Exocrine pancreatic insufficiency (EPI) does not cause cancer, but pancreatic cancer can cause EPI. They both also share a common risk factor: chronic pancreatitis.

EPI occurs when the pancreas does not make enough enzymes needed for digestion.

EPI does not cause cancer, but pancreatic cancer can cause EPI. Chronic pancreatitis is a risk factor for both EPI and pancreatic cancer.

Pancreatic cancer and EPI may cause similar symptoms, but not everyone with EPI will have pancreatic cancer.

Many potential risk factors may contribute to the development of cancer. Having a risk factor does not necessarily mean a person will develop cancer, but it may make it more likely.

EPI does not cause pancreatic cancer and is not considered a known risk factor for pancreatic cancer.

However, EPI and pancreatic cancer have a common risk factor known as chronic pancreatitis.

Pancreatitis refers to inflammation in the pancreas. Chronic pancreatitis means the pancreas will not recover or improve. It may progressively get worse over time, which can damage the pancreas permanently.

Some people are more likely to get pancreatitis than others. These include people who:

  • have obesity
  • smoke
  • drink excess amounts of alcohol

While EPI does not cause pancreatic cancer, pancreatic cancer can cause EPI. This may be due to the tumor blocking the pancreatic duct or surgery to remove all or part of the pancreas.

EPI can indicate that pancreatic cancer is present, but not everyone with EPI will have pancreatic cancer.

EPI is a treatable condition, and those living with it can have a good quality of life. Pancreatic enzyme therapy (PERT) is the main treatment for EPI. It involves taking oral medication to replace the enzymes the pancreas no longer produces.

If left untreated, EPI can lead to serious complications, including death.

Those living with EPI have a raised risk of mortality for several reasons.

Research has proven that there is a significant association between EPI and cardiovascular events in people living with chronic pancreatitis. Cardiovascular diseases are a leading cause of death around the world.

A 2018 study found that EPI is a significant independent risk factor for death in patients with chronic pancreatitis.

Those living with EPI are at risk of malnutrition. A 2018 study found a high prevalence of malnutrition among people with EPI and chronic pancreatitis.

Malnutrition can have serious consequences. People with EPI may also have other conditions that can make malnutrition even more dangerous.

In people with chronic pancreatitis, malnutrition can result in higher mortality and osteoporosis. In people with pancreatic cancer, it can result in lower survival rates.

In people who have had a pancreatectomy, malnutrition can cause:

  • longer hospital stays
  • more frequent infections
  • higher rates of death

Common causes of EPI may also be associated with higher rates of mortality.

Chronic pancreatitis is common in people with EPI. Research suggests the mortality rate for people with chronic pancreatitis is 4.3 times higher in males and 4.5 times higher in females compared with the general population.

Cystic fibrosis (CF) is another common cause of EPI. While life expectancy for people with CF is increasing, the life expectancy of people with CF is still lower than the general population.

Data from 2019 suggest the life expectancy of people born between 2015 and 2019 with CF is around 46 years. Of the babies with CF born in 2019, half are expected to live to 48 years of age or older.

Pancreatic cancer can cause a variety of symptoms. In the early stages, many people will not have symptoms. When symptoms do appear, they may include:

  • loss of appetite
  • nausea
  • vomiting
  • abdominal pain
  • changes in bowel habits
  • weight loss
  • jaundice

Approximately 66–92% of people with advanced pancreatic cancer will develop EPI.

In unresectable pancreatic cancer, the prevalence of EPI is 20–60%.

Abdominal pain and weight loss are symptoms that either pancreatic cancer or EPI may cause.

EPI may cause other symptoms besides the typical symptoms of pancreatic cancer, such as maldigestion, fat malabsorption, and steatorrhea.

EPI can cause a variety of symptoms. These may develop over time and initially may be mild.

Possible symptoms include:

  • bloating
  • gas
  • abdominal pain
  • weight loss
  • fatty stools
  • stools that look oily
  • stools that look bulky
  • stools that are orange or yellow
  • stools that smell foul
  • stools that are runny
  • stools that float and may be difficult to flush
  • stools that stain the toilet bowl

People with EPI may experience fat malabsorption, which can lead to deficiencies in vitamins A, D, and K. This can cause further symptoms, such as:

  • increased infections
  • poor healing of wounds
  • bone problems, such as osteoporosis
  • muscle weakness
  • bruising
  • fatigue
  • difficulties with sight, particularly when it is dark
  • nerve symptoms

EPI does not cause cancer. However, pancreatic cancer and EPI have common risk factors, such as chronic pancreatitis.

The majority of people with advanced pancreatic cancer will experience EPI.

Pancreatic cancer and EPI share some common symptoms, including weight loss and abdominal pain. But EPI will also cause other symptoms, such as fatty stools.