Pancreatic cancer

How common is pancreatic cancer?

Pancreatic cancer is the seventh leading cause of cancer deaths in the western world, is most common in men and its incidence increases with age.

Who are more likely to get pancreatic cancer?

The causes are not known, but there are some factors that may increase the likelihood of its occurrence. These include smoking, a diet rich in saturated fats, drinking large amounts of alcohol and caffeine, diabetes mellitus, cholelithiasis, heredity and, more rarely, chronic pancreatitis. People who have one or more predisposing factors shall not necessarily develop pancreatic cancer, while people without any predisposing factor may develop the disease.

Are there any symptoms indicative of pancreatic cancer?

In the early stages of the disease, the patient usually has no symptoms. However, even in advanced disease, symptoms are non-specific, i.e. they may appear in many different conditions and in a small percentage only are due to pancreatic cancer. The most common symptoms are: abdominal pain, back pain (due to the location of the pancreas), nausea and vomiting, jaundice (yellow skin and conjunctivae) and sometimes dark-coloured urine and colourless stools, loss of appetite, weight loss, weakness and tiredness. Symptoms of depression may occur several months before the diagnosis of pancreatic cancer and finally diabetes mellitus may suddenly appear or pre-existing diabetes mellitus may be deregulated.

What tests does a patient with suspected pancreatic cancer undergo?

The suspicion of the disease is initially raised by the onset of symptoms, the clinical picture and the imaging test, whether this is due to the patient’s symptoms or incidentally for other reasons. Imaging of the abdomen may include ultrasound, CT and MRI of the upper abdomen, while more specialized tests are Endoscopic Retrograde Cholangiopancreatography (ERCP) and Magnetic Resonance Cholangiopancreatography (MRCP).

How is pancreatic cancer diagnosed?

To establish the diagnosis of the disease, a biopsy and histological examination of a section of the suspected pancreatic region or other metastatic focus must be performed. Material for biopsy is usually obtained by endoscopy (transesophageal ultrasound) or percutaneously using a biopsy needle or cytological examination (FNB or FNA). Surgical biopsy may be necessary when the above methods fail to establish the diagnosis.

What is the CA 19-9 index?

In some cases of pancreatic cancer, the CA 19-9 cancer marker is elevated, but this does not mean that normal values exclude the disease. It is important to emphasise that the CA 19-9 index, like other cancer markers, serves as a marker for monitoring and response to treatment in patients who already have cancer and is in no way used to diagnose the disease in an asymptomatic population as part of a screening check-up.

What are the treatments available today?

The treatment plan is determined according to the extent of the disease and the patient’s general health condition. In limited tumours, surgical cancellation is performed followed by adjuvant chemotherapy.

What options are available if the disease cannot be treated surgically?

Locally advanced pancreatic cancers (which cannot be completely excluded due to spread to neighbouring tissues or even vessels) and metastatic cancers are treated with chemotherapy.