Fast Five Quiz: Test Your Knowledge of Metastatic Pancreatic Cancer Pathophysiology, Diagnosis, and Treatment

Michael J. Pishvaian, MD, PhD


September 26, 2018

A Virchow node refers to a palpable metastatic left supraclavicular node (felt behind the medial end of the left clavicle). Other nodes in the cervical area may also be affected by metastatic disease.

Other palpable physical examination findings indicating distant disease include:

  • Blumer's shelf: A metastatic mass in the rectal pouch, felt on rectal examination

  • Courvoisier sign: A palpable gallbladder, which may be associated with clinical jaundice and skin excoriations due to severe pruritus

  • Sister Mary Joseph nodes (nodules): Subcutaneous metastases in the periumbilical area

While these may be manifestations of metastatic pancreatic cancer, pain remains the most common presenting symptom. Typically, it manifests as mild to moderate epigastric tenderness. The pain may radiate to the midback or lower back. This pattern of radiation may indicate retroperitoneal invasion of the splanchnic nerve plexus.

To learn more about the physical examination findings associated with metastatic pancreatic cancer, read here.


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