Pancreatic cancer, mainly ductal adenocarcinoma, is annually responsible for approximately 46,400 cases and 39,600 cancer deaths in the US (Editor’s note .: In Germany in 2003, 12,686 cases of the disease were registered;.. The mortality rate for men is about 8% in women 5-6%). The symptoms consist of unintentional weight loss, abdominal pain and jaundice. The diagnosis is made by CT. Treatment typically consists of surgical resection and adjuvant chemotherapy and radiotherapy. The prognosis is poor because the disease is often advanced at diagnosis.

Most pancreatic cancers are exocrine tumors that develop from ductal and acinar cells. Endocrine pancreatic tumors are shown below (pancreatic endocrine tumors).

Pancreatic cancer, mainly ductal adenocarcinoma, is annually responsible for approximately 46,400 cases and 39,600 cancer deaths in the US (Editor’s note .: In Germany in 2003, 12,686 cases of the disease were registered;.. The mortality rate for men is about 8% in women 5-6%). The symptoms consist of unintentional weight loss, abdominal pain and jaundice. The diagnosis is made by CT. Treatment typically consists of surgical resection and adjuvant chemotherapy and radiotherapy. The prognosis is poor because the disease is often advanced at diagnosis. Most pancreatic cancers are exocrine tumors that develop from ductal and acinar cells. Endocrine pancreatic tumors are shown below (pancreatic endocrine tumors). Adenocarcinomas of the exocrine pancreas originate nine times more common than ductal acinar cells; 80% occur in the pancreatic head. Adenocarcinomas occur on average 55 years old and come in men 1.5 to 2 times more often than women. Primary risk factors are nicotine, chronic pancreatitis in medical history, obesity and possibly a long-standing diabetes mellitus (v. A. In women). Heredity plays a certain role. Alcohol and caffeine consumption appears to be no risk factors. Symptoms and discomfort symptoms occur late. At the time of initial diagnosis 90% of patients have a locally advanced tumor disease with involvement of retroperitoneal structures, spread to regional lymph nodes or liver or lung metastases. Most patients have severe upper abdominal pain that often radiates into the back. The pain can be alleviated by preventing or taking a Fetalposition. A weight loss often occurs. Adenocarcinomas of the pancreas head of the patient cause an obstructive jaundice (which often causes an itch) at 80-90%. A corpus carcinoma or tail may cause a Milzvenenobstruktion, which leads to splenomegaly, gastric and esophageal varices and gastrointestinal bleeding. At 25-50% of the patients, the cancer caused diabetes mellitus and so leads to symptoms of glucose intolerance (z. B. polyuria and polydipsia). Pancreatic cancer can affect (malabsorption, malabsorption Overview) in some patients the production of digestive enzymes by the pancreas (exocrine pancreatic insufficiency) and thus the ability to breakdown and absorption of nutrients. This malabsorption caused bloating and gas formation and aqueous, fatty and / or foul-smelling diarrhea, which leads to weight loss and vitamin deficiency. Diagnostic CT or magnetic resonance cholangiopancreatography (MRCP) CA 19-9 antigen to follow the course (not for early detection) (See also the US Preventive Services Task Force’s summary of recommendations Regarding screening for pancreatic cancer.) The preferred investigation is a spiral CT of abdomen or MRCP. If CT or MRCP show an obvious nichtresektable or metastatic tumor disease, percutaneous needle aspiration of achieving lesion for histological diagnosis should be considered. If the CT a potentially resectable or no tumor is illustrated, MRCP or EUS for staging or for detecting small, are used in the CT non-visible lesions. In patients with obstructive jaundice ERCP may be performed as the first diagnostic procedure. Routine laboratory test results should be analyzed. An increase in alkaline phosphatase and bilirubin indicates a biliary obstruction or liver metastases. The pancreas associated antigen CA 19-9 can be used to monitor the progress with diagnosed pancreatic cancer patients, and for the early detection in high-risk groups. However, this test is specific enough to serve for early detection among the general population neither sensitive nor. Increased levels should fall with successful treatment; a subsequent increase indicates a progression. Amylase and lipase levels are usually normal. Prognosis The prognosis varies depending on the stage, but overall survival is poor (5-year survival: <2%), as many patients are at diagnosis at an advanced stage of disease. Therapy Whipple procedure Adjuvant chemotherapy and radiotherapy symptom control at about 80-90% of cancers of the tumor at initial diagnosis due to metastasis or invasion of large vessels is considered nichtresektabel. Depending on the tumor location is the treatment of choice most often the Whipple procedure (pancreaticoduodenectomy). Adjuvant therapy with 5-fluorouracil (5-FU) and percutaneous radiotherapy are often used, resulting in a 2-year survival of 40% and a 5-year survival of 25%. This combination is also used in patients with localized but nichtresektabler tumor disease and achieved a median survival of about one year. Newer drugs (eg. As gemcitabine, irinotecan, paclitaxel, oxaliplatin, carboplatin) may be more effective than 5-FU-based chemotherapy, but no medication, whether alone or in combination, is clearly superior in prolonging survival (n. d. Übers .: meanwhile gemcitabine is the standard treatment for pancreatic cancer). Patients with hepatic or other distant metastases may be offered as part of a research program to chemotherapy, but the outlook is dismal, with or without these therapies, and some patients will choose it. When a nichtresektabler tumor is found during surgery and gastroduodenal or biliary obstruction is present or threatens a double gastric and biliary bypass surgery is usually performed for relief. In patients with inoperable tumors and jaundice endoscopic placement of bile duct stents relieves jaundice. However, in patients with a life expectancy of> 6-7 months because of the associated complications with stents, surgical relief should be considered. Symptomatic therapy analgesics (usually opioids) If necessary, A method for obtaining the biliary patency if necessary Pancreatic enzyme supplementation the end, most patients suffer from pain and die. Therefore, a symptomatic therapy is as important as one aiming at disease control therapy. The appropriate course of action in the terminal phase should be discussed (The dying patient). Patients with moderate to severe pain should receive an oral opioid at a sufficient dose to relieve the pain. Concerns about dependency should not stand in the way of effective pain management. In chronic pain is long-acting preparations (eg. As transdermal fentanyl, oxycodone, oxymorphone) best (n. D. Übers .: In Germany orally v. A. Administered slow-release morphine and hydromorphone retarded.). Percutaneous or surgical block of the celiac plexus controlled in most patients the pain well. In excruciating pain are opioids, s.c., i.v., administered epidural or intrathecal, an additional relief. When a palliative surgery or endoscopic placement of a biliary stent can not relieve the itching caused by obstructive jaundice, the patient can cholestyramine (4 g p.o., 1 to 4 times daily) will be treated. Also Phenobarbital 30-60 mg po 3 to 4 times a day can be helpful. Exocrine pancreatic insufficiency with obtained from the pig pancreas enzymes treated (pancreatic lipase). The patient should take enough to provide to 16000-20000 lipase units before each meal or snack available. If a meal expands over time (as in a restaurant), some of the tablets should be taken during the meal. The optimal intraluminal pH for these enzymes is 8, so some therapists proton pump inhibitors or H2 blockers administered two times a day. Diabetes mellitus should be monitored closely, and well adjusted. Summary Pancreatic cancer has a high mortality because it is usually diagnosed at a late stage of the disease. The main risk factors include smoking and chronic pancreatitis in prehistory; however, alcohol consumption appears to be an independent risk factor. The diagnostics include CT and / or magnetic resonance cholangiopancreatography (MRCP); Amylase and lipase are usually normal, and the antigen CA 19-9 is not sensitive or specific enough to serve for early detection among the general population. Approximately 80-90% of tumors are due to metastasis or invasion of large vessels at the time of diagnosis as nichtresektabel. When an operation is possible, the Whipple procedure should be selected; Also, adjuvant chemotherapy and radiotherapy is used. The symptom is monitored by adequate analgesia, through a gastric and / or biliary bypass surgery to relieve and sometimes by pancreatic enzyme preparations. Cystadenocarcinoma The cystadenocarcinoma is a rare adenomatous pancreatic cancer, which arises as a malignant transformation of a mucinous cystadenoma and most noticeable with upper abdominal pain and a palpable abdominal mass. The diagnosis is made by CT or MRI of the abdomen, which typically exhibit a necrotic tissue containing cystic mass; the space requirement can be misinterpreted as necrotic adenocarcinoma or pancreatic pseudocyst. In contrast to ductal adenocarcinoma cystadenocarcinoma has a relatively good prognosis. Only 20% of patients have metastases at the time of surgery; complete tumor excision means distal or total pancreatectomy or Whipple’s method results in a 5-year survival of 65%. Intraductal papillary mucinous tumor of intraductal papillary mucinous tumor (IPMT) is a rare malignancy, which leads to mucus and pancreatic duct obstruction. The histology can be benign, borderline or malignant. Most tumors occur in women (80%) and in the tail of the pancreas (66%) on. The symptoms are pain and repeated Pankreatitisattacken. The diagnosis is made by CT, sometimes by endoscopic ultrasonography, magnetic resonance cholangiopancreatography, or ERCP. Whether benign or malignant disease is present can not be distinguished without surgical resection, which is the treatment of choice. With a surgical resection, the 5-year survival for benign or borderline cases is> 95%, whereas in malignant tumors in 50-75%.

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