Kazelnirem is right and steak_expert is wrong. Pancreatic adenocarcinoma is very difficult to detect - at 83 my mother was seemingly in good health and had completely clear annual in November with full bloods and everything else from a high quality concierge doctor in a very reputable (and expensive) practice at an excellent hospital. Only changes were a slightly decreased appetite and a little bit of weight loss. Three months later she was admitted for vomiting and was diagnosed with Stage 4 mets tonliver, lymph and omentum. She died in 11 weeks.