Early manifestations of pancreatic cancer: the effect of cancer-nerve interaction

Abstract

Clinical manifestation is important for the diagnosis of pancreatic cancer (PanCa). No typical symptoms have been identified that clearly indicate the early stage of PanCa, although most patients with PanCa have symptoms before the cancer is diagnosed. These symptoms are often regarded as common gastrointestinal symptoms and are ignored. The pancreas is richly supplied with nerves, and neuro-cancer interactions begin prior to PanCa cell migration. We hypothesise that the cancer-nerve interaction does generate typical symptoms such as pseudomorphous satiety and mild pain in early PanCa. Constant satiety leads to weight loss. This biological behaviour allows the cancer to progress without attention from the cancer-bearing host. Cancer cells also target the endocrine pancreas, generating a hyperglycaemic state that results in increased energy for cancer cells. The combination of the so-called common gastrointestinal symptoms and diabetes may represent early typical symptoms of PanCa that can be used to improve early diagnosis.