of 50, or a known inherited mutation runs in your family, ask for genetic counselling [2]. Read more: Is cancer hereditary? and Which screening tests do I need?
If the doctor suspects pancreatic cancer, which tests are needed?
- 1
Examination and blood tests
The doctor examines your abdomen and orders liver blood tests; these show whether the bile duct is blocked [10].
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Biopsy guided by ultrasound from inside the stomach
Using an endoscope, a thin needle is passed through the wall of the stomach or bowel into the tumour and a small piece is taken; the same sample is also used for genetic testing of the tumour [2]. If you have jaundice, a small tube (stent) may be placed in the bile duct during a special endoscopy of the bile ducts so that bile can flow again [2, 10]. Worried about the biopsy? Read: Does a biopsy make cancer spread?
- 4
CA19-9 blood test
It is useful for following how well treatment is working, but it is not accurate enough to find cancer in people without symptoms [2]. Read more: What is a tumour marker?
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Genetic testing
If pancreatic cancer is confirmed, testing for inherited genes and genetic testing of the tumour are recommended for all patients [2, 10]. Read about treatment on the pancreatic cancer page.
Frequently asked questions
My skin has turned yellow but I have no pain; should I worry?
Jaundice should always be checked promptly, with or without pain. Jaundice has many causes, and not all of them are cancer. But the national guideline in England recommends that anyone aged 40 or over who develops jaundice be referred urgently to be checked for pancreatic cancer [3]. In pancreatic cancer, tumours in the head of the pancreas (most tumours) narrow the bile duct and cause jaundice and dark urine [2].
My back hurts; could it be pancreatic cancer?
Back pain is very common and most of the time has a simple cause. Pain that spreads from the upper abdomen through to the back, especially with unexplained weight loss, can be a symptom of pancreatic cancer [1, 2]. In one study, patients with back pain were diagnosed later [7]. If you are 60 or older and have back or abdominal pain with weight loss, ask your doctor to check the pancreas too [3].
I have just been diagnosed with diabetes; should I worry about pancreatic cancer?
Diabetes is very common, and most people who develop it never get pancreatic cancer [1]. Of every 100 people aged 50 or over with new diabetes, about 1 develops pancreatic cancer within 3 years [4]. If you are also losing weight without explanation, or you do not have the usual risk factors for diabetes such as obesity and a family history, talk to your doctor about checking the pancreas [1, 5].
Can a blood test or an ultrasound find pancreatic cancer early?
For people without symptoms, screening has not been shown to help people live longer; this is why general screening is not recommended [8]. The CA19-9 test is not accurate enough for this either [2]. If you have symptoms, guidelines recommend a CT scan, or an ultrasound if a CT scan is not possible [3].
Are the symptoms of pancreatic cancer different in women and men?
No; the symptoms of pancreatic cancer are usually the same in women and men [1].
Can pancreatic cancer be treated successfully if it is found early?
The best chance of successful treatment is when the tumour can still be removed with surgery; these patients do much better with surgery followed by chemotherapy [2]. But fewer than 2 in 10 patients are diagnosed at this stage [2]; so take the warning signs seriously. Read more: Pancreatic cancer
Does sugar cause pancreatic cancer?
Obesity and diabetes increase the risk of pancreatic cancer [9]; so keeping a healthy weight and controlling blood sugar helps. About sugar itself, read: Does sugar feed cancer?
Referral criteria and diagnostic points (for doctors)
For physicians
NICE NG12 referral criteria (updated 2026). Refer people aged 40 and over with jaundice using a suspected cancer pathway referral for pancreatic cancer (diagnosis or exclusion of cancer within 28 days) (recommendation 1.2.4). Consider an urgent, direct-access CT scan (within 2 weeks; an urgent ultrasound if CT is not available) in people aged 60 and over with weight loss and any of: diarrhoea, back pain, abdominal pain, nausea, vomiting, constipation or new-onset diabetes (recommendation 1.2.5). Unexplained weight loss of more than 5% within 6 months in people aged 60 and over: urgent investigation or referral on a cancer pathway (recommendation 1.13.2) [3].
Predictive value of symptoms in primary care. In a GPRD case-control study (3635 cases and 16,459 controls aged 40 and over), the PPV of every feature in those aged 60 and over was below 1% except jaundice at 22% (95% CI 14 to 52); the OR was 15 for weight loss, 5 for abdominal pain, 4.5 for nausea/vomiting, 2.2 for constipation, 2.1 for new-onset diabetes, 1.9 for diarrhoea and 1.4 for back pain, and several pairs of symptoms had PPVs above 1% [6]. In the prospective SYMPTOM cohort (391 patients aged 40 and over referred with suspected pancreatic cancer), no initial symptom distinguished cancer from no cancer, but later symptoms were predictive: jaundice (49% vs 12%), weight loss (55% vs 22%), fatigue (51% vs 26%), change in bowel habit and decreased appetite. Back pain, indigestion and diabetes were associated with longer diagnostic intervals [7].
New-onset diabetes. In the population-based Rochester cohort (2122 people aged 50 and over), 0.85% were diagnosed with pancreatic cancer within 3 years (observed-to-expected ratio 7.94); 56% of them less than 6 months after meeting the criteria for diabetes [4]. ENDPAC model (weight change, blood glucose change and age at onset of diabetes): a score of 3 or more identified 7 of 9 patients in the validation cohort with 85% specificity, and the prevalence of cancer in this group was 3.6% (4.4 times that of all patients with new-onset diabetes); a score of 0 or less (49% of patients) meant a very low risk. The model still needs prospective validation [5].
Screening and stage at diagnosis. The USPSTF recommends against screening asymptomatic adults (grade D); people with new-onset diabetes, smoking or obesity are considered part of the general population, but the recommendation does not apply to inherited syndromes or familial pancreatic cancer [8]. At diagnosis, 10% to 15% of patients are resectable, 30% to 35% locally advanced and 50% to 55% metastatic; about 70% of tumours arise in the head of the pancreas and present with biliary obstruction. Initial work-up: pancreas CT angiography with chest and pelvis CT, and EUS-guided fine-needle biopsy (FNB); germline testing for all patients [2].
Scientific evidence
Scientific evidence
1 itemModel to Determine Risk of Pancreatic Cancer in Patients With New-Onset Diabetes
Related cancer types
References
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Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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