Pancreatic Cancer - What is the Chances of Survival?

introduction

Of the Pancreatic cancer is next to that Stomach cancer and cancer of the colon one of most common cancer of the digestive tract.

In recent years it can be observed that there has been an increase in new cases of this tumor disease in the western industrialized countries of the world.

Currently around 10 out of 100,000 people fall ill each year. So it belongs to a disease that quite often occurs.

The Increase in people with pancreatic cancer is primarily to be found in the western industrialized countries and allows conclusions to be drawn about a connection between Lifestyle and diet of people in developed countries as opposed to people in developing countries.

The majority of people using Pancreatic cancer are in Age from 60 to 80 years. Thus, it is a disease of old age.

root cause

The Cause of pancreatic cancer has not yet been clarified with certainty.

In a small proportion of those affected there is one genetic cause in front. That is, the disease is hereditary and there is a familial accumulation.

General Risk factorsthat increase the likelihood of developing pancreatic cancer are those Age (this is a very established risk factor), the gender (Men are affected far more often in this context) and the Ethnic Origin (dark-skinned people are at increased risk).

With certain Underlying disease there is also an increased occurrence of the tumor such as, for example inherited and chronic pancreatitis, familial incidence of breast cancer or after surgical removal of the stomach.

Otherwise, one assumes a few other risk factors that are suspected of causing a Pancreatic cancer to favor.

This includes that Smoking, diabetes mellitus, obesity, pre-existing chronic inflammation of the pancreas and solvents.

In almost all patients, the tumor is in the Area of ​​the pancreatic head, the proportion is here about 80%. A tumor in the area of ​​the Pancreatic body occurs with a Frequency of 10% on and the rest 10 % are statically distributed over the occurrence in the area of ​​the Pancreatic tail.

Chance of survival without surgery

Of the Pancreatic cancer is without surgery for the person concerned one within a few months fatal disease.

Mostly because of that already advanced tumor growth Surgery is no longer possible in surrounding tissue or metastasis in other organs of the body.

When the diagnosis is made, that is usually the case End-stage pancreatic cancer in front. The tumor is no longer operable.

Since you are aware of this, it is even more important to be patient with you to examine the increased risk profile at regular intervalsin order to have the opportunity to discover the tumor at a stage of spread that still allows it to be removed by surgery and thus to improve the chances of survival.

To the Screening process but one also uses one to assess the later surgical situation Esophagus and gastroscopy, it will be a X-ray of the gastrointestinal tract causes a CT Image of the abdomen taken as well as a Chest x-ray made around eventual Discovering metastases in the lungs.

There is a possibility in the course too Detect tumor markers in the blood and this from time to time to check for changes. He calls himself CA19-9 and is used to monitor the progress, but is also used to look ahead to the effects of the therapy.

Without surgery does the patient have one medium chance of survival from weeks to months.

There is a possibility apart from an operation Irradiate tumor (Radiation therapy) and possibly in combination chemotherapy apply.

Using these procedures increases the median chance of survival by a few months.

treatment

In a patient in whom it does not yet cause the tumor to spread came, that is, the tumor under 2 centimeters in size has, has not grown into the surrounding tissue and has not already spread (metastasized) to other organs, a surgery be performed.

This is the situation at around 15 - 20% of those affected. The remaining 80% have to with one palliative (pain reliever) approach are supplied.

The operation is called Whipple surgery, named after George Hoyt Whipple, who was the first surgeon to perform this operation. The Whipple OP is also called Duodenopancreatectomy , which means something like that Removal of the pancreas and duodenum.

In Whipple surgery, which takes about 6-8 hours, away the surgeon den Duodenum, the Pancreatic head, Bile duct and gallbladder, the lower portion of the stomach and all in the vicinity of the structures just mentioned Lymph nodes.

If the tumor is in the area of ​​the body or the tail of the pancreas, these structures are also removed. In this situation it may be possible to operate in a gastric conserving manner, since anatomically speaking, the tail area of ​​the pancreas is more distant and you can leave your stomach in this way.

Through the generous removal of all structures one tries to a so-called R0 situation to achieve, that is, one would like to achieve that on the one hand entire tumor tissue removed as well as the surrounding tissue, in which possibly the smallest micrometastases are present, are removed.

At Removal of the entire pancreas Care must be taken all Functions of the pancreas now through drugs to replace.

insulin must be given in the form of injections, as the operation created a metabolic situation similar to diabetes.

Also Digestive enzymes can be administered in the form of drugs. This is very important to a normal metabolism and a normal Digestion of food components from Carbohydrates, proteins and fats to enable.

After the operation can be an accompanying chemotherapy With Gemcitabine or 5-FU (5- Flourouracil) to be carried out so that the Extend the life of the patient.

The Lethality to die during the operation is in larger medical centers at approx 5%.

The chance of survival after the operation is around 5 years for 20% of those treated.

In the best case, if the tumor has not spread and is less than 2 cm in diameter, the patient will have one after the operation 40% chance of survival after 5 years of still living.

In general, the prognosis for the tumor is very poor, the mean survival time is 8-12 months. Even with the best care and adequate follow-up care, almost all patients die within the first 2 years of being diagnosed.

Inoperable pancreatic cancer

Is the tumor inoperable, for example, because it has already spread, has grown into the surrounding organs or other concomitant diseases lead to an unstable circulatory situation, one comes palliative therapy in question.

In the palliative therapy situation is the Quality of life improvement in the foreground.

The patient should be symptom-free, the top priority in this context Freedom from pain.

The mean survival time at palliative therapy situation is 6-9 months.

Can support radiotherapy and chemotherapy Find application.

Patients with poorly controllable pain situations benefit from local radiation. In this case, the area where the pancreatic cancer is located is irradiated. It can also Bone metastases are irradiated, which usually lead to very severe pain and thus less severe discomfort.

Other Pain reduction options are insertion of a pain catheter Spinal cord or Blockage of the nerve plexuswhich for the information transfer of the pain of the pancreas is responsible for the processing pain center in the brain.

Furthermore you can Chemotherapy drugs can be applied. These substances are best suited for younger patients with a good general condition who want treatment.

Important substances are gemcitabine, 5-FU (= 5-fluorouracil) and erlotinib.

Gemcitabine affects that Tumor cell growth inhibiting. Typical side effects are Disorder in the blood picture, one Depletion of various blood cells, such as Gastrointestinal complaints how nausea, Vomit and Diarrhea. It can also have a negative impact kidney, lung and hair come.

5- fluorouracil is a chemotherapeutic agent which makes it impossible to build up the DNA in the cancer cell by incorporating the wrong building blocks and thus hindering the growth and cell reproduction of the tumor. The most common Side effects are nausea, vomiting and diarrhea.

Erlotinib inhibits receptors on the tumor cell receiving information for growth. The most common Side effects from Erlotinib are Loss of appetite and diarrhea, it can too acne-like skin reaction come and the drug often leads to faster fatigue.

About 5% - 25% of patients respond to radiation and / or chemotherapy.

Irradiation achieves good results in terms of pain relief.

With a combination of gemcitabine and 5-fluorouracil there is only an extremely slight improvement in survival time and thus a low chance of survival.

All in all it is Pancreatic cancer a malignant disease with a very poor chance of survival, which cannot achieve the desired success with the help of various therapeutic approaches.

A lifetime extension can neither be satisfactorily made possible, nor is it possible to cure a patient in an even smaller percentage.

Statistically, this means one 5 year chance of survival from 1%.

For those patients who were initially treated with a curative approach and those who were able to completely remove the tumor, the 5-year survival rate is approximately 5%.