Pancreatic Cancer: Information & Specialists in Pancreatic Cancer

Pancreatic cancer is a malignant tumor 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 also plays a role in regulating blood sugar levels and releases hormones into the bloodstream.

In principle, the tumor can develop in any part of this elongated organ; however, the head of the gland is most commonly affected.

Most pancreatic carcinomas develop in the exocrine region—that is, the part of the pancreas that secretes digestive enzymes.

For this reason, physicians also refer to this cancer as exocrine pancreatic cancer (usually ductal adenocarcinomas).

If a malignant tumor develops in the endocrine portion—which is responsible for regulating blood sugar—it is classified as an endocrine pancreatic tumor. This type differs in its behavior from an exocrine tumor.

Pancreatic carcinomas frequently metastasize relatively quickly.

The exact causes of pancreatic cancer are not yet known. However, certain factors are known to increase the risk of developing the disease.

Risk factors include smoking and heavy alcohol consumption.

In addition, advanced age and genetic predisposition play an important role.

Diabetes and a hereditary form of chronic pancreatitis also appear to slightly increase the risk.

Other risk factors are related to personal lifestyle:

• severe obesity
• a high-fat diet, and
• vitamin D deficiency

Pancreatic cancer largely lacks early symptoms. As a result, doctors often do not detect the tumor until it is at an advanced stage.

Symptoms usually do not become noticeable until the cancer has already progressed.

Depending on the tumor’s location, the following symptoms may occur:

• Pain in the upper abdomen that radiates to the back
• Diarrhea
• Fatty stools (steatorrhea)
• Yellowing of the skin
• Weight loss
• Feeling of fullness and
• deterioration of general health

If metastases have formed, additional organ-specific symptoms may occur, such as tenderness in the liver area.

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

Certain laboratory values are elevated in cases of tumor-related jaundice.

These include:

• Gamma-glutamyltransferase
• alkaline phosphatase, and
• direct bilirubin

However, there is no specific laboratory test for diagnosing pancreatic cancer. If pancreatic cancer is suspected, a transcutaneous ultrasound examination of the abdomen is usually performed first.

Since the accuracy of this ultrasound depends on the examiner, it should be performed by a specialist in pancreatic cancer.

Endoscopic ultrasound offers higher resolution, allowing doctors to detect even smaller tumors.

Contrast-enhanced thin-section computed tomography (CT) is considered the standard procedure for preoperative diagnosis. Magnetic resonance imaging (MRI) can also be used to better visualize soft tissues.

MRI provides clear imaging of soft tissues, helping to identify signs of tumor spread or metastases © Nejron Photo | AdobeStock

A cure for this cancer is only possible through early surgical removal of the carcinoma. To ensure that no cancer cells remain, (adjuvant) chemotherapy is often administered afterward.

However, doctors usually discover most tumors at a late stage, when a cure is no longer possible.

There are initial studies in which doctors have reduced the size of an inoperable tumor to make surgery possible.

This involved treatment with neoadjuvant (pre-surgical) chemotherapy and/or radiation therapy.

Otherwise, radiation therapy plays no major role in the treatment of pancreatic cancer.

Chemotherapy is used as adjuvant therapy (i.e., after pancreatic cancer surgery) and in palliative care.

The goal of palliative therapy is to control tumor growth and the symptoms associated with the tumor. This allows doctors to improve the patient’s quality of life and prolong their life. However, a cure is no longer possible.

Pain management is also important in pancreatic cancer. With appropriate, high-dose administration of pain medication, patients can continue to participate in their social and community lives.

Patients with pancreatic cancer should seek treatment at specialized clinics for pancreatic cancer that have extensive experience with this disease.

There, a high quality of care is guaranteed. Patients can benefit from the latest therapies by participating in clinical trials.

The German Cancer Society (DKG) certifies such interdisciplinary oncology treatment centers as pancreatic cancer centers. These centers can provide pancreatic cancer patients with high-quality care in accordance with the latest treatment standards.

These facilities hold what are known as tumor board meetings, where various experts in pancreatic cancer collaborate in an interdisciplinary manner.

They take into account the recommended diagnostic and therapeutic procedures to develop a personalized treatment plan for the patient. 

Typically, these include specialists from the following fields:

• Gastroenterology
• Oncology
• Radiation Oncology
• Radiology
• Surgery and
• Pathology

The German Society for General and Visceral Surgery (DGAV) is responsible for certification. 

Here, external reviewers regularly assess compliance with guidelines and, in particular, the quality of treatment.

The prognosis depends primarily on the stage at which doctors detect the pancreatic cancer.

In early stages, there is a chance of a cure.

In later stages, treatment is primarily palliative, as the prognosis is very poor at that point. The 5-year survival rate is only 6 to 7%.

However, new treatment approaches offer hope that treatment outcomes will improve in the future.