PANCREATIC CARCINOMA – CHALLENGES AND POSSIBILITIES
Pancreatic cancer (pancreatic carcinoma) is an extremely serious condition, both due to its prognosis and the difficulty of early detection. Patients often present in advanced stages, experiencing either severe back pain due to the invasion of nearby nerve structures or jaundice resulting from involvement of the bile ducts. The complexity is further heightened by the unique anatomical location, impacting not only the pancreas but also the liver and bile ducts. Moreover, significant blood vessels running in the vicinity of the pancreatic head may also be affected, influencing the operability of the disease.
Diagnostically, and following radiological examinations, the histology of the tumor becomes crucial for treatment decisions. While approximately 80% of pancreatic cancer cases are of adenocarcinoma origin (tissue producing mucinous products), there is a possibility that the malignant tissue is of neuroendocrine origin, offering a significantly better prognosis due to our excellent ability to intervene in mechanisms leading to tumor growth. Therefore, histology must be obtained in most pancreatic cancer cases through the use of a CT-guided fine-needle biopsy.
INTERDISCIPLINARY THERAPEUTIC DECISIONS BY THE WPK TUMOR BOARD
Once histology is determined, and radiological investigations are conducted, an interdisciplinary tumor board, consisting of radiologists, medical oncologists, radiotherapists, and surgeons, primarily determines the operability of the tumor. This may involve options for immediate operability if adjacent organs are unaffected, the possibility of operability in the future after tumor reduction, or the impossibility of operability. If operability is possible, it should only be pursued in cases where radical tumor resection without visible tumor tissue on-site is achievable.
Medical oncological measures encompass postoperative treatment, which has proven to positively impact patient prognosis, preoperative treatment to shrink the tumor and make it operable, and finally, maintaining the patient’s health for as long as possible in the case of metastatic and inoperable disease. For adenocarcinomas of the pancreas, chemotherapy is the primary treatment, with occasional consideration of radiation therapy. Chemotherapy involves modern drugs administered at relatively short treatment intervals. The application of such modern chemotherapy has proven effective in improving postoperative treatment outcomes and achieving operability for an initially inoperable tumor. Lastly, chemotherapy is effective in metastatic and inoperable disease, albeit to a lesser extent, as it has been shown to extend the lifespan of patients compared to older therapies.