A pancreatic tumor can be benign or malignant, with the majority of all diagnosed pancreatic tumors being malignant. While benign tumors can be removed with relative ease, malignant tumors, or pancreatic carcinomas, are known for their tremendous aggressiveness.
What is a pancreatic tumor?
Under a pancreatic tumor, the medical profession refers to tumors that have formed in the pancreas – pancreas. The majority of the tumors that develop are malignant; subsequently, the tumor affects the area of the pancreas that produces digestive enzymes. The ducts, which are located within the organ, are predominantly affected.
Causes
The pancreatic cells responsible for producing digestive juice begin to grow uncontrollably. Subsequently, a pancreatic tumor develops. Although there are benign and malignant tumors, malignant tumors (pancreatic carcinoma) occur more frequently. Malignant tumors are extremely aggressive and grow and multiply incredibly fast. A characteristic feature is the formation of metastases, which subsequently also affect other organs (such as the lungs or liver). Even though the development of a pancreatic tumor is known, doctors have not yet found an exact cause for which the growth of pancreatic cells degenerates and a pancreatic tumor forms. However, sometimes it is genetic changes that cause healthy pancreatic cells to turn into tumor cells.
Symptoms, complaints, and signs
A characteristic feature of pancreatic tumor is increasing icterus (jaundice); although this usually occurs only in the advanced stages of the disease, it is considered a classic leading symptom of tumor disease. Patients also complain of abdominal pain, which subsequently radiates to the back. Pain, which is described as dull and occurs mainly during the night, is also typical of pancreatic tumors. A bulging gallbladder (so-called Courvoisier sign) is also a sign that a pancreatic tumor has formed. Since the pancreatic tumor blocks the internal ducts of the pancreas, the glands are subsequently impaired in their function. As a result, patients also suffer from digestive problems; rapid weight loss is the consequence. Diabetes sometimes occurs in about ten percent of all cases. Altered skin pigmentation and thrombosis can also be the first signs of a pancreatic tumor. In the advanced stage, liver enlargement and also liver dysfunction are possible; severe emaciation and abdominal dropsy occur in the final stage.
Diagnosis and course of the disease
At the beginning, the physician performs an ultrasound examination. By means of ultrasound, it is possible that any other diseases can be excluded in advance, which can also cause abdominal pain or jaundice. With the help of magnetic resonance imaging or computer tomography, the physician can detect any tumors that may have formed in the pancreas. In a few cases, a gastroscopy and x-ray imaging of the internal ducts of the pancreas may also be necessary to make a definite diagnosis. Due to improved surgical techniques, a better cure rate can be said today. While benign tumors can be removed easily and without complications, malignant tumors in particular are extremely difficult to treat. Pancreatic carcinoma, for example, has the worst prognosis of all known carcinomas. The five-year survival rate is no more than 30 percent, and only 20 percent of all tumors can be surgically removed after the physician has made the diagnosis. In about 80 percent of all cases, the tumor returns – within 24 months; only in very few cases is a second operation possible.
Complications
There is an increased risk of complications with a pancreatic tumor, and this is especially true for malignant tumors. Because the tumor is usually located anatomically near the bile drain, it can cause bile to back up and extend to the gallbladder. As a result, there is a risk of gallbladder inflammation (cholecystitis). It is also possible for an abscess to develop in the liver. If cholecystitis spreads throughout the body, it can develop into life-threatening blood poisoning (sepsis).Without prompt medical treatment, this often results in the patient’s death. Sometimes a pancreatic tumor triggers a blockage of the intestine. The intestinal blockage can in turn lead to impaired metabolism or constipation. In addition, because the blood supply is reduced, there is a risk that the affected section of the intestine will become inflamed and die. A malignant pancreatic tumor often leads to metabolic disorders. For example, it can no longer produce sufficient hormones and enzymes. The development of diabetes mellitus is also possible in the further course of the cancer. Complications can also arise with the help of surgical treatment of the pancreatic tumor. Thus, the various interventions are considered serious and extensive. Conceivable sequelae are injuries to adjacent organs and body structures. These include, above all, blood vessels such as the main artery (aorta) or nerves. It is not uncommon for more severe bleeding or secondary hemorrhage to be evident.
When should you see a doctor?
Recurrent gastrointestinal symptoms, loss of weight and appetite, and signs of type 2 diabetes mellitus suggest a pancreatic tumor. A physician should be consulted if these complaints occur without a clear cause. If other unusual symptoms and complaints occur, it is best to consult the family doctor or a gastroenterologist. A pancreatic tumor manifests itself through aggressive growth and rapid metastasis, which is why early diagnosis may be life-saving. Smokers, alcoholics and people who are overweight are particularly likely to develop a pancreatic tumor. Likewise, diabetes patients as well as people with a family history of the disease belong to the risk groups. If these factors apply or an unhealthy lifestyle with little exercise and a one-sided diet is generally led, the symptoms described should definitely be clarified by a doctor. The family doctor, an oncologist or a gastroenterologist are responsible. During treatment, nutritionists, physiotherapists and psychologists are also consulted. Therapy always takes place under the supervision of a specialist, who must be informed of all unusual symptoms, side effects and events related to the disease. Because there is a high risk of recurrence, the patient must attend cancer screening at regular intervals after therapy.
Treatment and therapy
Four out of five carcinomas can no longer be treated surgically once the physician makes the diagnosis, since patients are already in an advanced stage. Even then, if only isolated metastases have been diagnosed in the liver, surgery will not result in a cure. However, if the tumor has not caused distant metastases or infiltrated major arteries, complete removal of the tumor is possible. However, if there is infiltration of the veins, surgery is also rendered impossible. During the operation, the physician also removes the lymph nodes – even if these are not affected. Even though this option is controversial, more and more doctors decide to remove the still healthy lymph nodes. During the surgical procedure, the physician does not attempt to remove the entire organ, so that a connection with the intestine is still possible. Depending on the location, the physician decides on a right-sided (duodenopancreatectomy), left-sided (pancreatic tail resection) or middle partial pancreatic resection. In left-sided partial resection, the spleen is also removed in almost all cases. Sometimes a total resection – the complete removal of the pancreas – may be the patient’s last chance for recovery. Then the bile duct and stomach are connected to the intestine. For this purpose, elevated loops of small intestine are used, which are “connected” to the stomach without tension. However, if the tumor is incurable, the physician opts for chemotherapy. In addition, chemotherapy may also be considered useful after surgery or even before surgery (if the tumor is too large and should be reduced in size).
Outlook and prognosis
Pancreatic tumor is among the most insidious cancers. According to the Robert Koch Institute Cancer Registry, the survival rate of male patients after 5 years is 6.4 percent. For women, it is 7.6 percent.Thus, pancreatic cancer has the lowest of all cancer survival rates. However, the prognosis of the disease depends to a large extent on the timing of diagnosis and subsequent treatment. The sooner the pancreatic tumor is treated appropriately, the more favorable the effect on the course of the disease. The type of tumor also plays a significant role. Surgical removal of the pancreatic tumor is possible in only 15 to 20 percent of all patients, which also has a negative effect on the further course of the disease. The 5-year survival rate for those who have undergone surgery is between 22 and 37 percent. The prognosis is particularly poor if the tumor is already in an advanced stage. The 5-year survival rate is only 0.2 to 0.4 percent. The situation is better for cystadenocarcinoma, which, however, only occurs rarely. This special form of pancreatic tumor is localized for a long time and is less aggressive. For this reason, its prognosis is more favorable. Endocrine carcinomas also usually have a better prognosis. In addition, a pancreatic tumor may recur. Likewise, metastasis is possible.
Prevention
Since no causes are yet known for what reason pancreatic cells degenerate and mutate into cancer cells, it is also not yet known what preventive measures could stop or prevent any tumor formation.
Follow-up
Tumor diseases require follow-up care. Many tumors form again after successful therapy. Doctors counter this life-threatening danger by closely monitoring the progress of the disease. The situation is no different with pancreatic tumors. In most cases, doctors and patients discuss follow-up care before the end of the initial therapy. It should be noted that a cure is not always possible. Sometimes doctors do not treat a pancreatic tumor because it is already too advanced at the time of diagnosis. In this case, aftercare has only a palliative function. Affected patients receive medical support in order to live without pain in the remaining time. Traditional aftercare takes place at least quarterly in the first and second year after the end of treatment. After that, the examination rhythm widens. From the fifth year of freedom from symptoms, an annual check-up is sufficient. Follow-up care is performed either in a clinic or by a physician in private practice. The main points are a symptom-related discussion and a physical examination. A physician can view the inside of the abdomen via endoscopic echography. A computed tomography scan is also common. Because of the low survival rate with a pancreatic tumor, inquiries about life also play a role that should not be underestimated. Psychotherapy may be prescribed if necessary.
Here’s what you can do yourself
Patients of a pancreatic tumor can support themselves and their organism by leading a healthy lifestyle. With a balanced diet and intake of vitamins, nutrients, and trace elements, the immune system is strengthened and well-being is improved. The body needs sufficient sleep and high-quality rest periods for good regeneration. Sleep hygiene should therefore be reviewed and adapted to the patient’s needs. Bedding, fresh air supply and possible environmental influences should be checked and optimized. Relaxation techniques and cognitive training help to establish an inner balance. The patient can use these procedures and methods on his or her own or with the help of professional support, as desired. Hectic, stress or excitement have a negative impact on health and weaken the patient. Sufficient exercise in the fresh air, leisure activities and conversations with relatives or other affected persons are perceived as beneficial and stabilizing. The patient’s focus should be on improving his or her well-being. A positive attitude towards life and laughter strengthen the affected person despite all adversities. An exchange with other sufferers in self-help groups or Internet forums can lead to new insights. Tips and advice on how to deal well with the disease in everyday life help to cope with all examinations as well as complaints.
