Brief overview
- Symptoms: No symptoms for a long time; later, upper abdominal pain, back pain, weight loss, loss of appetite, jaundice, diabetes mellitus, nausea and vomiting, digestive disorders, fatty stools, etc.
- Course of disease and prognosis: Cure only possible as long as tumor is localized; usually unfavorable prognosis because tumor is often discovered late and grows aggressively
- Examinations: Blood tests, abdominal ultrasound, endoscopic ultrasound, CT, MRI, magnetic resonance cholangiopancreaticography (MRCP), removal and analysis of a tissue sample, laparoscopy.
- Treatment: surgery, chemotherapy if necessary, radiotherapy (only in certain cases), pain therapy
- Prevention: there are no specific measures or prevention programs; however, it is advisable to avoid risk factors
What is pancreatic cancer?
- The largest part is formed by the exocrine tissue. It produces a digestive juice containing enzymes, which is directed into the small intestine and is essential to break down and digest the ingested food.
Both functions of the pancreas are vital for the human organism. If one of them fails, for example due to a tumor or due to another disease, this is life-threatening for the affected person.
Most often, pancreatic cancer develops in the head part of the pancreas.
How common is pancreatic cancer?
Pancreatic cancer is a relatively rare disease. Nevertheless, it is the third most common tumor of the gastrointestinal tract after stomach and colon cancer. The risk of disease is slightly higher for men than for women. The average age of onset is about 72 years for men and 76 years for women.
What are the symptoms of pancreatic cancer?
As soon as symptoms appear, pancreatic cancer is often already so advanced that the tumor presses on neighboring structures such as the bile duct, stomach and small intestine or grows into them. It is not uncommon for metastases to be present. The following symptoms often occur at this advanced stage of pancreatic cancer:
- loss of appetite
- unwanted weight loss: if, due to pancreatic cancer, the exocrine tissue produces too few or no more digestive enzymes, the organism breaks down nutrients in the intestine only to a limited extent or not at all. The impaired nutrient supply leads to weight loss.
- Nausea, vomiting, diarrhea and flatulence.
- Jaundice (icterus): Cancer in the pancreatic head presses on or obstructs the bile duct in some cases. Bile then backs up, causing jaundice: skin, mucous membranes and the white sclera in the eye turn yellowish. The urine is dark, the stool light-colored. In some patients, jaundice occurs as an early symptom of pancreatic cancer.
- Cough and shortness of breath in metastases to lungs or pleura
- Bone pain in skeletal metastases
- Neurological symptoms in case of metastases in the central nervous system
The symptoms of pancreatic cancer are similar to those of pancreatitis. Sometimes the two conditions occur together. This makes the diagnosis more difficult.
More rarely, small blood clots form in pancreatic cancer due to pressure on surrounding vessels. These may block the affected vessel (thrombosis). This often happens in the splenic vein, for example, which runs close to the pancreas.
If the pancreatic cancer spreads to the peritoneum (peritoneal carcinomatosis), the cancer cells secrete fluid into the abdominal cavity – “abdominal dropsy” (ascites) develops. Possible signs are a bulging or enlarged abdomen, unwanted weight gain and digestive problems.
What is the life expectancy with pancreatic cancer?
The much rarer endocrine forms of pancreatic cancer, on the other hand, usually grow more slowly and less aggressively. Their prognosis is therefore often more favorable, and those affected often survive for several years even if diagnosed late.
Overall, pancreatic cancer has one of the lowest survival rates of all cancers. Almost as many people die of pancreatic cancer each year as are newly diagnosed with it. Five years after diagnosis, only about ten percent of those affected have not yet died from the pancreatic tumor.
The reason for this is the usually late diagnosis and the aggressive growth, which causes metastases to form early on. As a result, curative surgery is rarely possible.
The causes of pancreatic cancer have not yet been fully researched. However, smoking and high alcohol consumption are regarded as reliable risk factors: According to experts, the so-called cotinine level is elevated in heavy smokers. This substance is produced when nicotine is broken down in the body and is considered carcinogenic. Regular alcohol consumption often inflames the pancreas – and chronic inflammation makes the glandular tissue more susceptible to pancreatic cancer.
Certain diseases are further established risk factors. For example, women with hereditary breast cancer or ovarian cancer and their relatives have an increased risk of pancreatic cancer.
Is pancreatic cancer hereditary?
Examinations and diagnosis
If pancreatic cancer is suspected, the physician will first conduct a detailed interview with the patient to obtain his or her medical history (anamnesis). Among other things, the doctor will ask for a detailed description of all symptoms, any previous illnesses and any known pancreatic cancer in the family.
Physical examination: The physician palpates the abdomen, for example, to detect swelling or hardening in the abdominal cavity.
Abdominal ultrasound: Using ultrasound, the physician assesses the size and condition of the pancreas as well as other abdominal organs (liver, gall bladder, stomach, small intestine, etc.) and the surrounding lymph nodes and examines them for metastases. However, small tumors less than one centimeter in diameter cannot be detected. Ultrasound examination is usually the first imaging examination when pancreatic cancer is suspected.
Tissue sample: The physician usually takes tissue samples from suspicious areas during endosonography. Alternatively, he inserts a hollow needle directly into the pancreas through the abdominal wall.
Computed tomography (CT): This special X-ray examination produces detailed cross-sectional images of the pancreas and other structures. This makes it possible to assess the exact location and size of the tumor and to detect any metastases (for example, in lymph nodes or the liver).
Magnetic resonance cholangiopancreaticography (MRI) is particularly informative with regard to a pancreatic cancer diagnosis: This MRI examination specifically visualizes the ductal systems of the pancreas and bile in detail. Most pancreatic cancers develop from the cells lining excretory ducts of the exocrine gland tissue (called adenocarcinomas).
Positron emission tomography (PET): In PET, the patient first receives a radioactively labeled substance. This accumulates in the tumor tissue due to the high metabolic activity. This allows the tumor tissue to be easily distinguished from the surrounding healthy tissue during tomography.
Chest X-ray: The X-ray images can detect any daughter tumors (metastases) in the lungs.
Skeletal scintigraphy: This examination is used to detect bone metastases. The patient is given a short-acting radioactive substance that accumulates specifically in bone metastases. The tumor sites can then be visualized with a special camera.
Pancreatic carcinoma: stages
- Stage 1: The tumor is confined to the pancreas.
- Stage 2: The tumor reaches a size of more than four centimeters in diameter; alternatively, if the tumor size is smaller, lymph nodes are already involved.
- Stage 3: The surrounding lymph nodes are increasingly affected, and the tumor may already be growing into larger blood vessels in its vicinity.
- Stage 4: Metastases have also formed in other organs (such as lung or liver metastases).
If pancreatic cancer is discovered at an early stage, the doctor will try to cure it as completely as possible.However, pancreatic cancer is usually discovered very late. A cure is then usually no longer possible. In this case, treatment serves to alleviate the symptoms of those affected and to slow down or stop further spread of the tumor (palliative therapy).
Surgical therapy
Surgery is only considered in ten to 20 percent of patients with pancreatic cancer. The operation is only really effective if the surrounding tissue is still cancer-free. If the tumor can be completely removed during surgery, a cure may be possible.
In the case of pancreatic cancer in the tail of the pancreas, the doctor often has to remove the spleen as well. In some cases of pancreatic cancer, it is not enough to cut out the diseased tissue from the pancreas – the doctor must remove the entire pancreas.
During the operation, the surgeon also removes at least ten to twelve of the neighboring lymph nodes. If they are not affected by cancer cells, there is a possibility that the tumor has not yet spread.
Chemotherapy
As a rule, pancreatic cancer surgery is followed by chemotherapy (adjuvant chemotherapy). The patient is given special drugs (cytostatics) that prevent the cancer cells from multiplying.
Sometimes chemotherapy is required even before surgery. This neoadjuvant chemotherapy is designed to shrink the tumor so that it can be removed more easily. If the tumor is already advanced and surgery is no longer an option, palliative chemotherapy for pancreatic cancer is the treatment of choice. The goal is to prolong survival and improve quality of life.
Radiotherapy
Experts do not generally recommend radiation therapy (radiotherapy) for pancreatic cancer. However, it is possible within the framework of controlled studies. It is usually used in combination with chemotherapy (radiochemotherapy) in patients with locally advanced pancreatic cancer for whom surgery does not promise success.
In the case of pancreatic cancer that can no longer be cured, doctors also use radiation to specifically alleviate symptoms such as tumor pain.
Other therapy concepts
The option of using newer therapeutic approaches such as targeted therapies and immunotherapies is usually only available for pancreatic cancer in the context of clinical trials. There is not yet sufficient data on the efficacy and benefit of these treatment approaches in pancreatic cancer.
Pain therapy
Many people with pancreatic cancer suffer from severe pain in the abdomen. These are treated by means of pain therapy according to the World Health Organization (WHO) step-by-step scheme:
For some patients with incurable pancreatic cancer, pain therapy with medication does not help sufficiently. In such cases, the doctor may try blocking a nerve plexus in the abdomen, the so-called coeliac plexus. This stops the pain stimuli from being transmitted to the brain.
Other measures
This can often be achieved with individually adapted pain therapy (as described above). If necessary, other palliative measures are added. If, for example, the tumor narrows or closes the bile duct, those affected suffer from jaundice. In this case, endoscopic surgery is helpful: the doctor inserts a small plastic tube (stent) into the bile duct to keep it open.
In addition to physicians, physiotherapists, masseurs, social workers, psychologists and chaplains support the palliative treatment of those affected by pancreatic cancer.
Diet for pancreatic cancer
Pancreatic cancer often disrupts the function of the pancreas. This is true even after surgery in which surgeons have removed the pancreas or parts of it. The pancreas makes important digestive enzymes. It also controls blood sugar balance with hormones such as insulin.
Nutrition in pancreatic head carcinoma
In case of cancer of the pancreas or after its operation, it is advisable to adjust the diet. Dietary tips for pancreatic cancer are:
- Do not eat large meals: Rather eat several times throughout the day (five to eight times) and in smaller amounts.
- No high-fat meals: Also, use special fats when cooking, so-called MCT fats (= medium-chain triglycerides). You can find these in a health food store, for example.
- Chew extensively: This ensures that sufficient saliva is mixed with the food. This contains substances that have a similar effect to the enzymes of the pancreas.
- Drink properly: Drink mainly water, tea or vegetable juices. It is best to leave alcohol completely aside in the case of pancreatic cancer. It puts a lot of strain on the organ.
As a general rule, eat what you tolerate best. To find this out, it helps to keep a food diary.
Diet in pancreatic cancer
This is because, in addition to injecting insulin, those affected must now also learn to recognize the signs of hypoglycemia, for example. Symptoms include, for example:
- tremor
- ravenous appetite
- Sweating
- Palpitations
- Circulatory problems
- fatigue
- confusion
- fainting, coma
Affected individuals should always carry dextrose or special sugar solutions in case of emergency. Also inform those around you so that in an emergency they know what is going on and are able to help accordingly.
If the cancer has destroyed large parts of the pancreas or doctors have removed the organ completely, both important digestive proteins and hormones are missing. Those affected are then also given drugs with enzymes and inject themselves with insulin from then on. Here, too, the treating physicians and nutritionists are the most important contacts.
Prevention
Studies have shown that a diet rich in fruits and vegetables with a high fiber content and many vitamins reduces the risk of disease. This applies not only to pancreatic cancer, but also to most other cancers. However, there are no specific dietary recommendations that reduce the risk of pancreatic cancer in particular.