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- EPZ - Europäisches Pankreaszentrum Chirurgische Universitätsklinik, INF 420 69120 Heidelberg
Pancreatic Cancer
Tumor / Adenocarcinoma
Pancreatic carcinoma, which in most cases is a "ductal adenocarcinoma", i.e. a degeneration of glandular cells of the ductal system, is a rare but feared diagnosis. Causes lie in the aggressive growth of the tumor and the usually absent symptoms in an early tumor stage. Symptoms may include a sudden yellowing of the skin when the pancreatic head is affected, abdominal pain, nausea, and new-onset diabetes mellitus (however, other diseases often underlie these symptoms). The diagnosis is then made by combining the findings from CT examinations ("staging", TNM classification), tumor markers and, if necessary, sampling during an endoscopic examination.
The treatment options depend on the stage of the cancer at the time of diagnosis. Only by removing the malignant neoplasm, i.e. by surgery, is the disease potentially curable.
If the cancer has already spread to other organs (e.g. liver, peritoneum, lungs), chemotherapy is recommended first. Radiological control examinations are performed during the chemotherapy. In rare cases, if there is only limited spread and a good response to therapy, removal of the tumor may appear possible. If the cancer has not spread to other organs but is in close proximity to vessels running along the pancreas (especially portal vein of the liver or upper visceral artery), the option of surgery is technically challenging and not always possible. The alternative is chemotherapy. If the cancer is detected at an early stage, i.e., no spread has been detected and it is small in diameter with no contact with blood vessels, surgery is the treatment option of choice. Microscopic evaluation of the removed tumor results in the recommendation for or against subsequent chemotherapy.
Despite surgery being performed, even in early stages, a malignant neoplasm of the pancreas is a disease that requires precise follow-up. There should always be close consultation between the patient and the treating physicians, and a joint treatment concept should be discussed.
Symptoms
- Often no symptoms in early stages, possibly increasing upper abdominal pain
- Possibly yellowing of the skin without occurrence of pain
- Possibly new onset diabetes mellitus
- Possibly thrombosis and inflammation of superficial veins
- Possibly nausea and vomiting, weight loss, fever, night sweats
Risk factors
- Frequent occurrence without presence of risk factors (origin unclear)
- Smoking
- Chronic pancreatitis
- Long-standing diabetes mellitus
- Genetic predisposition
