Pancreatic cancer is a malignant tumor disease of the pancreas. It is also known as pancreatic carcinoma or pancreatic cancer.
The pancreas is located in the upper abdomen and produces digestive enzymes, which it releases into the duodenum. It is also involved in blood sugar regulation and releases hormones into the bloodstream.
In principle, the tumor can develop in any section of this elongated organ, but the head of the gland is usually affected.
Most pancreatic carcinomas develop in the exocrine area, i.e. the part of the pancreas that secretes digestive enzymes. This carcinoma is therefore also referred to as exocrine pancreatic cancer (usually ductal adenocarcinoma).
If a malignant tumor develops in the endocrine part responsible for blood sugar regulation, it is an endocrine pancreatic tumor. This differs in its behavior from the endocrine tumor.
Pancreatic carcinomas form metastases frequently and relatively quickly.
The location of the pancreas and a depicted tumor in the head of the pancreas © lom123 | AdobeStock
The exact causes of pancreatic cancer are not yet known. However, factors that can increase the risk of developing the disease are known. Risk factors include smoking and increased alcohol consumption.
Older age and a genetic predisposition also play an important role.
Diabetes and a hereditary form of chronic pancreatitis also appear to slightly increase the risk.
Other risk factors can be found in personal lifestyle:
- severe obesity,
- a high-fat diet and
- vitamin D deficiency.
Early symptoms of pancreatic cancer are largely absent, meaning that the tumor is often only discovered late.
Symptoms only become noticeable when the tumor is already advanced. Depending on the location of the tumor, these may include
- Pain in the upper abdomen, which can radiate into the back,
- diarrhea,
- fatty stools (steatorrhea),
- yellowing of the skin,
- weight loss,
- a feeling of fullness and
- a deterioration in the general condition
can occur. If metastases have formed, other organ-specific symptoms, such as pressure pain in the liver area, may also occur.
From training.seer.cancer.gov; original SVG: Cradel - translation of File:Illu pancrease.svg; http://training.seer.cancer.gov/module_anatomy/images/illu_pancrease.jpg, Public domain, Link
Some laboratory values are elevated in tumor-related jaundice. These include
- Gamma-glutamyltransferase,
- alkaline phosphatase and
- direct bilirubin.
However, there is no specific laboratory test for the diagnosis of pancreatic cancer. If pancreatic cancer is suspected, a transcutaneous ultrasound examination of the abdominal cavity is usually carried out first. As the informative value of this ultrasound depends on the examiner, it should be carried out by an experienced pancreatic cancer specialist.
The endoscopic ultrasound examination has a higher resolution and can also detect smaller tumors.
Contrast-enhanced thin-layer computed tomography(CT) is the standard procedure for preoperative diagnostics. Magnetic resonance imaging (MRI) can also be used to better visualize the soft tissue.
MRI provides a good image of the soft tissues and thus provides indications of the spread of the tumor or its metastases © Nejron Photo | AdobeStock
A cure for the tumor disease can only be achieved by early surgical removal of the carcinoma. To ensure that all cancer cells are killed, this is often followed by (adjuvant) chemotherapy.
However, the majority of tumors are only discovered at a late stage, when it is no longer possible to cure them through surgery. However, there are initial studies in which an inoperable tumor was reduced in size to such an extent that surgery could be performed. This involved treatment with neoadjuvant chemotherapy (prior to surgery) and/or radiotherapy.
Otherwise, radiotherapy does not play a major role in pancreatic cancer treatment.
Chemotherapy is not only used in adjuvant therapy (i.e. after pancreatic cancer surgery), but also in the palliative situation. The aim of palliative therapy is to control tumor growth and the symptoms associated with the tumor. The aim is to improve quality of life and prolong life. However, a cure is no longer possible.
Pain therapy is also important in pancreatic cancer. Appropriate, high-dose administration of painkillers enables the patient to participate in social life.
Patients with pancreatic cancer should seek treatment at specialized pancreatic cancer clinics that have a lot of experience with pancreatic cancer. There, a high quality of treatment can be guaranteed and, if necessary, they can benefit from the latest therapies by participating in clinical trials.
The German Cancer Society (DKG) certifies such oncological interdisciplinary treatment centers as pancreatic cancer centers, which guarantees a high quality of care for patients with pancreatic cancer according to the latest and most modern treatment options (guidelines).
At these facilities, there are so-called tumor conferences in which various pancreatic cancer experts work together on an interdisciplinary basis, taking into account the diagnostic and therapeutic procedures recommended by guidelines in order to create a tailor-made treatment concept for the individual patient. As a rule, these are specialists from the following fields
An equivalent certification as a center for surgical pancreatic diseases including pancreatic cancer is carried out by the German Society for General and Visceral Surgery (DGAV). Here too, external experts regularly check compliance with guidelines and in particular the quality of treatment.
The prognosis depends primarily on the stage at which the pancreatic cancer was discovered. In early stages, there is a chance of recovery.
In later stages, treatment is primarily palliative, as the prognosis is then very unfavorable. The 5-year survival rate is only 6 to 7 %.
However, there is hope that new treatment concepts will improve treatment outcomes in the future.
