What is pancreatic cancer?
The pancreas is one of the largest glands in the human body. It lies immediately below the diaphragm in the back of the abdominal cavity, behind the stomach between the spleen and the first section of the small intestine (duodenum).
The pancreas has two very important functions: It produces the digestive fluids that are necessary for breaking down and disintegrating food inside the intestines. The pancreas’ second function is to produce the hormones insulin and glucagon which regulate blood sugar levels.
Pancreatic cancer can develop in any part of the organ. The most commonly affected area is the head part of the pancreas. The numerous different types of pancreatic cancer are related to the different tissue types of the gland.
In Germany, approximately three per cent of all cancers are pancreatic cancers. Every year, around 7,400 men and 7,600 women develop pancreatic cancer.
In most patients, it is diagnosed in advanced age. On average, men are 69 and women 76 years old when they develop the cancer.
Even today, treating malignant tumours of the pancreas is rarely successful. The chances of surviving five years after diagnosis are very small.
Pancreatic cancer is the fourth most common cause of cancer-related death in women and men.
Frequently asked questions
The causes of pancreatic cancer are not yet known. There are, however different factors that can increase the risk of developing the disease. Smoking and excessive alcohol consumption are the most significant risk factors. According to current findings, patients who have had their stomach removed are also at an increased risk of developing this cancer. Diet as well as genetic factors also play a role in the occurrence of pancreatic cancer.
Risk factor: Smoking
Smoking cigarettes has been proven to be a risk factor for developing pancreatic cancer. Smokers are estimated to have an approximately 3.5-fold increased risk of developing pancreatic cancer. About a quarter of all pancreatic cancer cases have a causal relationship with smoking.
Risk factor: Alcohol consumption
Alcohol, too seems to increase the risk of developing pancreatic cancer. Excessive alcohol consumption is estimated to increase the risk of developing the disease 2.5-fold.
Risk factor: Pre-existing conditions
People who are suffering from a hereditary form of pancreatitis in particular are at increased risk of developing pancreatic cancer. In up to 40 per cent of cases, patients with hereditary pancreatitis will develop pancreatic cancer by the time they are 70.
People who have had to have stomach surgery in the past have a three- to seven-fold increased risk of developing pancreatic cancer.
Risk factor: Diet
Dietary factors probably also play a role in the occurrence of pancreatic cancer. A diet high in meat and fat is possibly also associated with an increased risk of developing the disease.
Risk factor: Genetic factors
In some families, pancreatic cancer occurs more frequently. In the vast majority of patients, however there is no hereditary component to their pancreatic cancer.
Pancreatic cancer is often only diagnosed at an advanced stage. In pancreatic cancer in particular it is important that the tumour is detected in time. The earlier it is diagnosed the better the prognosis.
Pancreatic cancer is one of the cancers with few symptoms during the early stages. Those symptoms in turn are not very distinctive and could be explained by other, more harmless causes.
Unspecific symptoms include:
Unexplained weight loss, abdominal or back pain, jaundice, loss of appetite and nausea, recent onset of diabetes, or vomiting
The following examinations are used for diagnosis:
- blood counts
- ultrasound
- determination of tumour markers
- endoscopy, i.e. an examination of the stomach, first section of the small intestine, pancreatic and bile ducts
- computed tomography (CT scan) and magnetic resonance imaging
Depending on the stage and type of the respective cancer, physicians and patients will decide together what type of treatment or combination of treatment methods is most suitable: surgery, chemotherapy, or radiotherapy usually in combination with chemotherapy. When choosing the right treatment method, the patient’s age and general state of health will also be taken into consideration.
Chemotherapy is aimed at destroying cancer cells in the whole body with medicinal products that inhibit cell growth (cytostatics). Cytostatics are very effective against rapidly growing cells. Cancer cells are particularly fast-growing.
Tumour stages
In order to find the most suitable treatment, the diagnostic procedures described must be used to determine how advanced the disease is before treatment is initiated.
First, the tumour is staged.
This is based on the TNM classification (see table below), amongst others. T is the size and spread of the primary Tumour; N = the number of lymph Nodes (Latin for knots) affected and M is the presence and localisation of distant Metastasis.
| TX | Primary tumour cannot be assessed |
| T0 | No evidence of primary tumour |
| Tis | Carcinoma in situ |
| T1 | Tumour limited to pancreas, no more than 2 cm in size |
| T2 | Tumour limited to pancreas, more than 2 cm in size |
| T3 | Tumour has spread beyond the pancreas but has not invaded the celiac artery or the superior mesenteric artery |
| T4 | Tumour has invaded the celiac artery or the superior mesenteric artery |
| NX | Regional lymph nodes cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Regional lymph node metastasis present |
| MX | Distant metastases cannot be assessed |
| M0 | No distant metastases |
M1 | Metastasis to distant organs |
The TNM criteria are used to classify the cancer’s stages, which are crucial for deciding the correct treatment. Stage I is the earliest stage where the tumour is least advanced, while Stage IV is a very advanced tumour with distant metastasis. A detailed overview of staging using the TNM criteria is given in the table below.
| Stage 0 | Tis | N0 | M0 |
| Stage IA | T1 | N0 | M0 |
| Stage IB | T2 | N0 | M0 |
| Stage IIA | T3 | N0 | M0 |
| Stage IIB | T1-3 | N1 | M0 |
| Stage III | T4 | Every N | M0 |
| Stage IV | Every T | Every N | M1 |
Additionally, it is of huge significance whether the tumour was resected completely during surgery. Surgery success is described as follows:
| RX | Residual tumour cannot be assessed |
| R0 | No residual tumour present |
| R1 | Laboratory tests show residual tumour |
R2 | Visible residual tumour |