Information
Editors
Carcinoma of the Pancreas
Essentials
- Carcinoma of the pancreas should be suspected in a patient with
- continuous upper abdominal discomfort or notable unexplained weight loss
- painless jaundice.
- The possibility of carcinoma of the pancreas should also be kept in mind in patients with upper abdominal pain, recent-onset diabetes or acute pancreatitis.
Epidemiology
- Pancreatic ductal adenocarcinoma (PDAC) is among the ten most common cancers.
- Endocrine tumours of the pancreatic isles (insulinoma, gastrinoma, vipoma, glucagonoma, somatostatinoma, carcinoid tumour) are very rare.
Symptoms and occurrence
- Weight loss 90%
- Vague upper abdominal discomfort 80%
- Jaundice 55%
- Epigastric pain radiating to the back 30%
- Recent-onset diabetes 30%
- Loss of appetite 20%
- Malaise 15%
- Symptoms caused by endocrine activity of the tumour
Diagnostics
- Routine laboratory examinations are not helpful in early diagnosis. Plasma alkaline phosphatase and glutamyl transferase concentrations are often increased.
- The sensitivity and specificity of CA 19-9 is about 80%. It is mainly used in specialized care for the diagnosis and monitoring of carcinoma of the pancreas.
- Ultrasonography may show a biliary obstruction or liver metastases and sometimes a tumour in the pancreas. A normal ultrasonographic finding does not exclude carcinoma of the pancreas, because the visibility of the pancreas is almost always incomplete and there may be no bile duct obstruction.
- In the case of suspected carcinoma of the pancreas, the basic examination is a contrast-enhanced body CT scan, which is performed in specialized care as a multiphasic, targeted examination of the pancreas.
- In unclear situations, further investigations may include upper abdominal MRI, ultrasonography-guided sampling either endoscopically or percutaneously, or PET-CT.
Treatment
- Pancreaticoduodenectomy (Whipple's procedure) can be performed if the tumour has not spread to adjacent tissues. It is possible in approximately 20% of patients.
- Chemotherapy and/radiotherapy for tumours that have spread to adjacent tissues provide palliative relief to about 50% of the patients but improve long-term prognosis only slightly.
- Results of chemotherapy are poor.
- Palliative surgical bypass of the biliary or digestive tract to relieve symptoms of obstruction may be performed if necessary.
Prognosis
- Centralization of surgical treatment improves outcomes and long-term prognosis.
- The 5-year age- and gender-adjusted survival rate for PDAC is below 10%. If surgical treatment is feasible, the prognosis is significantly better (up to over 20-25%).
- More than half of patients diagnosed with ductal adenocarcinoma of the pancreas die within 6 months from diagnosis. On the other hand, 1 in 8 patients treated with radical surgery survives for more than 10 years.
- The prognosis of periampullar carcinoma is better (because diagnosis is made earlier).