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Pancreatic Cancer: Causes, Symptoms and Treatment

Pancreatic cancer is a malignant tumor of the pancreas. It is one of the most aggressive cancers and is often not diagnosed until an advanced stage due to its lack of early symptoms.

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Things worth knowing about "Pancreatic Cancer"

Pancreatic cancer is a malignant tumor of the pancreas. It is one of the most aggressive cancers and is often not diagnosed until an advanced stage due to its lack of early symptoms.

What is Pancreatic Cancer?

Pancreatic cancer is a malignant tumor arising from the cells of the pancreas, a gland located behind the stomach. More than 90% of cases are classified as ductal adenocarcinoma, originating from the cells lining the pancreatic ducts. The pancreas serves two key functions: it produces digestive enzymes (exocrine function) and regulates blood sugar levels by secreting hormones such as insulin and glucagon (endocrine function). Pancreatic cancer is associated with one of the poorest prognoses among all cancers, largely because it typically causes no symptoms in its early stages and is therefore usually detected at an advanced stage.

Causes and Risk Factors

The exact causes of pancreatic cancer are not fully understood. However, several well-established risk factors are known to increase the likelihood of developing the disease:

Smoking: One of the most significant and preventable risk factors.
Chronic pancreatitis: Long-term inflammation of the pancreas significantly raises the risk.
Type 2 diabetes mellitus: Both a risk factor and a potential early sign of pancreatic cancer.
Obesity: Being significantly overweight is associated with increased risk.
Family history: Approximately 10% of cases have a hereditary component.
Age: The risk increases substantially after the age of 60.
Chronic alcohol use: Can lead to pancreatitis and subsequently to cancer.

Symptoms

Pancreatic cancer rarely causes symptoms in its early stages. The following signs typically appear only once the disease has progressed:

Jaundice (icterus): Yellowing of the skin and eyes due to bile duct obstruction, especially in tumors of the pancreatic head.
Upper abdominal or back pain: Often described as a persistent, girdle-like pain.
Unintentional weight loss and loss of appetite.
Nausea and vomiting.
New-onset or worsening diabetes mellitus.
Steatorrhoea: Pale, greasy, foul-smelling stools due to reduced enzyme production.
Fatigue and general weakness.

Diagnosis

Diagnosing pancreatic cancer requires a combination of investigations, as no single reliable screening method exists:

Imaging studies: Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) are the primary methods for visualizing the tumor.
Endoscopic ultrasound (EUS): Combines endoscopy with ultrasound for detailed examination of the pancreas.
ERCP: Endoscopic retrograde cholangiopancreatography to evaluate the bile ducts and pancreatic duct.
Tumor marker CA 19-9: A blood test that may be elevated in pancreatic cancer, though it lacks specificity.
Biopsy: A tissue sample is required for definitive diagnosis.

Treatment

Treatment depends on the stage of the disease and the overall health of the patient.

Surgery

Complete surgical removal of the tumor (curative resection) is the only potentially curative option. Depending on the location of the tumor, different procedures may be used, including the Whipple procedure (pancreaticoduodenectomy) for tumors in the head of the pancreas. Unfortunately, surgery is only possible in approximately 15-20% of patients at the time of diagnosis.

Chemotherapy

Chemotherapy is used both as an adjuvant treatment following surgery and as the primary therapy for inoperable tumors. Commonly used agents include gemcitabine, FOLFIRINOX (a combination regimen of multiple cytostatic drugs), and nab-paclitaxel.

Radiation Therapy

Radiotherapy may be used in selected cases for local tumor control or in combination with chemotherapy (chemoradiotherapy).

Palliative Care

For patients with advanced, incurable pancreatic cancer, the focus shifts to relieving symptoms. This includes pain management, biliary drainage for jaundice, and comprehensive palliative care support.

Prognosis

The overall prognosis for pancreatic cancer remains poor. The 5-year survival rate across all stages is approximately 10-12%. For patients whose tumors are detected early and fully resected, this rate may rise to 20-25%. Due to the absence of early warning symptoms and the rapid spread of the disease, most patients are diagnosed at a metastatic stage.

References

Ryan D.P., Hong T.S., Bardeesy N.: Pancreatic Adenocarcinoma. New England Journal of Medicine, 2014; 371:1039-1049.
Leitlinienprogramm Onkologie (German Cancer Society): S3 Guideline Exocrine Pancreatic Cancer, Version 3.1 (2021). AWMF Registration No. 032-010OL.
American Cancer Society: Cancer Facts and Figures 2023. Atlanta: American Cancer Society, 2023.

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