Symptoms

Pancreatic cancer causes symptoms only in an advanced stage. It manifests itself as painless jaundice (icterus), which is due to a narrowing of the bile duct (ductus choledochus): the pancreatic enzymes are released into the small intestine (duodenum = duodenum) for food digestion. As the gallbladder and liver pass through the head of the pancreas, this duct is compressed from the outside by the tumour growth and finally compressed completely.

The formed bile can no longer flow off, accumulates back into the gallbladder and liver and passes into the blood. The white skin of the eye (sclera) turns yellow. If not treated in time, this so-called mechanical icterus (jaundice) (due to congestion of the bile ducts) leads to progressive damage to the liver, so that it can no longer fulfil its extensive tasks in the metabolism (liver insufficiency).

Other symptoms (upper abdominal and back pain)

Upper abdominal pain Other common symptoms are dull upper abdominal pain that can radiate to the back and weight loss. This is caused by a disturbance in the utilization of food (maldigestion): In addition to the bile duct, the pancreatic duct (Ductus pancreaticus), which also runs within the gland, can also be compressed so that the enzymes required for the digestion of food, which are formed by the pancreas and released into the pancreatic duct, no longer reach their site of action in the small intestine. This symptom is accompanied by inflammation of the pancreas and is therefore also known as secondary obstructive pancreatitis (i.e. closing inflammation of the pancreas).

Occasionally, a painful but not dangerous inflammation of the superficial leg veins (a so-called thrombophlebitis) also occurs. Back pain Many patients with pancreatic cancer suffer from back pain. However, the reversal of this sentence hardly applies.

More than every second person has back pain in the course of their life. This makes this clinical picture one of the most common ones of all. Causes are often tensions of the musculature or spinal disorders.

Because back pain is so frequent, doctors rarely associate it with pancreatic cancer. They are a very unspecific symptom. Anyone who goes to a doctor with back pain should therefore never fear a direct diagnosis of cancer.

Back pain often goes away over time or with the administration of painkillers such as diclofenac. The cause of pancreatic cancer-related back pain is probably due to irritation of surrounding nerves. It is not uncommon for tumour diseases to be coupled with inflammation of the surrounding tissue. Since the pancreas tail in particular is located very far back in the abdomen, a tumour in this area can cause back pain.

Histology

Tumours of the pancreas originate from the gangetic epithelia, i.e. surface cells of the pancreatic ducts (see anatomy). The tumour forms gland-like structures that can also produce mucus and spreads diffusely throughout the entire organ. Because the pancreas is not surrounded by a protective capsule of connective tissue, the tumour quickly grows beyond the pancreas and attacks surrounding structures.

This explains the extremely poor prognosis of pancreatic cancer (see below). There is a high risk of metastases (metastases) being spread to other organs through the bloodstream, as the tumour tends to grow into vessels. Especially frequent are metastases.

The liver (65%)
The lungs (25%)
And in the skeleton (10%)

If the symptoms described are suspected, a tissue sample is taken from the pancreas (fine needle puncture). The atypical appearance of the tumour cells allows a clear diagnosis under the microscope (histopathological diagnosis). Special caution is required when taking the sample, as there is a risk that the tissue does not originate from the tumour, but inadvertently from the surrounding organ part which is “only” affected by inflammation.

However, the main reason for a late diagnosis of pancreatic cancer is the long, painless course of the disease, not a false diagnosis. Further diagnostic possibilities are: proteins produced by the tumour can be detected in the blood. (so-called tumour markers, these are more or less specific for a certain tumour: those used mainly in pancreatic cancer are called CEA and CA 19-9.

Finding new markers for different tumours is the subject of current research). – an ultrasound examination (sonography)

Computer tomography, CT
MRI, magnetic resonance imaging
Tumour marker

The diagnosis of pancreatic cancer includes a physical examination, an ultrasound and CT scan, as well as a blood test. Although there are no specific values that are only changed in the blood in the case of pancreatic cancer, there are some blood values that may sometimes indicate a malignant disease in general.

These include lipase in the blood – what does it say? Iron metabolism disorders with low iron levels in combination with low haemoglobin levels in the blood can also indicate tumour-related anaemia. – high blood sugar levels in the case of diabetes mellitus that is not prescribed

High inflammation values (CRP value, leucocytes)
And increased enzymes of the pancreas (e.g. lipase)