Forecast | Pancreatic cancer

Forecast

The prognosis is very poor. Due to the late diagnosis (the tumours are then usually already several centimetres in size) only 10 to 15% are operable. Only a few patients survive longer than 5 years. Pancreatic cancer responds poorly to chemotherapy. Therefore, with a comparatively low incidence of the disease (about 3% of all cancers), mortality is high: among cancer deaths, this tumour is the fifth most common.

Chances of survival

In principle, it can unfortunately be said that the chances of survival of pancreatic cancer are extremely poor, regardless of type and spread. The reason for this is on the one hand the anatomical location of the pancreas, which allows tumour growth in almost all upper abdominal organs, and on the other hand the often very late diagnosis. Symptoms only develop in an advanced stage and a preventive examination for pancreatic cancer is not standard in Germany.

This is why the disease is only detected at a late stage. The method of choice for the diagnosis of pancreatic cancer is ultrasound of the upper abdomen and, if suspected, a biopsy (tissue sample) with pathological findings. The only curative therapy for pancreatic cancer is surgical removal.

However, this can only be carried out completely if the tumour has only spread slightly. Overall, only about 20% of tumours are completely resectable. Even after such an operation, the probability of the patient surviving another 5 years is only about 10%.

For the remaining patients with non-operable pancreatic cancer, this probability is less than 1%. Often they die after about 10 months as a result of their cancer. This number varies slightly between patients depending on their overall well-being and response to chemo- and radiotherapy. Overall, pancreatic cancer is one of the cancers with the worst prognosis.

Final stage

Due to the usually very late diagnosis, the disease often progresses rapidly with or without treatment. Although there are possibilities to limit the progress of the tumour growth, there is usually no cure. At first, an attempt is made to restore the drainage of bile acids.

This is usually achieved by placing a stent in the pancreatic duct. It is also possible to remove the part of the pancreas affected by the tumour, sometimes with very time-consuming surgery. A chemotherapeutic measure can also be used.

There are essentially three different therapeutic options available for the treatment of pancreatic cancer: Treatment can be carried out using only one option or a combination of both. The choice of therapy depends on many different factors. These include, for example, the age and sex of the patient, but also the operability of the tumour and the progress of the disease.

The final therapy of the tumour is often determined by doctors from different disciplines in the course of a so-called tumour conference. Internists, surgeons, pathologists, anaesthetists etc. are involved.

The treatment of choice for pancreatic cancer is surgery. It is the only curative option to remove the tumour completely. The extent of the tumour should be determined in advance using various imaging techniques (e.g. MRI, ultrasound, etc.).

In addition, lymph node infestation and possible distant metastases should be clarified by the doctor. All this is important to be able to assess the operability of the cancer. In principle, the following applies to all tumour diseases: the smaller the spread, the better the chances of treatment.

But what happens during such an operation? The type of operation depends on the location of the tumour. If it is located in the tail of the pancreas, either only this part is removed or, if its extent is unclear, the entire gland is removed.

As a rule, the spleen must also be removed. The aim of the operation is to remove the tumour as completely as possible. To do this, it is also necessary to cut out part of the surrounding healthy tissue.

In this way, the surgeon tries to prevent individual cancer cells that may have detached from the tumour from resecting as well. Often the tumour border is examined immediately after the removal on the light microscope to determine whether the resection border is tumour-free. In this case one speaks of a R0 resection.

However, much more often the pancreatic cancer is located in the area of the head of the organ. This lies directly adjacent to the duodenum and stomach. In this case, the so-called Whipple’s operation is used, which is considerably more complicated than pancreas tail resection.

In the Whipple procedure, in addition to the pancreas head or the entire pancreas, duodenum, bile duct with gallbladder, surrounding lymph nodes and parts of the stomach are also removed. This is necessary because the pancreas is located close to these organs and therefore there is a risk of tumour spread. It is hoped that this extensive procedure will result in the complete removal of all tumour cells.

Since the connection between the stomach and the small intestine is missing after the removal of the duodenum, the digestive tract must be reconstructed surgically. For this purpose, a loop of the small intestine is sutured to the stomach and, depending on the extent of the resection, the pancreatic outlet and bile duct system are reconnected. This ensures that the patient’s digestion functions to a certain extent after the operation.

Patients often find it difficult to digest after a Whipple operation. As a result, a diet should be followed and the portion size reduced. If the pancreas is removed completely, hormones such as insulin must also be replaced with medication.

If it is not possible to remove the entire tumour during the operation, its size must be reduced either before or after the operation by means of radiation and chemotherapy. In this case one speaks of a neo- or adjuvant therapy. A second major branch of pancreatic cancer therapy besides surgery is chemotherapy.

Chemotherapy is the treatment of a tumour with drugs that inhibit the growth of cells. These drugs are called cytostatic drugs. They work particularly well on cells that grow strongly and divide quickly.

These criteria are met not only by tumour cells but also by healthy cells such as hair root cells or the cells of the haematopoietic bone marrow. This results in the generally known side effects of chemotherapy (hair loss, paleness, bleeding tendency, nausea, etc.). However, it should be noted that pancreatic cancer can never be cured by chemotherapy alone.

This always requires an operation. A few examples of cytostatic drugs used to treat pancreatic cancer are capecetabine and erlotinib. Chemotherapy often consists of a cocktail of different cytostatic drugs with different mechanisms of action.

It is hoped that a lower dosage of individual drugs will lead to fewer side effects. The last major curative therapy option is radiotherapy. This is often done before or after surgery in combination with chemotherapy.

Radiotherapy is a targeted attempt to destroy cancer cells with the help of radioactive radiation. Thanks to modern technology, the radiation dose can be concentrated almost exclusively on the tumour tissue so that as little healthy tissue as possible is damaged. As with chemotherapy, radiation therapy alone cannot cure pancreatic cancer.

This is still not possible without surgery. If the tumour cannot be cured, palliative medical treatment must be used. Palliative measures are therapies that do not cure the tumour but keep its effects as small as possible.

The aim of palliative medicine is to make the patient’s remaining life as comfortable as possible. Pain therapy is in the foreground here. For most patients, tumor pain is the greatest impairment.

Treatment is carried out with common oral painkillers such as paracetamol, but in more severe cases also intravenously, for example with morphine. In addition to pain relief, the company also tries to treat the classic symptoms of pancreatic cancer. For example, icterus, which is caused by a blockage of the bile duct due to strong tumor growth, can be treated minimally invasively with a stent. In cases of severe nausea and vomiting, the option of a gastric tube must be considered. – Surgery

  • Radiotherapy
  • Chemotherapy