Professor MD Max Reinshagen
Pancreatic cancer is one of the ten most common tumor types in Germany. Smoking and passive smoking as well as heavy obesity promote the disease. But also chronic inflammation of the pancreas and pre-existing conditions such as diabetes type II are considered risk factors. In many cases, however, it remains unclear what triggered tumor growth. In early stages, the disease, also referred to as pancreatic carcinoma, often causes no clear symptoms. The tumor is therefore often recognized only when it is well advanced. For patients with cancer of the pancreas, this situation is usually very stressful. The following texts provide a brief overview of the most important facts about pancreatic carcinoma and its treatment.
This text is part of a detailed information about pancreatic carcinoma. It is aimed at patients with pancreatic cancer, their relatives and friends as well as those interested in finding out about the disease. It provides a brief overview of symptoms, research and treatment options for pancreatic cancer. References to further information and the sources used are listed at the bottom of this page. In most patients with malignant pancreatic cancer, the tumor starts from the portions of the pancreas that produce digestive juices. Experts speak of "exocrine pancreatic tumors". The following information mainly refers to this type of tumor.
Patients with pancreatic carcinoma rarely have symptoms in early stages of the disease. Therefore, the tumor is often discovered late. First symptoms may be poor appetite, weakness, nausea, vomiting or diarrhea. Frequently, sufferers also report that they have long felt a pressure sensation in the upper abdomen or pain in the back. Especially if newly occurring abdominal pain radiate in the back and are also noticeable at night, you should consult a doctor. However, many of these symptoms do not clearly indicate pancreatic cancer. They can also occur in other digestive system disorders, for example gastrointestinal infections. Significant weight loss is definitely a warning sign. If someone inadvertently loses weight significantly within a few months, it can always be due to a malignant disease, such as pancreatic cancer. The cause of weight loss should definitely be clarified by a medical examination.
What causes these and other complaints? Above all, an exocrine pancreatic tumor causes discomfort when it displaces or infiltrates neighboring organs such as the stomach, duodenum, peritoneum, or spleen, interfering with its function. This explains nonspecific pain and indigestion, but also complaints that are typical of the affected organs. An example is biliary discomfort: Through the pancreatic head runs the bile duct, which leads from the liver through the pancreatic head to the duodenum. If a tumor narrows this bile duct, the bile produced in the liver can not run off. In affected patients, corresponding symptoms develop: Due to the lack of bile in the intestine, the fat digestion may be disturbed. Undigested fat is excreted in the form of so-called "fatty stools": the stool has a lighter color than usual and is greasy, sticky or shiny, and smells particularly unpleasant. If the bile accumulates, the dye contained in the bile fluid increasingly enters the blood and accumulates in the body. A yellowing of the white skin, a brown color of the urine and yellowing and itching of the skin are the result. These symptoms are referred to as "jaundice", in technical terms: "jaundice". These gall bladder complaints are initially not typical of pancreatic carcinoma. They can also be found in other diseases, especially if gallstones are laying the bile duct. However, gallstones usually cause severe pain that may not necessarily occur in pancreatic cancer. Some patients with advanced pancreatic tumors may experience insulin production disorders. Patients therefore develop signs of diabetes, the diabetes. In some patients, a pancreatic carcinoma leads to altered blood clotting. As a result, blood clots form in the blood vessels, so-called thromboses.
For symptoms suggestive of pancreatic cancer, the doctor first asks about possible risk factors and whether anything has changed in the general condition. This is followed by a physical examination, which includes, for example, the palpation and listening of the abdomen. In addition, physicians use a variety of imaging techniques to confirm or, if possible, rule out the suspicion:
Tissue examination: What tumor is present? In order to prove that a change in the pancreas is actually cancer and which form exactly, the doctors take a tissue sample from the organ. This procedure is usually performed in the hospital, because if possible, the tumor is completely surgically removed and then examined. Can not a patient be operated on, perhaps because heart problems or another previous illness make anesthesia more difficult? Then the doctors take a tissue sample (biopsy) with a fine needle through the abdominal wall of the pancreas, under local anesthesia. Such a fine-needle biopsy is performed by physicians even if surgery is no longer planned in advanced disease and a "palliative" systemic treatment is considered. Palliative therapy is designed to alleviate discomfort.
Pancreatic cancer is an aggressive disease. The tumor usually spreads early into the environment, even before the first symptoms appear. Therefore, this cancer is often diagnosed very late, when it is already well advanced. Untreated, patients with pancreatic carcinoma usually only survive a few months. Spontaneous cures or a disease without treatment are very unlikely. Healing surgery is only possible in a small proportion of patients who have not yet spread the tumor to other organs and tissues. Chemotherapy can extend the average survival time by several months. However, for other reasons, it is also recommended to many sufferers: In advanced disease, chemotherapy should delay the onset of distressing symptoms, alleviate them, and improve quality of life. Even if there is no causal treatment against the tumor itself, soothing measures can improve the quality of life of many patients.
Early Stages: Surgery Can Heal When the tumor is completely removed, patients can hope for a long-term cure. Prerequisites for surgery are: The tumor has not yet formed a dislocation in other organs. The patient does not suffer from severe comorbidities that make surgery too risky. Surgical intervention with the goal of healing is possible for every fifth patient with pancreatic cancer. The type and extent of the procedure depend on where the tumor is inside the pancreas and how tall it is. Important questions during surgical planning are therefore: Can a part of the pancreas be preserved (partial resection or partial resection)? Or does the organ have to be completely removed (complete resection or total pancreatectomy)? If only the tumor is removed, the doctors will also cut out a sufficient margin of adjacent healthy pancreatic tissue for safety. For each operation, they remove at least ten lymph nodes near the pancreas and examine them for migrating tumor cells. Although part of the pancreas can be preserved, additional organs may need to be removed if the tumor is adjacent to it. There are various surgical procedures for this. They are traditionally named after the surgeons who developed them. The technical names, however, are based on the scope and the organs involved. For example, Whipple or Kausch-Whipple surgery involves removal of the pancreatic head, duodenum, bile, bile duct and part of the stomach. It is also referred to as partial duodenopancreatectomy, with complete removal as a total duodenopancreatectomy. Some patients may also be affected by other organs, such as the spleen. If, however, the operation reveals that the tumor has already formed visible metastases in other organs, the procedure is discontinued. Other forms of treatment enable affected patients to have a better quality of life without the consequences of a very large and stressful operation that does not improve their chances of recovery would. For some patients with inoperable, locally advanced pancreatic carcinoma, a so-called sequential treatment concept may be considered. If there are no long-distance measurements during the course of chemotherapy over a period of three months, radiation chemotherapy may follow. In some patients, the tumor can then be surgically removed. However, the study results so far are not uniform. You should discuss with your doctor whether the benefit outweighs the risks in this approach in the personal situation.