Pancreatic Cancer - Symptoms, Diagnosis, Therapy

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

Pancreatic cancer

Pancreatic cancer (pancreatic cancer) only accounts for three to four percent of all tumor diseases, but due to its high degree of malignancy it is responsible for around six percent of all cancer deaths. According to Statistics Austria, more than 1,500 new cases and deaths from pancreatic cancer are counted in Austria each year, and the trend is rising. The mean age of onset is 71 years for men and 75 years for women.

Pancreatic cancer is often discovered by chance during an examination (e.g. ultrasound of the abdomen). The therapy depends mainly on the affected organ parts, the stage of the disease and the general health of the patient. Complete healing can only be achieved if the tumor can be completely removed surgically.

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The pancreas is located behind the stomach in the abdominal cavity. Their main functions concern digestion and sugar metabolism. The causes of pancreatic cancer are not known. Certain factors can increase the risk of the disease. Because pancreatic cancer rarely causes symptoms in its early stages, it is important to watch out for warning signs.

What types of pancreatic cancer are there?

Pancreatic cancer © Henrie

Pancreatic cancer can in principle occur in any area of the organ. The various forms of cancer are based on different tissue types:

• Exocrine tumors (common):

  • Ductal exocrine tumors originate from cells that line the small ducts of the saliva-forming gland.
  • Acinar tumors originate from the enzyme-producing gland ends in the pancreatic duct system.
• Endocrine tumors (rare): can originate from the hormone-producing cells of the islets of Langerhans, which are scattered within the glandular lobules.

What are the risk factors?

The causes of pancreatic cancer are not known. Certain factors can increase the risk of the disease, especially when they are combined, for example:

• Smoke;
• high alcohol consumption;
• frequent contact with certain pollutants, eg pesticides, weed or fungicides, chlorinated hydrocarbons, chromium and chromium compounds, solvents (2-naphthylamine, benzidine or benzene derivatives), nickel, electromagnetic fields and fuel vapors;
• Obesity;
• Previous illnesses: e.g. inflammation of the pancreas, diabetes mellitus;
• genetic predisposition to pancreatic diseases.

How to prevent pancreatic cancer

First and foremost are a healthy lifestyle and the avoidance of possible risk factors (especially smoking and alcohol). Which nutritional factors play a role in the development of pancreatic cancer is not yet fully understood. Large studies have shown that a diet rich in fruits and vegetables, high in fiber and vitamins, can generally lower the risk of cancer. A balanced diet also helps to maintain or achieve a healthy body weight.

Pay attention to warning signs

Pancreatic cancer rarely causes symptoms in the early stages. They usually only occur when the tumor is so large that it hinders the production of digestive enzymes or their flow into the duodenum, or when it has already spread to other organs such as the stomach, duodenum, liver or peritoneum. Among other things, the following complaints occur:

• Weight loss,
• Pain in the abdomen or back,
• Jaundice,
• Loss of appetite,
• Nausea,
• Vomit,
• Diabetes mellitus.

If these complaints occur, a doctor should be consulted immediately for a detailed clarification. The earlier a pancreatic cancer is discovered, the greater the chances of recovery.

How is the diagnosis made?

If pancreatic cancer is suspected, the doctor initiates the necessary diagnostic steps. Important examinations for the detection of pancreatic cancer are:

• physical examination;
• Laboratory tests: urine, stool, blood, including tumor markers such as CA 19-9 (CA = cancer antigen) and CEA (carcinoembryonic antigen); if an endocrine tumor is suspected, also chromogranin A, NSE (neuron-specific enolase), insulin, glucagon, gastrin, VIP (vasoactive intestinal polypeptide), PP (pancreatic polypeptide);
• Ultrasound examination;
• Computed tomography (is the most suitable X-ray examination for the initial diagnosis);

If pancreatic cancer is diagnosed, further examinations are necessary to determine the extent of the tumor, for example:

• Lung x-ray,
• Endoscopy of the stomach and duodenum,
• endoscopic representation of the pancreatic duct and biliary tract using X-rays (ERCP), endosonography,
• MRI,
• Tissue puncture,
• Laparoscopy,
• PET-CT,
• Skeletal or octreotide scintigraphy.

How is pancreatic cancer treated?

The treatment strategy depends primarily on the type of tumor, the stage of the disease and the patient's general health. Complete healing can only be achieved if the tumor can be completely removed surgically. Therefore, if pancreatic cancer is suspected, clarification must be carried out quickly. All other therapy options are used primarily to reduce the size of the tumor before a planned operation, to limit further tumor growth or to alleviate symptoms.

surgery

The aim is to eliminate the tumor tissue and the surrounding lymph nodes as completely as possible. The operation used to be considered very complicated. The postoperative results have improved significantly, not least due to specialization in pancreatic surgery, so that the procedure can now be considered safe.

• Pancreatic head carcinoma: With the head of the pancreas, the gallbladder, the lower part of the bile duct, the duodenum and sometimes also part of the stomach are removed (so-called Whipple operation). The interrupted connections are then restored. A hospital stay of several weeks and a longer recovery period are required after the operation.
• Pancreatic tail cancer: Usually the spleen has to be removed as well.
• Total pancreatectomy: In some cases, the entire pancreas must be removed.
• Lymph nodes: In the course of the operation, lymph nodes (at least twelve) are also removed from the immediate vicinity of the pancreas. If they do not contain cancer cells, this indicates that the tumor has not spread. The number of affected lymph nodes also gives an indication of the later course of the disease.

chemotherapy

Cytostatics are designed to kill cancer cells throughout the body, but cannot cure the tumor on their own. Adjuvant chemotherapy, ie performed after the operation, can have a beneficial effect on the course of the disease and improve the chance of recovery. Gemcitabine, Erlotinib, Nab-Paclitaxel, 5-FU / Folinic Acid, Irinotecan and Oxaliplatin are available. In the case of locally advanced tumors that cannot be safely removed by surgery, chemotherapy is carried out prior to the operation (neoadjuvant) in order to reduce the size of the tumor and achieve a better starting position for the surgery. If a tumor is no longer curable, palliative chemotherapy is carried out to possibly reduce the size of the tumor and alleviate the symptoms.

radiotherapy

In the case of locally advanced tumors that could not initially be operated successfully, radiation can be carried out in combination with chemotherapy before the planned operation (neoadjuvant chemoradiotherapy). The tumor and the tumor extensions in the surrounding tissue are thereby reduced in size. This increases the chance that the tumor can be completely removed during the subsequent operation.

In addition, radiation therapy is also used to eliminate tumor symptoms (e.g. pain) (palliative treatment).

Targeted drug therapies

These drugs (e.g. the tyrosine kinase inhibitor Erlotinib) target malignant tissue and largely spare healthy tissue. For example, they are directed against factors that promote tumor growth, cut off the blood supply to the tumor or prevent signal transmission between tumor cells.

Palliative therapy

Targeted therapies These substances (eg the tyrosine kinase inhibitor Erlotinib) target malignant tissue and largely spare healthy tissue. For example, they are directed against factors that promote tumor growth, cut off the blood supply to the tumor or prevent signal transmission between tumor cells. Palliative therapy

It is used when the disease has progressed so far that a cure or effective tumor treatment is no longer possible. Palliative treatment includes alleviating tumor-related complications and complaints, pain therapy, nutrition and psychosocial counseling or care for those affected, e.g. in the context of self-help groups or special psycho-oncological facilities or through psychotherapy.

Enzyme and hormone therapy

A tumor or surgery-related destruction of the pancreas can result in digestive enzymes and hormones no longer being formed in sufficient quantities. Severe digestive disorders (exocrine pancreatic insufficiency) and / or diabetes mellitus can result. The missing enzymes or hormones (insulin) can be permanently supplied to the body in the form of drugs.

Aftercare & Rehabilitation

Regular check-ups should be carried out after tumor therapy. Tumor aftercare pursues the following goals:

• recognize and treat a recurrence of the cancer in good time if the tumor could be surgically removed;
• Determine, treat and, if necessary, alleviate the consequences of the operation and comorbidities;

• to generally help with physical, mental and social problems.

  Follow-up treatment (rehabilitation) is often recommended in order to speed up the recovery and recovery process. There are specially set up aftercare clinics that can also carry out certain parts of a chemotherapy cycle if necessary. Furthermore, help is offered in nutritional issues and in coping with psychological or social problems.

Whom can I ask?

Several medical specialties are involved in the diagnosis and treatment of pancreatic cancer. If you have any abnormalities or warning signals, contact your general practitioner. This / he / she initiates the further investigation, in which, among other things, specialists in nuclear medicine, internal medicine and surgery can be called in. If you are already undergoing treatment or follow-up care, regular appointments will be made with the treating doctor.

How are the costs going to be covered?

All necessary and appropriate therapies are covered by the health insurance carriers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic. For more information, see Costs and Deductibles.

When hospitalization is required

Hospitalization is usually required for the diagnosis and treatment of pancreatic cancer. The hospital costs are billed for. The patient has to pay a daily contribution to the costs. Further medication treatment at home takes place by prescription from the general practitioner or specialist. You can find more information under What does the hospital stay cost?