STEP 2: Presentation, initial investigations and referral

Many cases present with non-specific symptoms or are asymptomatic until advanced stages of the disease.

The following signs and symptoms should be investigated:

  • acute pancreatitis where the cause is not alcohol ingestion and gall stones are not evident
  • new-onset diabetes
  • jaundice that is progressive, together with unexplained weight loss and abdominal pain that may radiate to the back (the jaundice may also be accompanied with dark urine, light-coloured stools and itchy skin)
  • pain, which is often severe, unrelenting and of a short duration
  • unexplained weight loss
  • pale and greasy stools
  • nausea and vomiting
  • constipation
  • fatigue
  • gall bladder enlargement
  • a blood clot in the leg without a clear risk factor
  • incidental lesions found on radiology.

Initial investigations

Where there is suspicion of pancreatic cancer, consider an abdominal CT scan with pancreatic protocol, conduct serum CA 19-9 and liver function tests and early referral is strongly indicated, usually prior to a definitive diagnosis. Where jaundice is present, the following should be performed urgently: liver function tests, abdominal ultrasound and CT where appropriate.

Referral options

At the referral stage, the patient’s GP or other referring doctor should advise the patient about their options for referral, waiting periods, expertise, if there are likely to be out-of-pocket costs and the range of services available. This will enable patients to make an informed choice of specialist and health service.


The GP’s responsibilities include:

  • explaining to the patient and/or carer who they are being referred to and why
  • supporting the patient and/or carer while waiting for specialist appointments
  • informing the patient and/or carer that they can contact Cancer Council on 13 11 20.



Patients who present with jaundice should be referred for tests within 48 hours and followed up rapidly.

Other symptoms require review within 2 weeks.

Patients with suspected or proven pancreatic cancer should be seen by a gastroenterologist, oncologist or hepatopancreaticobiliary surgeon with expertise in pancreatic cancer management and linked to a multidisciplinary team within 1 week of referral to the specialist.