Pancreatic cancer (pancreatic carcinoma)

Description

Pancreatic carcinoma (cancer of the pancreas) is one of the rarer but nevertheless dangerous tumour diseases. In Austria, 3.7% of all cancers are of this type, and most of those affected are found between the 6th and 8th decade of life.

The pancreas is located behind the stomach and produces both digestive juices, which break down various components of food, and the hormones insulin and glucagon, which together are responsible for regulating blood sugar levels.

If the pancreas is tumorously altered, it is nevertheless very rare for there to be a complete loss of organ function. Far more often, neighbouring organs are affected. This is due to the fact that liver and bile secretions first flow into the large pancreatic duct and only pass through it into the small intestine.

When a growth obstructs the excretory duct, which is used together, there is a congestion of secretions in all three organs. This circumstance results in impaired digestion and possibly also inflammation.

90% of pancreatic cancer is caused by a malignant mutation (transformation) of the cells lining the duct (ductal exocrine tumor). Much less frequently, in about 1 in 10 patients, so-called endocrine tumors are found. These can arise, for example, in the hormone-producing cells (islets of Langerhans), which are found in the glandular lobules.

It is still largely unknown why changes occur that lead to pancreatic tumours. However, a number of risk factors are known to increase the likelihood of developing the disease:

Smoking

For every person who smokes, the risk increases by a factor of about 3.5.

Alcohol

Heavy, excessive alcohol consumption increases the probability of contracting the disease by a factor of about 2.5. In conjunction with other factors (smoking!), the risk is probably multiplied.

Pre-existing conditions

People who have already had stomach surgery (e.g. because of a stomach ulcer) are also more susceptible to pancreatic cancer.

Genetic changes

The hereditary form of pancreatic cancer is rarer, accounting for about 5-10% of all cases.

Toxins

Poisons against vermin (pesticides), weeds (herbicides) or fungi (fungicides) are also suspected of being carcinogenic. Chlorinated hydrocarbons, electromagnetic fields, fumes from fuels and even chromium are also discussed as possible influencing factors.

Pancreatitis

People who have suffered from inflammation of the pancreas since birth or for several years (chronically) are particularly at risk.

It is usually a long way until a definitive diagnosis of pancreatic cancer is made, as only mild and unspecific symptoms are present. The typical occasional nausea is rarely enough for a visit to the doctor. More often, a specialist is not consulted until the disease is advanced and symptoms such as jaundice or pain in the upper abdomen are noticeable.

By this time, in 50% of cases, the tumor has already metastasized, i.e. formed daughter tumors.

Common symptoms

• Loss of appetite
• Weight loss
• Feeling of weakness
• Diarrhoea
• Itching
• back pain (due to proximity to the spine)

Because of the uncharacteristic symptoms, imaging techniques (in the abdomen) are specifically informative. These include:

• Sonography (ultrasound)
• Endosonography (ultrasound with endoscope from the inside)
• Computer tomography (CT)
• Magnetic resonance imaging (MRT)

If the diagnosis of pancreatic cancer has already been made, it is important to determine how far the disease has progressed. The following procedures are used for this purpose:

• X-ray
• Gastroscopy (gastroscopy)
• Endoscopy of the bile and pancreatic ducts (ERCP)
• Biopsy (tissue puncture)
• Blood test (tumor markers such as CA19-9)

A complete cure is rare, because the diagnosis of pancreatic cancer is often very late.

If the tumour only affects the pancreas, it is possible to remove it by surgery. Because this is a major operation, it is only performed in clinics that specialise in it. Depending on the size of the tumour, small parts of the pancreas and even parts of the stomach, small intestine or biliary system can also be removed (Whipple's operation).

Chemotherapy usually begins within the first 6 weeks after surgery, and then lasts for 6 months.

Because the pancreas is an important producer of enzymes and hormones (insulin and glucagon), these may need to be supplied to the body from outside.

Pancreatic cancer can also be inoperable. If this is the case, attempts are made to increase life expectancy. For this purpose, radiation and chemotherapy are used in combination as so-called radiochemotherapy. However, complete cure is not possible.

For pain, drugs (non-steroidal anti-inflammatory drugs, opioids) are given according to a graduated scheme defined by the WHO.

Studies are currently being conducted to investigate biological therapies. The approach of this therapy is the fact that the tumor tissue could also be recognized as foreign by the immune system. Attempts are therefore being made to stimulate the body's own defences in such a way that altered tissue is attacked independently.

Because of the usually late diagnosis, the chances of survival of pancreatic tumors are very poor. Due to the inconspicuous symptoms, pancreatic carcinomas are often already inoperable at the time of diagnosis.

The 5-year survival rate is between 6% (men) and 8% (women).