The pancreas is a gland about 15 to 20 cm long, located behind the stomach. It consists of two types of glandular tissue and a duct leading to the intestine. In the exogenous glandular tissue of the pancreas, digestive enzymes and bicarbonate are formed, which are important in the intestine for the breakdown of food components. The pancreatic islands (also called Langerhans islands) represent the endocrine (hormone-producing) glandular tissue. Among other things, they produce insulin and glucagon, which regulate the blood sugar level in the body.
The pancreatic cancer experts treat all malignant tumors of the pancreas. In most cases, these are exocrine pancreatic carcinomas, of which adenocarcinomas are by far the largest group, and cystadenocarcinomas and azine tumors are less common.
In the case of rare endocrine pancreatic tumors, the substance formed usually gives the tumor its name. They are also treated by pancreatic cancer specialists:
- The insulinoma originates from the beta cells of the pancreatic islets and is usually benign.
- The glucagonoma produces high amounts of glucagon and is usually malignant.
- The gastrinoma originates from gastrin-producing cells and is usually malignant.
- VIPoma (Verner-Morrison syndrome, WDHA syndrome) is characterized by an overproduction of VIP (vasoactive intestinal peptide).
- Somatostatinoma is extremely rare.
- The ACTHom produces the adrenocorticotropic hormone (ACTH) and is usually malignant.
- The PPom forms the pancreatic polypeptide.
- Neuroendocrine tumors (NET, neuroendocrine neoplasia, NEN, carcinoids) of the pancreas are very rare.
Symptoms of pancreatic cancer and side effects of the treatment are also treated by pancreatic cancer specialists. These include, among other things:
- Treatment of cancer pain according to the WHO-stage scheme and severe pain in the abdominal cavity by blocking the coeliac plexus (nerve plexus).
- Treatment of exhaustion and permanent fatigue that can be caused by the cancer itself or the treatment itself
- Treatment of bile flow obstructions (bile stasis, cholestasis)
- Treatment of tumor-induced constrictions at the stomach outlet and duodenum
The basis of every diagnosis is the patient survey (anamnesis) and physical examination. This provides the physician with information, for example, on complaints, previous illnesses and medication taken. If there is a suspicion of cancer, further examinations are carried out:
- Endosonography: With an ultrasound examination "from the inside", i.e. a probe is inserted through the mouth into the stomach or intestine, the pancreas can be checked for changes; this allows even smaller tumors to be detected.
- Sonography: An ultrasound examination of the upper abdomen can also be used to assess the pancreas.
- Computed tomography (CT): It can also be used to examine the pancreas.
- Magnetic resonance imaging (MRI) in combination with magnetic resonance cholangiopancreaticography (MRCP): This allows the pancreas and the bile ducts to be visualised very well.
- Taking tissue samples (biopsies) to confirm diagnosis or plan treatment.
- Determination of the tumor marker CA19-9 to assess whether the therapy is effective.
- Spreading diagnostics: Computer tomography or ultrasound examination of the pancreas can be used to determine the extent to which the tumor has spread within the pancreas and whether it has already spread to neighbouring tissue.
- Spreading diagnostics: Using ultrasound examination (abdominal sonography), computer tomography or magnetic resonance tomography of the upper abdomen and X-ray examination of the chest area, it can be examined whether the pancreatic carcinoma has already formed secondary tumors in other organs (metastases).
- Laparoscopy if there is suspicion of a tumor of the peritoneum.
- Determination of hormone levels when endocrine pancreatic tumors are suspected.
- Explorative laparotomy in patients with endocrine pancreatic tumors whose exact location cannot be determined from the outside due to their small size: The pancreas is exposed during abdominal surgery and the pancreas is examined by ultrasound and manually (with the hand) during surgery.
- Angiographic and nuclear medicine procedures (somatostatin receptor scintigraphy, octreotide scan) for suspected endocrine pancreatic tumors.
Based on the investigations, the tumor stage (tumor staging) can be estimated using the TNM classification and the course of the disease. The therapy can be planned together with the assessment of the physical condition.
The range of services offered by a pancreatic cancer specialist includes the following treatment methods:
- Resection (surgical removal) of pancreatic carcinoma in localized and small tumors
- Kausch-Whipple operation for the treatment of pancreatic cancer in the pancreas head, in which, in addition to the pancreas head, the duodenum, gall bladder with bile duct, lower part of the stomach (stomach outlet, pylorus) and lymph nodes are removed.
- Pancreas head resection (PPPD), which preserves the pylorus (gastric outlet), is similar to the Kausch-Whipple operation, in which parts of the stomach are not removed.
- Supportive chemotherapy after surgery (adjuvant chemotherapy)
- Chemotherapy before surgery (neoadjuvant chemotherapy)
- radiation (radiotherapy) of local tumors or metastases
- supportive radiochemotherapy (combination of radiation and chemotherapy)
- Systemic (whole-body) chemotherapy and treatment with targeted drugs for tumors that cannot be surgically removed
- So-called percutaneous transhepatic cholangiodrainage (PTCD; a kind of puncture with a hollow needle through the skin) to drain the bile to the outside.
- Endoscopically retrograde cholangiopancreaticography (ERCP; a special endoscopic procedure) with insertion of stents (tubes) or catheterization for the treatment of bile stasis
- Injection of substances to block the plexus coeliacus (nerve plexus) in case of severe pain
- Cutting the kidney nerves to treat pain
- Placement of stents in the duodenum to treat or prevent constriction of the duodenum; alternatively, the stomach and small intestine can be connected.
- Treatment with new drugs or methods within the framework of clinical studies
- after-care treatments
- Psycho-oncological care
Patients with pancreatic cancer should be treated in hospitals that have extensive experience with pancreatic cancer. The German Cancer Society certifies such oncological treatment centres as pancreatic carcinoma centres, which guarantees a high quality of care for patients with pancreatic cancer. These hospitals have so-called tumor conferences in which various pancreatic cancer experts work together, usually specialists from the fields of gastroenterology, oncology, radiotherapy, radiology, surgery and pathology. They develop individual treatment strategies for each patient, taking into account the diagnostic and therapeutic procedures recommended by guidelines.
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