Pancreatic cancer: causes, symptoms, stages, investigation and treatment?

Tumours and pancreatic cancer: what should we know? What are the prognoses of oncologists?

+ Answers to frequently asked questions...

What are the causes and symptoms, including stages?
How is it screened and treated?
Information regarding mortality and survival rates, as well as other interesting facts in the article.

Pancreas = pancreas.

Malignant and benign tumors of the pancreas are called pancreatic neoplasms. Unfortunately, it is the benign ones that are very rare.

It is one of the most common types of tumour, and in terms of mortality, it ranks first.

Read also:
Are tumour and cancer the same thing?

The incidence (prevalence) of pancreatic cancer (ductal carcinoma) is high

The term pancreatic cancer refers to several malignant tumours of the pancreas. This general term is also used in common practice for ductal adenocarcinoma, which accounts for about 80 to 90% of pancreatic cancers in general.

Table with an overview of benign and malignant tumours

This tricky type of tumour with a high mortality rate is found everywhere in the world. It is the fourth most common cause of cancer deaths ever.
High incidence is also recorded in Sweden, Norway, Finland and virtually all of northern and central Europe.
Less frequently encountered in Turkey, Iran, Afghanistan, Pakistan, the Arabian Peninsula, Africa and Asia.

As regards the individual characteristics of patients suffering from this serious disease, it is up to twice as often observed in men than in women.
It is relatively rare in young people. Up to 70% of cases are old people of retirement age.

Why is pancreatic cancer so dangerous? Why do more than 95% of patients die from it?

What is the tricky part of pancreatic cancer?

The guiding principle in all diseases is early diagnosis, which is rare in the case of pancreatic cancer. If it is diagnosed earlier, it is usually a coincidence.

Late diagnosis of ductal carcinoma is due to an asymptomatic course in the first stages of the disease. The first symptoms only appear in advanced stages.

Another major problem is the high mortality rate during surgery. Even advances in surgical techniques have not reduced these figures.

Moreover, by the time the cancer is detected, it is too late for surgery. This infaustic disease is also characterised by inoperability at an advanced stage.

The rapid progression and early formation of metastases in the liver and lymph nodes is an additional problem. Surgery, which is impossible in most cases anyway, is not even considered once metastases have developed. As they develop, the patient's condition deteriorates rapidly and complications related to liver dysfunction are associated.

Treatment is almost impossible, and not only from a surgical point of view. These cancers are characterised by resistance to chemotherapy and radiotherapy. That is why the number of patients seeking other alternative treatment options is increasing.

We do not know the causes of ductal carcinoma, but we assume

The aetiology (cause) of ductal carcinoma is unknown. However, patients with this diagnosis share certain anamnestic data that are both risk factors for the development of the tumour and presumed causes.

Multiple patients with pancreatic cancer have the coexistence of several at the same time.

Risk factors, presumed causes:

1. Alcoholic beverages (alcohol ⇒ carcinogen), smoking (tar ⇒ carcinogen, nicotine ⇒ addictive non-carcinogen)
2. poor dietary habits (high meat diet, rich in animal fats)
3. obesity (increases the incidence of pancreatic cancer by 12%)
4. genetic predisposition (4 to 16 % - BRCA2, DPC4, STK, p16, p53 and PALB2 gene mutations have been reported)
5. other pre-existing pancreatic diseases, especially diabetes (twice the risk) and pancreatitis (considered to be precancerous)
6. long-term exposure to carcinogens (asbestos, ionising radiation)

Symptoms of the disease are a poor prognostic sign

Ductal adenocarcinoma is a very progressive type of tumour that does not manifest itself in the first stages. Its detection at the onset of the disease is often accidental, e.g. during computed tomography of the abdomen for another reason (trauma, gallbladder colic).

The appearance of symptoms is a sign of advanced to terminal (last, end stage).

Which symptoms are observed in patients with pancreatic cancer?

Pancreatic cancer typically begins to manifest with weight loss, which tends to be at the forefront. Often this is the first manifestation of the disease at all. Weight loss progresses. Significant cachexia develops, which, together with other symptomatology, resembles pancreatitis.

Interesting:
The cause of tumour cachexia (malnutrition), which also accompanies other cancers, is unclear.
It reaches a very high degree.
It is thought to arise from the complete exhaustion of the living organism through an increase in basal metabolism (increased energy expenditure caused by the malignant disease).

It is associated with general symptomatology (such as weakness, excessive fatigue) and vegetative symptomatology characterised by nausea, vomiting, rapid heart rate, low blood pressure, pallor, sweating.

The excruciating pain is localized in the upper quadrant of the abdomen, more to the left, similar to pancreatitis. Also as in pancreatitis, it is violent to tingling initiated by food. Patients do not tolerate the supine position because it intensifies the pain.

They enforce a position on the left side with the lower limbs flexed or a position on all fours.

The progression of the condition brings with it other symptoms such as yellow discolouration of the skin, mucous membranes and eyes. These occur in 20% of patients if the tumour is located on the tail of the pancreas (cauda pancreatis).

However, the head of the pancreas (caput pancreatis) remains the most common site of the tumour, affecting up to 70-80% of cases, and the processus uncinatus. In this case, icterus is not observed, only in the case of obstruction of the bile ducts and liver by metastasis.

Ascites (water in the abdominal cavity), splenomegaly (enlargement of the spleen) and hepatomegaly (enlargement of the liver) are almost always signs of metastasis of the primordium. Pancreatic cancer most often metastasizes to the liver, resulting in these manifestations.

Table with basic symptomatology of ductal carcinoma

Which investigations are necessary for the final diagnosis?

A definitive diagnosis cannot be made on the basis of positive anamnestic data, risk factors and symptoms alone.

These are similar in multiple diseases such as pancreatitis, pancreatic cyst, pancreatic abscess, other tumours of the stomach, gallbladder and abdomen.

What does the blood test reveal?

Routine blood tests carried out in the GP's surgery are often negative. Therefore, neither the doctor nor the patient may suspect that a malignant process is developing in the pancreas. Non-specific changes in the patient's blood count include anaemia and elevated amylase and lipase.

Often accelerated sedimentation is observed.
This does not mean cancer. These changes are also seen in other diseases.

Standard blood tests are supplemented with oncomarker tests when the physician suspects pancreatic cancer or other cancers.
Non-specific oncomarkers (Ca 19-9, Ca 125, CEA and some others) are often found positive. Oncomarker C19-9 has the highest affinity in pancreatic cancer. It is elevated in up to 90% of patients with this diagnosis. Its concentration is directly proportional to the stage.
However, we still have not concluded ductal adenocarcinoma. However, these tests suggest a lot and point the physician in the right direction.

Imaging examination methods

Blood tests are complemented by imaging investigations, which include endoscopic retrograde cholangiopancreatography ERCP, computed tomography (CT), magnetic resonance imaging (MRI) and the currently widely used magnetic resonance cholangiopancreatography (MRCP).

• Ultrasonography is a sonographic examination that uses a sonograph to reveal the internal conditions of the organs of the abdominal cavity. In pancreatic cancer, this examination is inadequate because it only detects cancer if it reaches a size >1.5 cm.
• ERCP is an endoscopic examination in which the organs of the digestive system are examined by a combined method using an endoscope and X-rays. The endoscope is a medical instrument of tubular shape, ending in a camera with its own illumination. It is introduced through the oral cavity after anaesthesia. Although the examination is not comfortable, it can detect various diseases of the internal organs of the digestive tract, including the pancreas, without the use of a scalpel. Forceps can be attached to the endoscope, which also allows the removal of material for further examination (biopsy).
• CT scanning is a non-invasive radiological examination method which, with the help of X-rays, allows the physician to get a detailed view of the internal organs. It can capture various morphological (shape) anomalies (differences) as well as pathological processes (inflammation, tumour, abscess).
• PET-CT is positron emission tomography. It is a state-of-the-art imaging method that is not common in medical institutions. It is available in isotope centres. It is used to investigate the stage and course of the disease, postoperative recurrence and metastasis of ductal carcinoma.
• MRI is a non-invasive radiological examination method, more advanced than CT. The patient is placed in a strong magnetic field and a radiofrequency pulse is sent into the patient's body by the machine. The pulse lasts for a short time and when it is over, a signal is taken which produces an image of the patient's body with all the details. It is one of the most detailed examination methods ever.
• MRCP is a medical imaging method that uses a magnetic field to image internal organs. It is mainly used to visualize the bile and pancreatic ducts. It also has the advantage of showing the surrounding parenchyma of the internal organs. Therefore, it is one of the most used techniques for suspected pancreatic cancer. It is gradually replacing ERCP because the result is identical and the MRCP examination is less invasive for patients.

Invasive examination methods

Invasive examination methods include ERCP with material collection. This can also be obtained by surgery or puncture. The material is then sent for further examination.

Cytological examination by percutaneous sampling (taking the material through the skin) is also important. Histological examination (examination of the tissue under a microscope) detects the presence of the Ki-ras oncogene, the suppressor gene and the BRCA2 gene.

Survival of a patient with pancreatic cancer: prospects for life

Patients with ductal adenocarcinoma have a very negative outlook for the future. It is a very progressive tumour with early metastasis and survival ranges from a few months to a maximum of 5 years. It is directly proportional to the stage of the disease at which it is detected. The prognosis is also poor for patients with operable cancer because of recurrence.

Patient survival can only be improved if we uncover the exact cause of the cancer, understand the communication of cancer cells with our immune system and understand the mechanism by which the tumour acts.

Until then, we can only hope that this still mysterious disease does not become ill or is caught in time.

Stages of pancreatic cancer:

• Stage I, so-called local carcinoma - surgical removal is possible, survival time ranges from 17 to 24 months
• Stage II, borderline carcinoma - surgical removal is possible, survival time ranges from 14 to 20 months, about 10% of patients survive >20 months
• Stage III, advanced carcinoma - third or advanced stage does not allow surgical removal, survival time ranges from 8 to 14 months
• Stage IV, terminal, metastatic carcinoma - absolutely inoperable and infaustive, survival time is no more than 6 months

What chances and treatment options does today's medicine offer?

The first surgical resection of the head of the pancreas was performed in 1934 by the American surgeon Alan Whipple.

Nowadays, despite significant medical advances, surgical resection of the carcinoma is still considered the only effective method of treating pancreatic cancer. Its main aim is to completely remove the tumour in the hope that the disease will not recur.

In some cases, resection is followed by chemotherapy in order to prevent recurrence. In the past, the often combined surgical solution followed by radiation is hardly used, except in the USA.

Resection is only possible in the first and second stages of the disease, and is absolutely contraindicated when metastases are confirmed. This means that it is only performed in about 10% of patients. These patients must meet the criteria of the National Comprehensive Cancer Network.

The basic criteria for surgical treatment options include:

• absence of metastases
• absence of vascular damage (VMS or vena portae)
• the presence of a fat body around the arterial spurs (truncus coeliacus) of the aorta
• presence of a fat body around the main hepatic artery
• the presence of a fat body around the arteria mesenterica superior, which is the main abdominal artery branching off the abdominal aorta

Important:
In patients with advanced pancreatic cancer and contraindications to surgical resection, palliative surgery is indicated to reduce pain, modify jaundice, and attempt to restore intestinal passage.

People are increasingly turning to alternative treatments

Alternative homeopathic treatments for various types of cancer are experiencing a major boom. This is especially true for those diseases for which today's medicine falls short. Pancreatic cancer is clearly among them.

Even if it doesn't help, it won't kill

The method of treatment is always suggested by the doctor, but the patient does not have to agree. It is always up to the individual to decide. In the case of ductal carcinoma, there really are not many options, so patients try to help themselves as much as they can.

There is a lot of literature that lists all sorts of different ways of treating cancer. Whether they really work is not entirely certain. What is certain, however, is that all over the world there are cases of people who have been cured, as if by a miracle. The alternative ways have one major common denominator - and that is a change of diet.

Books on cancer treatment agree on some points when it comes to diet.

The main principles of diet in pancreatic cancer:

• Absolute abstinence from alcohol, cigarettes and other drugs.
• omitting sugars - proven to cause some cancers (intake only in the form of fresh fruit and vegetables)

Read also:
Sugar, our sweetest enemy

• omitting fatty and red meat
• omitting animal fats
• Omission or minimal intake of fats (vegetable)
• omitting salts, spices and flavourings (only in fresh form, e.g. parsley)
• protein intake in the form of lean meat prepared by water or steam
• intake of fresh fruit
• intake of fresh or steamed vegetables
• sufficient fluid intake (plain water, herbal teas, 100% fruit juices without added sugars diluted with water)