Understanding Pancreatic Cancer: Symptoms, Diagnosis, and Treatment Options

Pancreatic cancer, also known as pancreatic carcinoma, is a cancer that occurs in particular in patients between the ages of 60 and 80. A tumour in the pancreas usually does not cause any symptoms for a long time and only causes problems in advanced stages. In this article, you will learn how pancreatic cancer becomes noticeable, how it is treated and what the life expectancy with pancreatic cancer is.

What is the function of the pancreas?

As the name suggests, the pancreas is a large gland between the stomach and the spine in the upper abdomen. It is divided into pancreatic head, body and tail.

On the one hand, they produce enzymes directed into the small intestine to help break down the food components. The so-called exocrine part of the pancreas performs this task.

On the other hand, the pancreas plays a vital role in regulating blood sugar levels. The so-called endocrine part of the pancreas produces, among other things, the hormones insulin and glucagon, which help to lower or raise blood sugar levels.

 

Causes: How does pancreatic cancer develop?

The exact cause of pancreatic cancer has not yet been finally clarified. What is certain is that there is a specific genetic predisposition in parts of the population to develop pancreatic cancer – this means that the predisposition is hereditary. Furthermore, some known risk factors can promote development. Which includes:

• Smoking
• overweight
• heavy alcohol consumption
• an already existing chronic inflammation of the pancreas (so-called pancreatitis )
• long-standing type 2 diabetes

In pancreatic cancer, the exocrine tissue of the pancreas usually proliferates and spreads not only in the pancreas but also in the surrounding tissue. In most cases, this happens in the area of ​​the head of the pancreas, which is right next to the duodenum – called pancreatic head carcinoma.

If the cancer is not treated, the malignant cells can spread throughout the body and form metastases. Such secondary tumours can arise, for example, in the lymph nodes, the spleen or the intestine. The cancer cells often also affect the lungs, the bones or liver metastases.

What are the symptoms of pancreatic cancer?

Pancreatic cancer does not cause any discomfort or symptoms in the early stages. This makes it a dreaded disease for many.

In later stages, the cancer can cause abdominal pain in the upper abdomen. This pain can radiate to the back in the form of a belt and can also appear as pure back pain.

A tumour of the head of the pancreas, a carcinoma of the head of the pancreas, is most often manifested by jaundice. Jaundice means that people’s skin turns yellow. This symptom often occurs first in the eyes, where the whites of the eyes turn yellowish. However, jaundice can also occur with many other diseases and is not proof of the presence of pancreatic cancer.

Other signs of pancreatic cancer can include nausea and vomiting, as well as general symptoms such as weight loss and fatigue. The criterion for weight loss is an unintentional decrease of more than ten per cent of the original body weight in the last six months.

In rarer cases, a so-called paraneoplastic syndrome can develop in pancreatic cancer. Here, the blood tends to clot more so that those affected (repeatedly) get thrombosis, i.e. blood clots that block the veins.

 

How is pancreatic cancer diagnosed?

If patients experience symptoms that also occur with pancreatic cancer, they should first contact their family doctor. The symptoms of a pancreatic tumour are very unspecific. They can also indicate other diseases, so general examinations are probably first carried out in the family doctor’s office. These include a physical exam, a blood test, and possibly an abdominal ultrasound.

Suppose the suspicion of pancreatic cancer persists after the first examinations in the family doctor’s practice. In that case, those affected are usually referred to a gastroenterological ward in the hospital, which is very familiar with gastrointestinal tract diseases. Here, an ultrasound is carried out again because the pancreas can be examined quickly and well with an ultrasound – any changes can be detected in this way.

Suppose a mass (i.e. an accumulation of tissue) can be seen in the ultrasound. In that case, further imaging procedures are usually carried out better to assess the size and extent of the tumour. These other imaging methods include, for example, an endosonography, i.e. an ultrasound examination that is carried out internally through the stomach, or a computer tomography (CT). Tissue from the suspicious structure in the pancreas may also be removed during the endo sonography to be able to better assess the type of cancer under the microscope.

Specific blood values  ​​can also be elevated in pancreatic carcinoma. There are unique tumour markers that can be repeatedly determined throughout the disease and provide information as to whether there are metastases, for example.

After all these tests have been carried out and the diagnosis has been made with certainty, the cancer is assigned to a specific stage. Treatment and prognosis of pancreatic cancer depend, among other things, on this stage.

How is pancreatic cancer treated?

Pancreatic cancer is divided into different stages, from one to four. The therapy depends, among other things, on the previous course of the tumour disease, i.e. how far it has already progressed. But other factors can also play a role.

Stages 1 to 3: pancreatic cancer is sometimes curable

In stages 1 to 3, a curative therapeutic approach is usually chosen. This means that a treatment plan is pursued to cure the cancer. First, the part of the pancreas affected by the tumour is surgically removed. Depending on the size of the tumour, parts of the duodenum or the stomach may also have to be operated on. If the tumour can be completely removed by surgery (a so-called R0 resection), patients should undergo chemotherapy afterwards.

The sole use of chemotherapy, i.e. treatment without surgery, is not suitable for the curative therapy of the tumour.

 

Palliative therapy for pancreatic tumour

If the pancreatic cancer has already formed metastases, i.e. those affected are in stage 4, a palliative treatment plan is chosen. This means that the goal of treatment is no longer to defeat the cancer but to extend the lifespan of the patient and, at the same time, maintain the highest possible quality of life.

In people who are already very old and weak or in whom the cancer is returning, palliative therapy can also be helpful in lower cancer stages. Palliative therapy for pancreatic tumours includes chemotherapy, radiotherapy (radiation) in the case of bone metastases and various methods to reduce pain (e.g. with medication ) and to improve and maintain digestion.

Fatty chair as a result: What is behind it?

Since the pancreas is an essential organ of the digestive system, digestive problems can occur as a result of both advanced pancreatic cancer and surgical removal of the organ. Typically, patients have so-called fatty stools, i.e. light-coloured, almost yellow stool that has the consistency of diarrhoea. The body lacks the pancreatic enzymes that typically help digest dietary fats.

Those affected should ideally eat many small, high-carbohydrate meals throughout the day. In addition, supplementing the missing pancreatic enzymes with tablets can also be helpful.

What is the life expectancy of pancreatic cancer?

A prognosis for life expectancy in pancreatic cancer is not so easy to give since individual factors play a significant role. Unfortunately, pancreatic carcinoma is usually an aggressive form of cancer.

In Germany, the 5-year survival rate for pancreatic cancer is eight per cent for men and nine per cent for women. This means that five years after diagnosis, eight per cent of diagnosed men and nine per cent of women are still alive.

However, the exact prognosis depends on many factors and varies among those affected. Factors affecting survival time include:

• Cancer stage
• the aggressiveness of the tumour
• Alter
• Nutritional and general condition

 

How do you die from pancreatic cancer?

Pancreatic cancer causes a variety of symptoms in the final stages. At this point, those affected are usually cared for by a palliative care team that is well-versed in caring for terminally ill patients. If those affected or their relatives wish it, it can make sense to be transferred to a hospice for the last few weeks of life or the dying phase.

Here or in the care, an attempt is made to keep the patient’s quality of life as high as possible until the end and to alleviate symptoms as best as possible. An essential part of the therapy is, therefore, a sufficient administration of painkillers, for example, morphine. Both the pancreatic cancer itself and metastases cause severe pain. Gradually, however, those affected will become weaker despite good care and pain therapy. Many patients lose their appetite and thus also a lot of weight. However, it is impossible to predict precisely what the individual dying process will look like.

Psychological counselling services are available to help those affected and their relatives who have been diagnosed with pancreatic cancer and to make it easier to deal with terminal cancer. Talk therapy or a support group can help people better accept and cope with their diagnosis.