Information on pancreatic cancer

What is pancreatic cancer?

Pancreatic cancer - pathological changes in the pancreas
Pancreatic cancer or pancreatic carcinoma is a malignant neoplasm of the pancreas. Every year, around 15 out of 100,000 people in Germany develop pancreatic cancer, making it the third most common tumor disease of the gastrointestinal tract. Only stomach and colon cancer are more common.

Cancer causes normal body cells to transform into malignant tumor cells. These multiply uncontrollably, no longer perform their normal function and displace surrounding healthy tissue. If the tumor cells spread via the blood or lymphatic system, they can form colonies in foreign tissue, so-called metastases.

Depending on the tissue of origin of the cancer cell, different forms of pancreatic cancer are distinguished. The most common form is the so-called "ductal adenocarcinoma", less common forms include squamous cell carcinoma, cystadenocarcinoma or acinar cell carcinoma.

Men and women are affected by this disease to roughly the same extent. Pancreatic cancer is more of a tumor disease of older people, the average age of onset is around 60 to 80 years.

Function of the pancreas

The pancreas is a gland in the abdominal cavity that has two main functions. A distinction is made between the exocrine and endocrine parts.

The exocrine part of the pancreas produces digestive juices that are released into the duodenum with the bile and are used to break down the food pulp. The secretion contains important enzymes that play an important role in the absorption of fats from food.

On the other hand, the endocrine part of the pancreas regulates the human blood sugar level via hormones. The hormone insulin lowers the blood sugar level by allowing the sugar to be absorbed into the body's cells. Its counterpart is glucagon, which raises the blood sugar level. Other hormones are produced in small quantities for precise regulation.

If there are disorders of the endocrine function, the patient develops diabetes mellitus (diabetes), for example. If the exocrine part is impaired, digestive disorders can arise in which dietary fats are no longer absorbed properly and are therefore excreted in the stool (so-called fatty stools).

The pancreas lies transversely in the upper abdomen and is divided into the head of the pancreas, which is crossed by the bile ducts, the body of the pancreas and the tail of the pancreas. The majority of tumors arise in the exocrine part of the pancreas. In most cases, the cancer cells develop in the area of the bile ducts in the head of the pancreas.

Symptoms: How do you notice pancreatic cancer?

The pancreas is a relatively small organ that is well integrated into the abdominal cavity. Therefore, the symptoms that occur are very uncharacteristic and difficult to attribute directly to the pancreas. The problem with pancreatic cancer is that there are no early symptoms.

Patients usually complain of:

Loss of appetite
Dull abdominal pain
Nausea and weight loss
A drop in performance
Non-specific back pain

A relatively common symptom of pancreatic cancer is painless jaundice, i.e. painless yellowing of the skin. In around 25% of all pancreatic head carcinomas, this can even be an early symptom. In the late stage, these symptoms are present in 90% of cases.

Jaundice is a sign of bile duct obstruction with bile stasis. This is caused by the tumor tissue narrowing the bile ducts and obstructing the flow. In addition to the yellowing of the skin and sclera ("white of the eye"), the stool becomes discolored and the urine turns dark because the bilirubin, which is normally excreted mainly via the bile, has to be excreted from the body via other routes. If, in addition to the jaundice, the congested gallbladder can be felt through the abdominal wall, this is called the "Courvoisier sign"

Non-specific symptoms such as the new onset of diabetes or a worsening of existing diabetes can also be signs of pancreatic cancer.

Due to the uncharacteristic symptoms of the disease, the tumor is usually only discovered at an advanced stage. Diagnosis is also made more difficult by the fact that many symptoms can also be signs of pancreatitis. This can also occur as a concomitant symptom of pancreatic cancer.

Diagnosis: How is pancreatic cancer diagnosed?

If there are any suspected symptoms, an ultrasound examination is usually carried out first. This can sometimes detect the tumor directly, but above all it can make bile stasis and possible liver metastases visible.

In some cases, a blood test is also carried out. However, this only plays a minor role in the diagnosis of pancreatic cancer, as there are often no or only very unspecific changes. The determination of so-called tumor markers usually does not provide clear diagnostic information, but can be used to monitor the progression if necessary.

Other diagnostic methods are endosonography, ERCP and CT with contrast medium.

Endosonography and ERCP

Endosonography (ultrasound “from the inside”) can be used to determine the size of the tumor and the involvement of neighboring lymph nodes. With the help of an additional ERCP (endoscopic retrograde cholangiopancreatography), the bile ducts and the pancreatic ducts can be examined from the inside and the bile stasis is visualized again. During this invasive procedure, a catheter can also be inserted to keep the bile ducts open and relieve the bile stasis.

In recent years, the so-called "one stop shop" MRI has established itself as the most important diagnostic procedure. It includes an MRI examination including ERCP and an MR angiography. The latter method allows the three-dimensional representation of vessels. Thus, with the "one stop shop" MRI, maximum information can be gained within one session.

Computed tomography with contrast medium
The last most important examination is computed tomography (CT) with contrast medium, because this is where tumor size, extent, metastases or enlarged lymph nodes can be best seen. The CT scan can then be used to assess which treatment methods are suitable and whether surgical removal of the tumor is possible. The vessels that are also affected must be taken into account in particular. If large vessels are already overgrown by the tumor, complete tumor resection is no longer possible without causing massive collateral damage.

Therapy: How is pancreatic cancer treated?

The treatment options for pancreatic cancer are varied and should be considered individually in each case. For this purpose, each individual case is discussed in a tumor conference. Doctors from different disciplines come together to develop an optimal treatment strategy.

Curative therapy

An operation with a curative approach is only possible for 20% of patients, as the tumor stage is usually very advanced when the diagnosis is made. Surgical therapy must always be integrated into an interdisciplinary oncological collaboration.

Depending on the location of the tumor, various surgical techniques are used to remove the tumor, with the additional removal of other organs, such as the spleen or parts of the duodenum. The aim of an operation is always the complete removal of the malignant tumor tissue with the necessary safety margin.

In general, it is also possible to perform this tumor operation laparoscopically (minimally invasive), which is associated with a faster recovery, less pain and smaller abdominal incisions (and thus scars).

Postoperative (adjuvant) chemotherapy is of the utmost importance in the treatment approach. Studies have shown that this can prolong the life of patients. Combined radiochemotherapy is not recommended for pancreatic carcinoma.

Life without a pancreas

After the pancreas has been completely removed, the functions of the organ must be balanced and replaced. Since the endocrine pancreas can no longer control the blood sugar level, diabetes mellitus inevitably develops. This must be treated closely and for the rest of your life. Patients must then monitor their blood sugar levels and inject themselves with insulin accordingly.

Since the production of digestive enzymes also ceases, these must be supplied from outside. This is usually done by taking capsules regularly.

Studies have shown that the quality of life of patients after complete removal of the pancreatectomy is the same as that of patients with diabetes due to other causes. Good training and cooperation from patients is particularly important here.

Palliative therapy

If the cancer is at an advanced stage and has already formed metastases in other organs, then a palliative therapy concept is sought. The aim here is not to cure the disease, but to alleviate the patient's symptoms and improve the quality of life.

Chemotherapy can be considered to extend life. The various advantages and disadvantages should be weighed against each other. Depending on the symptoms, further measures are then used. This includes, for example, improving bile drainage to relieve jaundice symptoms or adequate pain therapy for tumor pain.

Procedures for tumor reduction - HIFU for pancreatic cancer
A state-of-the-art procedure for tumor reduction is HIFU therapy (ultrasound-guided high-intensity focused ultrasound). In this treatment approach, the tumor is "exposed" to sound from the outside using high-energy ultrasound waves. This causes the tumor cells to heat up so much that they "boil" and the tumor shrinks.

This procedure is still in its early stages, but numerous studies have already shown that HIFU therapy can be a successful therapeutic approach to tumor shrinkage with only minor side effects. Although the method is not yet standard, it is used in many cases for inoperable pancreatic tumors.

Chances of recovery from pancreatic cancer

Overall, pancreatic cancer is characterized by a difficult diagnosis, difficult treatment and therefore a difficult prognosis. Pancreatic carcinomas are the fourth most common cause of cancer-related deaths.

The only chance of recovery is radical surgical removal in combination with chemotherapy. However, pancreatic carcinoma can only be completely removed in around 15% of cases. The occurrence of metastases in other organs further worsens the prognosis.

The overall 5-year survival rate is around 8%. This means that only 8% of all patients survive a period of 5 years after diagnosis. In a stage with a small tumor size and without the presence of metastases, this rate is around 40%.

Risk factors for pancreatic cancer

Many different factors play a role in the development of pancreatic cancer, many of which have not yet been sufficiently researched. However, some risk factors have been identified.

In some cases there is a genetic predisposition. These are various genetic changes that increase the likelihood of developing the disease.

Studies assume that around 2-3% of all pancreatic cancers have such a predisposition. In around 70% of these cases, the so-called familial pancreatic syndrome is suspected to be the cause. In this case, 2 or more first-degree relatives must also be affected without any other tumor syndrome being present.

Other risk factors include cigarette smoking, high alcohol consumption and being very overweight. Chronic inflammation of the pancreas and pancreatic cysts also increase the likelihood of developing the disease.

Prevention of pancreatic cancer

To prevent the development of pancreatic cancer, the risk factors that can be influenced should be avoided. If there is a corresponding genetic predisposition, general preventive examinations by your family doctor are recommended in order to detect any changes as quickly as possible. However, general screening of healthy patients is not currently recommended.

In general, a healthy lifestyle should be aimed for, with no nicotine or large amounts of alcohol. A special diet to prevent pancreatic cancer cannot be recommended, but the diet should be balanced and adapted to the recommendations of the German Nutrition Society.

Which doctors and clinics are specialists in pancreatic cancer?

Anyone suffering from pancreatic cancer wants the best medical care for themselves. That is why patients ask themselves, where can I find the best clinic for pancreatic cancer?

Since this question cannot be answered objectively and a reputable doctor would never claim that he is the best doctor, one can only rely on the experience of a doctor. The more patients a doctor treats with pancreatic cancer, the more experienced he becomes in his specialty.

Pancreatic cancer specialists are therefore clinics and doctors who have specialized in the diagnosis and treatment of cancer of the digestive organs. These can be certified as a visceral oncology center by CIO Bonn.