Pancreatic Cancer

Pancreatic cancer is a malignant disease that usually affects the glandular tissue of the pancreas, and in rare cases the hormone-producing cells. Malignant diseases of the pancreas have increased in Germany in recent years. The onset of the disease is usually after the age of 60.

Causes and risk factors

The exact causes of pancreatic cancer are not known. The main risk factors include:

  • Smoking
  • Frequent alcohol consumption
  • Obesity
  • Chronic pancreatitis (inflammation of the pancreas)
  • Longstanding diabetes mellitus
  • Genetic causes, common familial occurrence

Symptoms

Pancreatic carcinomas do not cause any specific symptoms at the beginning and are therefore usually discovered late. In some cases, the tumour has already progressed so far that it has affected other organs.

Symptoms of pancreatic cancer may include:

  • Non-specific upper abdominal pain
  • Jaundice (icterus) due to narrowing of the bile duct
  • Digestive disorders: nausea, vomiting, diarrhoea, constipation, fatty stools (light, shiny, greasy stools), loss of appetite
  • Unintentional weight loss
  • In advanced stages: severe upper abdominal pain, back pain
  • Hormone disorders (in endocrine pancreatic carcinoma)
  • Tendency to thrombosis

Diagnosis

In addition to laboratory examinations that indicate a restriction of pancreatic function or disturbances of the bile and pancreatic secretion outflow, a tumour marker, CA 19/9, is also tested for if pancreatic carcinoma is suspected. This tumour marker can indicate pancreatic carcinoma, but is not specific, so further examinations are necessary as well. Ultrasound, endosonography, CT (computer tomography) and MRI (magnetic resonance imaging) are used. These provide information about the extent of the disease.

In the multi-disciplinary tumour meeting, in which gastroenterologists, surgeons, radiologists, oncologists and, if necessary, other specialists take part, the possible therapy options are then discussed. The end result is an individually tailored therapy concept that promises the best possible prospects of success.

Treatment

Surgical treatment

Surgery aims to completely remove the tumour tissue in the pancreas. If the disease is detected early enough and has not already affected other organs or surrounding tissue, the surgical intervention can enable a cure. If metastases are already present, surgery is not usually performed, but other therapies, especially chemotherapy, are resorted to.

Depending on the location of the tumour, not only parts of the pancreas and the lymphatic drainage area are removed during the operation, but also the gall bladder, the lower part of the bile duct, the duodenum and, if necessary, part of the stomach (Kausch-Whipple operation). In most cases, however, the stomach can be completely preserved (PPPD).

If the tumour can no longer be removed surgically, but is blocking the flow of bile due to its size or location, the biliary stasis and the resulting jaundice can be eliminated with the help of a stent.


Drug therapies

If complete removal of the tumour is not possible by surgery or if metastases have already formed in other organs, chemotherapy is used. This causes degenerated cells to be destroyed and the growth of the tumour slowed down. The patient's chance of survival can thus be increased and their quality of life improved. In rare cases, primary (neoadjuvant) chemotherapy can achieve a situation where a previously inoperable tumour can be operated on after all.

In advanced, metastatic pancreatic cancer, antibody-based targeted therapies can be used to complement chemotherapy in some patients. These have a direct effect on the metabolic processes of the cancer cells. The drugs are based on different mechanisms of action that inhibit either the blood supply or the cell growth of the tumour in different ways. Whether the approved drugs hold promise can only be clarified individually, based on the histological characteristics of the tumour and other factors. In addition, there is the consideration of possible side effects that can also occur with this group of medicines. In the multi-disciplinary tumour meeting, the specialists involved discuss the best possible approach in detail.

Unfortunately, a complete cure in advanced stages is not possible at present, even with this still quite new therapeutic approach. However, in many cases the drugs lead to a longer-term containment of the disease and thus to a sustained improvement in the quality of life and possibly also to a prolongation of life, such as with PIPAC therapy.


Integrative therapies

During your inpatient stay at Havelhöhe, we combine conventional medical therapies with integrative treatments that help you to strengthen your self-healing powers, activate the immune system and mobilise your strengths. Mistletoe is available as an accompanying naturopathic medicine, especially for pancreatic cancer. Depending on the type of administration, dosage and preparation, a therapy can exert direct cell-killing effects on the cancer cells, strengthen the immune system and also reduce the side effects of cancer therapy, e.g. symptoms of any occurring exhaustion or fatigue syndrome. Studies have shown positive effects on the quality of life and lifespan of patients with pancreatic cancer.

Further integrative therapies can additionally significantly reduce the side effects of cancer therapy. These include movement and body therapies, e.g. eurythmy therapy and rhythmical massage therapy, as well as painting and music therapy. Additional support is provided by our anthroposophic care therapies, which promote regeneration.

You also have the option of taking advantage of psycho-oncological counselling. You can discuss possible fears there as well as the effects of the disease on your family situation or perspectives for the time after treatment.

Perspectives

Since pancreatic cancer is usually diagnosed at a very late stage, there is often no prospect of a complete cure. However, even with more advanced disease, we now have good treatment options that can improve the quality of life for a longer period of time. At the Havelhöhe Oncology Centre, we work closely with our Department of Interdisciplinary Oncology and the Supportive Cancer and Palliative Care  Unit in these cases and offer PIPAC (pressurised intraperitoneal aerosol chemotherapy) and HIPEC (hyperthermic intraperitoneal chemotherapy).

After-care

Regular follow-up is important in order to be able to respond to changes at an early stage and to treat any secondary symptoms that may occur in a targeted manner. In the beginning, the follow-up examinations take place more frequently, every three to six months, but later the intervals increase.

In addition to the physical and laboratory examination, the doctor looking after you will usually carry out an ultrasound of the abdomen. In addition, if necessary, he will arrange psychological or other medical services to further improve the patient's quality of life. (www.krebsinformationsdienst.de/wegweiser/adressen/psychoonkologen.php)

Before discharge from the Havelhöhe Community Hospital, you will receive an aftercare passport from our Aftercare Documentation and Study Outpatient Department, in which all therapies and check-ups can be clearly noted. Medical aftercare is provided on an outpatient basis by your attending general practitioner or consultant, with whom we work closely.

We also ask you to report to our aftercare outpatient clinic at regular intervals so that we can document the progress of your treatment.