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Pancreatic cancer - symptoms, causes and therapy

Pancreatic cancer - symptoms, causes and therapy


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Pancreatic carcinoma

A malignant tumor of the pancreas rarely occurs, but it is one of the most dangerous types of cancer and there is only a minimal chance of a cure. After the diagnosis of pancreatic cancer, those affected usually only have a few months left to live. The disease is only recognized early in exceptional cases, so that surgery can lead to an improved prognosis. As a rule, the therapy is limited to an improvement in the quality of life in the remaining lifetime. Living healthily and avoiding smoking and alcohol are the best measures to reduce your own risk of pancreatic cancer.

Note: This article focuses primarily on information about the most common form of cancer in the pancreas, exocrine pancreatic cancer.

Definition

Malignant tumors of the pancreas are known in the professional world as pancreatic carcinoma. In principle, the cancer can originate from all areas of the organ and from different cell types. However, the so-called head area is most frequently affected, where around seventy to seventy-five percent of all carcinomas develop.

Most of the cases are exocrine tumors, which in their name originate from the exocrine cells that produce and release digestive juices. Malignant changes in the small gland ducts are often the starting point for the disease. The most common form of cancer is adenocarcinoma. This cancer is diagnosed in up to ninety-five percent of all cancers in the pancreas. However, endocrine tumors are rarely found.

Taken as a whole, tumors of the pancreas are rather rare cancers, but they are the fourth most common cause of cancer death in Germany. According to current data from the Robert Koch Institute, just over 17,000 people contracted this type of cancer in 2014. Men and women are equally affected, with the disease mostly occurring in older age (over seventy years).

The death rate is only slightly below the number of people affected, which demonstrates the high aggressiveness of the disease and the difficulty in diagnosing and treating it. The survival rate after five years in Germany is around ten percent. This is the lowest expectation among all cancers. Better prognoses apply to the rare endocrine tumors. As with many other cancers, increasing numbers of people with pancreatic cancer are observed over time and continue to be expected.

Anatomy and function of the pancreas

The pancreas is located in the upper abdominal cavity, between the stomach, spleen, liver and duodenum, and is divided into three sections: head, body and tail. The gland consists of two different tissue parts, the exocrine and the endocrine tissue.

The exocrine (outgoing) area produces the pancreatic juice, which contains important digestive enzymes (e.g. amylase, lipase and proteases) and releases the glandular secretion to the duodenum. This ensures the breakdown of the carbohydrates, fats and proteins contained in the food in the intestine.

The endocrine part produces hormones in special cells of the so-called Langerhans islands (pancreatic islet cells), which regulate, for example, the carbohydrate metabolism via the blood sugar level. For this, the hormones insulin and glucagon are released directly into the blood. Other hormones also control digestion and growth processes.

With these important functions, the pancreas is a vital organ, the disease of which often has serious consequences. For example, if too little insulin is produced, diabetes mellitus develops in the long term. If the exocrine component is disturbed, the food consumed can no longer be digested accordingly and the body is no longer supplied with the necessary nutrients.

Symptoms

The great danger of pancreatic carcinoma assumes, among other things, that no symptoms appear for a long time in all forms and the disease is therefore discovered late. When the first symptoms appear, the tumor is often already relatively large and it is not uncommon for metastases to form in other parts of the body. Due to the position of the organ, abdominal and back pain are rare, non-specific complaints that occur early on, but are unspecific.

If there is already a shortage of digestive enzymes, if their drainage is difficult or if other organs are also affected, various symptoms can occur. By relocating the bile ducts, jaundice (jaundice) with accompanying itching, dark urine and lightly discolored stool can develop. If the size or position of the tumor limits the function of the pancreas, there may also be a feeling of pressure in the upper abdomen and indigestion, which can manifest itself through so-called fat stools, because the necessary enzymes for digesting fat are missing.

In addition, cancer generally results in loss of appetite and pathological weight loss. Nausea and vomiting can also occur.

If there is a lack of insulin production, new diabetes can also be an indication of pancreatic cancer.

Causes and risk factors

So far, there is no knowledge of the exact causes that cause the development of pancreatic cancer. However, there is sufficient knowledge about various factors that increase the risk of this cancer.

Smoking is considered the most important risk factor in this context. Up to a quarter of all pancreatic cancers are now associated with active or passive smoking. Furthermore, alcohol abuse (especially in combination with nicotine consumption), obesity (obesity) and diabetes are among the favorable factors.

If sufferers suffer from other pancreatic diseases, such as an inherited chronic pancreatitis, an increased susceptibility to cancer is also assumed. In addition, if close relatives of the first degree are already suffering from a pancreatic tumor, the likelihood of a further occurrence increases significantly (familial pancreatic carcinoma). However, the reasons for this are not yet known.

Furthermore, rare hereditary diseases or pre-existing diseases such as Peutz-Jeghers syndrome (rare polyp disease) can be associated with an increased likelihood of pancreatic cancer.

So far it has not been scientifically proven whether diet has an impact on the development of pancreatic cancer. It is believed that eating smoked or grilled food frequently increases the risk of cancer. The excessive intake of protein-rich and fatty foods is also one of the suspected nutritional risk factors.

In addition, as with other cancers, it has not yet been clearly clarified which environmental factors have harmful effects. Contact with a number of pollutants such as certain solvents, pesticides, herbicides, nickel or chromium could represent a further risk factor for pancreatic cancer.

Diagnosis

For all types of cancer and especially for pancreatic carcinomas, the earlier the disease is discovered, the greater the chances of a cure. So, especially if the above symptoms occur, an exact medical examination is absolutely advisable. This always includes a medical history and a general physical examination. Unfortunately, there are still no special examination methods that can detect cancer in the pancreas at an early stage. Therefore, a lot of current research aims to detect and treat pancreatic cancer earlier. If there is initial suspicion, targeted examinations are usually carried out.

Blood tests can give first indications of organ functions and by determining tumor markers, cancer can also be indicated under certain circumstances. These markers are substances produced by tumors, but are not always found in those affected or are sometimes also found in healthy people. Therefore, further examinations are still necessary for a reliable diagnosis.

Above all, the organs in the abdomen are examined from the outside using ultrasound and checked for visible growths. Under certain circumstances, an endoscopic ultrasound method (endosonography) can also be used, in which a small ultrasound head is pushed through an endoscope through the mouth into the stomach and duodenum. Since the pancreas is directly adjacent here, even small changes can be better recognized and assessed. During this procedure, a tissue sample can be taken for further histological examinations.

A mirroring of the pancreas and bile duct, the so-called endoscopic retrograde cholangio-pancreatography (ERCP), is very similar to this procedure. With the help of the introduced endoscope, the pancreas and bile duct systems (mouths) can be displayed particularly well. Possible occlusions can also be removed using a stent and secretions from the bile and pancreas can be removed for further analysis.

If abnormalities have been identified, more precise information about the location and size of the tumor can be obtained using computer or magnetic resonance imaging and the other organ structures and positions as well as possible metastases can be mapped. This provides important information for subsequent therapy options. Another imaging technique that can provide additional information about particularly active (cancer) cells is so-called positron emission tomography (PET).

In the overall view, cancer and the stage can then be reliably determined. If metastases have been identified in other organs, additional examinations are usually necessary.

Treatment

The exact examination results and the associated prognoses provide important decision criteria for an appropriate therapy. In principle, the options consist of surgery and chemotherapy. Further measures have not yet been developed sufficiently or are limited to palliative medicine treatments in order to alleviate the symptoms in the remaining life as best as possible. Often there is little chance of a cure or the tumor cannot be surgically removed for various reasons.

Surgery

Surgery is usually only considered at an early stage and is rarely performed due to the lack of early detection. However, if there is a surgical intervention on the head of the pancreas, this is a rather complicated and comprehensive surgical method, which experts also refer to as a Whipple operation. With the aim of removing the carcinoma, parts of the pancreas, duodenum, stomach and gallbladder with the bile ducts are usually also removed. An attempt is made to preserve as much of the organs as possible so that the digestive system can be restored in a further step. In severe cases, however, entire organs must also be removed, such as the pancreas (total pancreatectomy).

Surgery on the tail section is usually less complicated and less serious since, in addition to partial resection of the pancreas, often only the spleen has to be removed.

Due to the extensive surgery, disease-like symptoms can occur after the operation. If insulin is absent, diabetes can develop. If enzymes are missing, digestive problems can arise. This may require permanent medication. If entire organs have been removed, this can have further consequences for those affected.

It is important to look after a special diet afterwards, whereby a high-quality food with a high proportion of fruits and vegetables with many vitamins and minerals is most important. Furthermore, attention should be paid to a low-fat diet or to the consumption of special fats, so-called MCT fats, which can be absorbed particularly well by the small intestine. Other recommendations include eating several small meals a day compared to the usual three large meals. If necessary, those affected must receive insulin after individual adjustment.

Chemotherapy

As a rule, every surgery is followed by safety and due to the high probability of (still undiscovered) metastases, chemotherapy. The cancer cells are to be killed and prevented from further growth by means of certain cytostatics. Due to the toxic effects of the medication (not only against the tumor cells), there are often undesirable side effects. Hair loss, changes in taste, nausea and vomiting are typical.

Sometimes such therapy is used before surgery to reduce the size of the tumor and make it operable. Chemotherapy is mainly used when many organs are affected by metastases. The cell poison is transported to all parts of the body via the bloodstream in order to stop and suppress the disease. A complete cure is usually not to be expected without surgery.

Radiotherapy

The option of radiotherapy for pancreatic cancer is very rare and only available in clinical studies. The tumor cells should also be killed in the best case and there should be a complete cure. Sometimes radiation therapy can also be used to relieve symptoms.

Relief of pain and other ailments

This form of treatment is of greatest importance if the cancer is considered incurable. Symptoms and complications that arise then become the focus of treatment in order to maintain the quality of life for those affected as long as possible. For example, narrow bile ducts, which no longer allow digestive juices to flow unhindered, are often expanded or drained again. Nutritional systems via the intestine or veins may also be used.

Pain therapy also deserves special attention. Effective pain relievers can be administered in various forms. The first step is to combat the complaints with non-opioid agents. If this is not successful, opioids of different strengths are also used.

Holistic medicine: prevention and treatment supplement

Natural healing methods that help those affected in addition to conventional therapy can be summarized in a general way under a healthy lifestyle. Sufficient and not stressful exercise and a healthy diet play an important role. As with most types of cancer, the well-tried rule from naturopathy is a useful preventive measure: eat lots of fruits and vegetables.

If you want to reduce your own risk of pancreatic cancer, smoking and alcohol as well as a normal body weight are advisable. It is also important to be in good mental health. The latter can be supported through individual psychotherapeutic treatment or with self-help groups. (tf, cs)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. rer. nat. Corinna Schultheis

Swell:

  • Pschyrembel: Clinical dictionary. 267th, revised edition, De Gruyter, 2017
  • Herold, Gerd and co-workers: internal medicine. Self-published by Gerd Herold, 2019
  • Robert Koch Institute (ed.): Cancer in Germany for 2013/2014, 11th edition (2017), krebsdaten.de
  • dkg-web (ed.): ONKO internet portal - basic information on pancreatic cancer (access: July 31, 2019), krebsgesellschaft.de
  • German Cancer Aid Foundation (ed.): The Blue Guide - Cancer of the Pancreas. Stand as of 2/2018, krebshilfe.de
  • German Cancer Research Center (ed.): Cancer Information Service: Cancer Types - Pancreatic Cancer (accessed: July 24, 2019), krebsinformationsdienst.de

ICD codes for this disease: C25ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


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