Pancreatic Cancer (Carcinoma of the Pancreas)

What is Pancreatic Cancer?

Pancreatic cancer is a malignant new formation of the pancreas. The most common form is the “ductal adenocarcinoma," rarer types include squamous cell carcinoma, cystadenocarcinoma, or acinar cell carcinoma.

Adenocarcinoma affects 10-15 out of 100,000 people in the western world every year, which puts it in 4th place among deaths causing cancer. After colorectal cancer and stomach cancer, pancreatic cancer is the third most common tumor in the digestive tract.

Men are affected three times as often as women. Pancreatic cancer is more likely a tumor disease of old age, with the peak age being in the 70s. Pancreatic carcinoma is more common in smokers, people with high alcohol consumption, and people who are very overweight.

The Function of the Pancreas

The pancreas is a gland in the abdominal cavity that has two main functions. Firstly, it produces digestive juices that are released into the duodenum with the bile and serve to break down the food pulp. The pancreas also regulates the blood sugar level very precisely via hormones (insulin, glucagon, etc.).

If it comes to dysfunctions, the patient will develop conditions such as diabetes mellitus. The pancreas lies transversely in the upper abdomen and is divided into the pancreatic head, which is traversed by the bile ducts, the pancreatic body, and the pancreatic tail. Most tumors grow in the pancreatic head.

Symptoms of Pancreatic Cancer

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

Mostly the patients complain about:

• Loss of appetite
• Dull stomach pain
• Weight loss
• Loss of power.

The leading symptom of pancreatic head cancer (70% of the tumors are located in the pancreatic head) is painless jaundice, which means the painless yellowing of the skin, which is a sign of bile duct obstruction with bile congestion. In addition to the yellow coloring of the skin and the sclera ("white of the eye"), the stool is discolored, and the urine turns dark because the bilirubin, which is usually mainly excreted via the bile, is discharged from the body in other ways. When the congested gallbladder is felt through the abdominal wall, this is called the "Courvoisier sign."

Non-specific symptoms such as the new appearing 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 discovered at an advanced stage, so the survival prognosis for pancreatic cancer is very poor.

Diagnosis: How Is Pancreatic Cancer Detected?

If there are suspected symptoms, an ultrasound examination is usually carried out first. In some cases, the tumor can be detected directly, but above all, the bile flow and any liver metastases can be visualized. Other diagnostic methods include endosonography, endoscopic retrograde cholangiopancreatography, and computed tomography with contrast agent.

Endosonography and Endoscopic Retrograde Cholangiopancreatography

With the help of endosonography (ultrasound "from inside"), the size of the tumor and also the involvement of neighboring lymph nodes can be made comprehensible. With the help of an additional ERCP (endoscopic retrograde cholangiopancreaticography), the bile ducts and the pancreatic ducts can be examined from the inside, and the bile congestion is visualized again. In this invasive procedure, a catheter can also be inserted to keep the bile ducts open and relieve the bile congestion.

Computed Tomography with Contrast Agent

The final most important examination is computed tomography (CT) with a contrast agent, as this is the best way to determine the size and extent of tumors, metastases, and enlarged lymph nodes. Based on the CT, it is possible to evaluate whether the tumor can be surgically removed, which is possible because the vessels affected by the tumor must be considered. If the tumor has already overgrown too large vessels, complete tumor resection is no longer possible without massive collateral damage.

Therapy: How Is Pancreatic Cancer Treated?

Surgery with a curative approach is only possible in 20% of patients, as the tumor stage is usually very advanced at the time of diagnosis. Surgical therapy must always be integrated into interdisciplinary oncological collaboration.

Especially the postoperative (adjuvant) chemotherapy is of utmost importance in the therapeutic approaches. Depending on the tumor location, there are various surgical techniques for tumor removal with additional removal of other organs, such as the spleen or parts of the duodenum. The aim of surgery is always the complete removal of the malignant tumor tissue with the necessary safety distance.

In general, it is also possible to carry out this tumor surgery laparoscopically (minimal invasive), which is associated with faster recovery, less pain, and smaller abdominal incisions (and thus scars).

Method for Tumor Reduction – HIFU in Pancreatic Cancer

A state-of-the-art procedure for tumor reduction is HIFU therapy (high-intensity focused ultrasound). In this treatment approach, the tumor is treated with ultrasound from outside using high-energy ultrasound waves, which causes the tumor cells to heat up so much that they "boil" and the tumor reduced. This procedure is still in its early stages, but numerous studies have already shown that HIFU therapy is a successful therapy approach for tumor reduction with only minor side effects.

Healing Chances for Pancreatic Cancer

Pancreatic carcinoma is a malignant new formation with an extremely poor prognosis, as it is usually only diagnosed at a very advanced stage of the disease. The only chance of recovery is with radical surgical removal in combination with chemotherapy. But even with this radical therapy, only 25-30% of patients are still alive after five years.

Which Doctors and Clinics Are Specialists in Pancreatic Cancer?

Anyone who has pancreatic cancer wants the best medical care. Therefore, the patient is wondering where to find the best clinic for pancreatic cancer.

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

Pancreatic cancer specialists are clinics and doctors who specialize in the diagnosis and treatment of cancers of the digestive organs. OnkoZert can certify them as a visceral oncology center.

Sources:

• Innere Medizin, Gerd Herold und Mitarbeiter, 2014
• Chirurgie, Siewert/Stein, 9. Auflage, Springer Verlag
• www.krebsinformationsdienst.de/tumorarten/bauchspeicheldruesenkrebs/bauchspeicheldruesenkrebs2.php