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Pancreatic Cancer

What are the main risk factors causing pancreatic cancer? Is age an important risk factor for the disease? What about obesity?

Age is a risk factor for pancreatic cancer, but not modifiable, whereas obesity and overweight are important modifiable risk factors.

How is the function of the pancreas affected by pancreatic cancer?

With tumor growth and dexchange of normal tissue by cancer cells both exokrine and endokrine pancreatic function are impaired. This can result in fatty diarrhoe, bloating and weight loss, because components of nutrition are not digested well and the lack of insulin causes diabetes. All of these symptoms are early warning signs for pancreatic cancer and require further examinations.

Is it a condition that affects one age group more often or is it influenced by gender?

The mean age to develop pancreatic cancer is during the 6th an 7th decade of life, with male gender more frequently being afftected.

At what stage of the disease is pancreatic cancer usually found?

When diagnosed the tumor is often locally advanced infiltration surrounding organs and blood vessel or spread to distant organs (metastases) in the majority of patients. Only 25% of patients deemed resectable at the initial diagnosis.

Can pancreatic cancer spread to other organs in the body? If so, where?

Typically, pancreatic cancer cells spread to loco-regional lympatic nodes, to the liver and the peritoneum, less frequently spread to the lungs and rarely to the bones is found.

Are the symptoms of this disease noticeable from the very beginning? What are the main symptoms of pancreatic cancer?

The diagnosis is late, because of atypical symptoms such as light pain in the epigastric region, radiating to the back, loss of appetite together with weight loss. Main symptoms are painless jaundice and significant weight loss over several weeks together with upper abdominal pain radiating in the back.

 

What tests are used for diagnosis and what annual screening tests are recommended?

Contrast-enhanced, high resolution computed tomographic (CT) scan provides a high yield of correct diagnosis in patients with warning signs and allow decisions upon resectability. Blood test with pancreatic (amylase and lipase), liver (GOT, GPT, GGT) and bile (bilirubin, alkaline phosphatase) parameters together with tumor markers (CEA and CA19.9) add further important information. For unclear results further examinations with contrast enhanced magnetic resonance imaging (MRI) and endoscopic ultrasound with needle biopy may be required.

What complications can occur in pancreatic cancer? Is jaundice one of them?

Cancer of the pancreatic head can cause painless obstructive jaundice with impairment of general condition, liver function, digestion and bile duct infection (cholangitis). Thrombosis and thromboembolic events such es lung embolism are caused by the diseases’ influence of the blood clotting system (paraneoplastic syndrome).

What is the recommended treatment for this disease? How does it differ depending on the stage of the cancer?

Radical resection of the tumor and its deposits is key for long lasting cure. However, as this is only feasable in a minority of patients (<25%) at initial diagnosis, mulimodal, interdisciplinary concepst aim to control and down-stage the disease by chemo- and radiation therapy and to convert it into a resectable condition after 3 to 6 months of neoadjuvant treatment.

What ensures successful treatment of pancreatic cancer?

Radical resection of the entire tumor together with its deposits followed by adjuvant chemotherapy ensures treatment success. It is important to reliably assess the initial stage of disease in order to guide the following treatment accordingly. Patients with resectable disease should undergo upfront surgery, but if radical resection is questionable because of locally advanced tumor, neoadjuvant treatment is required in order to control and convert the disease into a resectable situation.

Are there ways to prevent pancreatic cancer? If so, what are these?

There are few factors know that increase the risk to develop pancreatic cancer. These are smoking and overweight / obesity. Avoiding theses factors may decreas the risk for pancreatic cancer. Furthermore, healthy lifestyle and eating, frequent physical exercises and less stress may be preventive as well.

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