Evaluation of Floating Stools in Adults

Introduction to Pancreatic Cancer Risk

• The American College of Gastroenterology and the National Comprehensive Cancer Network suggest that pancreatic cancer incidence increases dramatically with age, with the majority of cases diagnosed above age 65 1, 2
• The absence of cardinal symptoms such as abdominal or back pain, marked and rapid weight loss, painless jaundice, and new-onset diabetes in older adults is reassuring, as these are typical presentations of pancreatic cancer 1, 3, 5, 6

Clinical Presentation and Diagnosis

• The European Society for Medical Oncology and the National Comprehensive Cancer Network indicate that pancreatic cancer typically presents with abdominal or back pain, marked and rapid weight loss, painless jaundice, and new-onset diabetes in older adults 1, 3, 5, 6
• Normal lipase levels effectively exclude pancreatic exocrine insufficiency, as true steatorrhea from pancreatic cancer would be accompanied by elevated lipase or other pancreatic enzyme abnormalities 7

Appropriate Clinical Approach and Management

• The American Gastroenterological Association recommends reassurance as the primary intervention, explaining that the symptom profile is inconsistent with pancreatic cancer, all relevant laboratory tests are normal, and age and absence of risk factors make malignancy extremely unlikely 4, 7
• Consider dietary modification trials, monitoring for development of alarm symptoms, and reassessment if symptoms change or new features develop 7

Indications for Further Workup

• The National Comprehensive Cancer Network suggests that imaging would only be appropriate if the patient develops persistent abdominal or back pain, unintentional weight loss, jaundice, new-onset diabetes, or a palpable abdominal mass 1, 3, 5, 6
• If imaging were ever needed, the appropriate initial study would be pancreatic protocol CT (contrast-enhanced multi-detector CT) 3, 6