1. Abdominal pain: Pain is the main symptom of pancreatic cancer, and it is present regardless of whether the cancer is located in the head or tail of the pancreas. Most of the patients show pain in the upper abdomen, and those who show pain are 85％ already inoperable for surgical resection or already in the progressive stage. The pain is usually not related to diet, and most of it is mild at first, but gradually worsens in a persistent manner. The degree of pain varies from fullness and distension, dull pain to severe pain. The pain radiates to the right side of the head of the pancreas, while most of the tail cancer radiates to the left side. Pain in the lower back is indicative of a more advanced stage and poor prognosis. In pancreatic cancer, the pancreatic duct may be enlarged by the cancer, which may cause obstruction, dilatation, distortion and pressure increase, resulting in continuous or intermittent distension and pain in the upper abdomen. Sometimes, pancreatitis is also combined with pancreatitis, causing visceral neuralgia. The early stage of the lesion often presents a more extensive but not easy to locate and vague nature of the upper and middle abdominal fullness and discomfort, vague pain or dull pain, and often worsens 1 to 2 hours after eating. This is mostly seen in early stage pancreatic head cancer with pancreaticobiliary duct obstruction, which is caused by the increase of bile and pancreatic juice secretion induced by drinking alcohol or eating fatty food, thus causing a sudden rise of pressure in the bile duct and pancreatic duct. Since the pancreas is rich in blood vessels and nerves and adjacent to the retroperitoneal plexus, when the lesion expands and metastasizes and affects the peritoneum, pancreatic head cancer can cause right upper abdominal pain, while cancer of the tail of the pancreatic body is to the left, and sometimes it can involve the whole abdomen. Low back pain is common, and it is more intense in progressive lesions, or it is limited to the bundle of both quarters, suggesting that the cancer metastasizes to the retroperitoneal plexus along the nerve sheath. The abdominal pain of typical pancreatic cancer is often aggravated when lying on the back, especially at night, forcing the patient to sit up or bend forward or bend the knees to relieve the pain, sometimes causing the patient to toss and turn at night, which may be due to the infiltration of the cancer and compression of the abdominal nerve plexus. Zhu Jiqiao, Department of Hepatobiliary, Pancreatic and Splenic Surgery, Beijing Chaoyang Hospital In addition to pain in the middle abdomen or left upper abdomen or right upper abdomen, a few cases complain of pain in the left or right lower abdomen, around the umbilicus or the whole abdomen, and even testicular pain, which can be easily confused with other diseases. When the cancer tumor involves visceral peritoneum, peritoneum or retroperitoneal tissues, there may be pressure pain in the corresponding area. 2.Jaundice: Jaundice is an important symptom of pancreatic cancer, especially pancreatic head cancer. Jaundice is obstructive in nature, accompanied by deep yellow urine and clay-like stools, and is due to the invasion or compression of the lower end of the common bile duct. Jaundice is progressive and is unlikely to subside completely, although there can be slight fluctuations. The temporary reduction of jaundice is related to the remission of inflammation around the jugular abdomen in the early stage, while in the late stage it is due to the ulceration and decay of the tumor invading the lower part of the common bile duct, and the jaundice produced by the jugular abdomen tumor is more likely to fluctuate. Jaundice from pancreatic body tail cancer appears only when it reaches the head of the pancreas. Some patients with pancreatic cancer develop jaundice in late stages due to liver metastases. About 1/4 of patients have a combination of intractable pruritus, which is often progressive. Although it is currently thought that the occurrence of pruritus in obstructive jaundice may be related to the accumulation of bile acids in the skin, a small number of patients without jaundice or with mild jaundice can also have pruritus of the skin. An enlarged gallbladder may be palpable in nearly half of the patients, which may be associated with inferior biliary obstruction. Clinically, obstructive jaundice with enlarged gallbladder without pressure is called Courvoisier’s sign, which has diagnostic significance for pancreatic head cancer, but the positive rate is not high. If there is chronic inflammation of the gallbladder, the gallbladder may not be enlarged, and the gallbladder is often enlarged by laparotomy and laparoscopy, but there are no clinical signs. Therefore, pancreatic head cancer can never be ruled out without a painlessly enlarged gallbladder. About 50% of patients have large liver due to cholestasis and metastasis of cancer. In the past, the diagnosis of pancreatic cancer was often based on painless jaundice as the first or essential symptom of pancreatic cancer, and the presence of jaundice was an important basis for the diagnosis of pancreatic cancer, so the opportunity for early diagnosis and surgery was often lost. However, painless jaundice is still the most common symptom of pancreatic cancer, and about 50％ patients with this symptom have the opportunity to undergo radical surgery. The early or late appearance of jaundice is closely related to the location of the cancer tumor, and jaundice is often seen in pancreatic head cancer. Jaundice may fluctuate and manifest as complete or incomplete obstructive jaundice. Cancer tumors in the caudal part of the body or away from the biliopancreatic duct may also cause jaundice due to lymph node metastasis compressing the extrahepatic bile duct or due to adhesions and flexion near the bile duct. The most common symptom is loss of appetite, followed by nausea and vomiting, and diarrhea or constipation or even black stool, often fatty diarrhea. The loss of appetite is related to the lower end of the common bile duct and the pancreatic duct being blocked by the tumor, and the bile and pancreatic juice cannot enter the duodenum. Obstructive chronic pancreatitis of the pancreas leads to poor exocrine function of the pancreas, which also inevitably affects appetite. A small number of patients present with obstructive vomiting due to tumor invasion or compression of the duodenum and stomach. About 10 patients have severe constipation due to frequent inadequate feeding. In addition, about 15 patients have diarrhea due to pancreatic exocrine dysfunction; steatorrhea is an advanced manifestation and is a characteristic symptom of pancreatic exocrine dysfunction, but it is relatively rare. Upper gastrointestinal bleeding can also occur in pancreatic cancer, manifested as vomiting blood, black stool or only positive fecal occult blood test, the incidence is about 10％. Gastrointestinal bleeding can occur due to invasion of adjacent cavernous organs such as the duodenum or stomach, and is more likely to occur due to decay of the cancer itself. It is also occasionally seen that the splenic vein or portal vein is embolized due to tumor invasion, secondary to portal hypertension, leading to rupture of esophagogastric fundic varices and hemorrhage. Unlike other cancerous tumors, pancreatic cancer is often associated with wasting and weakness at the initial stage. This symptom is not related to the location of the cancer. Among the digestive tract tumors, pancreatic cancer causes the most prominent weight loss, which is obvious within a short period of time after the onset of the disease. Some patients first show progressive weight loss before other symptoms appear. The reason for weight loss is due to loss of appetite, reduced eating, or reluctance to eat due to epigastric discomfort or induced abdominal pain after eating despite having an appetite. In addition, poor pancreatic exocrine function or pancreatic fluid outflow through the pancreatic duct is obstructed, affecting digestion and absorption function, also have a certain relationship. 5, the abdominal mass pancreatic deep in the back of the abdomen is difficult to feel, the abdominal mass is the result of the development of the cancer itself, located where the lesion is located, such as the lump has been felt, it is mostly in the progressive or advanced stage. Chronic pancreatitis can also be felt as a lump, which is not easily distinguished from pancreatic cancer. Pancreatic cancer can cause dilatation of the bile ducts and gallbladder inside and outside the liver, as well as cholestatic enlargement of the liver, so the enlarged liver and gallbladder can be palpated. The cancer is irregular in shape, variable in size, firm in texture, and may have obvious pressure pain. The abdominal mass caused by this disease is relatively more common than the cancer of the tail of the pancreatic body because the lesion of the head of the pancreas often has other obvious symptoms before the appearance of the mass. When the cancer compresses the abdominal aorta or splenic artery, a blowing vascular murmur can be heard around the umbilicus or in the left upper abdomen. Sometimes the abdominal masses are enlarged liver and gallbladder, and pancreatic cysts complicated by pancreatic cancer. Symptomatic diabetes mellitus is the first symptom of diabetes mellitus in a few patients, that is, they suffer from diabetes mellitus before the main symptoms of pancreatic cancer such as abdominal pain and jaundice appear, so that the accompanying wasting and weight loss are mistaken as the manifestation of diabetes mellitus without considering pancreatic cancer. It is possible that pancreatic cancer has occurred in addition to the original diabetes. Therefore, if a diabetic patient develops persistent abdominal pain, or if diabetes suddenly appears in the elderly, or if the condition of the original diabetes suddenly worsens recently, one should be alert to the possibility of pancreatic cancer. 7. Thrombophlebitis in advanced pancreatic cancer patients with wandering thrombophlebitis or arterial thrombosis. If there is deep vein thrombosis in the lower extremity, it may cause edema in the affected lower extremity. The incidence of arterial and venous thrombosis is about 25％ and seems to be more common in carcinoma of the body and tail of the pancreas. spain believes that the carcinoma may secrete some substance that promotes thrombosis. For example, portal vein thrombosis can cause varicose veins or ascites in the lower esophagus, and splenic vein thrombosis can cause splenomegaly, which can lead to acute upper gastrointestinal hemorrhage in these patients. Some patients with pancreatic cancer may show mental symptoms such as anxiety, impatience, depression and personality change. The mechanism of occurrence is still unclear, probably due to the fact that patients with pancreatic cancer mostly have symptoms such as intractable abdominal pain, inability to sleep peacefully and inability to eat, which easily affects mental and emotional symptoms. 9. In addition, patients often complain of fever and obvious weakness. There may be high fever or even chills and other symptoms similar to cholangitis, so it is easy to be confused with cholelithiasis and cholangitis. Of course, when there is biliary obstruction combined with infection, there may also be chills and high fever. Some patients may also have small joint redness, swelling, pain, heat, subcutaneous fat necrosis around the joint and unexplained testicular pain. The supraclavicular, axillary or inguinal lymph nodes may also be enlarged and hardened due to metastasis of pancreatic cancer.