Internal Medicine

End-stage pancreatic cancer

Note

All information given here is only of a general nature, tumor therapy always belongs in the hands of an experienced oncologist!

Synonyms

Pancreatic carcinoma (or more precise term in the narrower sense: ductal adenocarcinoma of the pancreas), pancreatic carcinoma, pancreatic cancer, pancreatic tumor

English: pancreatic carcinoma

General information

Pancreatic cancer belongs to the most aggressive Cancer forms that exist and are understood as a malignant degeneration of cells in the pancreas.

Both men and women are equally affected by this serious illness, which tends to occur between the ages of 50 and 60.

More information can be found here: Pancreatic Cancer Age

The first Symptoms usually occur in pancreatic cancer very late on, sometimes only in the end stage and then they are mostly unspecific, i.e. not particularly typical of pancreatic cancer.

More information can be found here: Pancreatic cancer signs

More and more attempts are made to find good therapies, but contrary to many other types of cancer there are hardly any symptoms at first and a Chemotherapy doesn't work very wellbecause the tumor does not respond adequately.

Duration of illness

The duration of the illness can be not stipulate a blanket for all concerned. It all depends on when the disease is discovered as such. It is a very early stage can get the disease through surgery cured become. However, it is a late stage orhe the terminal stage the prognosis is unfortunately bad. The mean survival time is usually only 1-2 years, depending on how hard the body is fighting and how well the chemotherapy and radiation therapy work.

More information can be found here: Pancreatic cancer prognosis

Illustration pancreatic cancer

Figure pancreatic cancer: risk factors (A), signs / symptoms (B), therapy (C)

Pancreatic cancer -
(Pancreatic cancer)

Liver - Hepar
Pancreas - Pancreas
Main bile duct -
Common bile duct
Head of the pancreas -
Caput pancreatis
Pancreatic tumor (malignant)
ductal adenocarcinoma
Body of
Pancreas -
Corpus pancreatis
Pancreatic duct
(Main execution course) -
Pancreatic duct
Tail of
Pancreas -
Cauda pancreatisauda
Spleen - Sink
Stomach - Guest
Risk factors:
A. - Chronic pancreatitis -
To smoke cigarettes -
Alcoholism - very fatty
and protein-rich diet
Signs / Symptoms:
B - yellowing of the conjunctiva -
Yellowing of the skin -
Lightening of the stool -
Dark urine -
Upper abdominal pain
Therapy:
C - Operation (in advance
MRI, ultrasound) -
radiotherapy
(in combination with chemotherapy) -
chemotherapy
(Drugs-cytostatics)

You can find an overview of all Dr-Gumpert images at: medical illustrations

What does end stage mean?

End-stage pancreatic cancer means a very far advanced tumor stage. Mostly there are already so-called Metastases before, that is, tumor cells settle in other organs, vessels or lymph nodes.

In the final stage, however, it can also be a very large, tumor no longer operable act in the pancreas, which causes many symptoms because its size greatly disrupts the function of other organs.

Symptoms

Often times, the problem with pancreatic cancer is that Symptoms very unspecific could be. Especially Nausea and vomiting are often seen in connection with pancreatic cancer.

Only when the symptoms persist for a very long time, the first go to the doctor and there are more detailed examinations like a Computed Tomography carried out. Unfortunately that is cancer at this time often very advanced.

Other symptoms may also Indigestion in the form of Constipation or diarrhea be because the pancreas is not only responsible for the production of insulin but also for the production of various, for the Digestion of necessary enzymes responsible is. They travel through the pancreatic duct to the digestive tract, where they break down food. If these digestive enzymes are no longer released into the digestive tract, the food cannot be properly broken down into its individual nutrients. This is also one reason why many patients also benefit a lot from their illness as the disease progresses body weight to lose (also called "tumor cachexia"). Those affected often report that they have the Lost appetite have and thereby additionally lose weight. Diet for pancreatic cancer should be discussed with the doctor.

Furthermore, the pancreas can become enlarged Imprint of the Duodenum to lead.

Terminal pain

It occurs in most patients strong pain on, sometimes called Back pain be interpreted. Usually the pain is in the Upper abdomen or in the Middle of the abdomen (Abdomen) to find.

Where the pain occurs also has something to do with the Spread of metastases in the body to do. There, where daughter tumors (= metastases) occur, characteristic complaints arise. Depending on where the primary tumor is in the pancreas, are preferred Lymph nodes In the immediate vicinity, the duodenum, bile duct, spleen, stomach, liver, lungs, large intestine or bones are attacked. The invasion of the bones by the tumor can trigger bone pain, which, depending on the location, can be felt as leg or back pain, for example.

More information can be found here: Pancreatic back pain

Pancreatic cancer is usually only discovered when the tumor has spread to other tissue, which is why it is usually already that at the time of diagnosis End-stage pancreatic cancer.

Jaundice (jaundice)

Since there is an increasing in the course of tumor growth Distension of the pancreas constrictions often arise Biliary tract, the one Bile build-up in the liver have as a consequence. In most cases this will reduce the work performance of the liver severely restricted and a Yellowing of the skin (jaundice)which is most often the very first symptom of pancreatic cancer. Most of the time, the patients go to the doctor first, which usually means the end stage of the pancreatic cancer.

They start first Conjunctiva of the eyes yellowish in color, followed by the rest of the skin of the body. Since the digestive tract is absent from the bile, it can also become one Discoloration of the stool (light gray stool) and dark urine.

In addition to the yellowish skin coloration, it can also be moderate to severe itching come on the skin because metabolic products of the bile fluids are deposited in the skin.

Water in the stomach

In advanced pancreatic cancer, there is almost always an accumulation of Water in the stomach. This also as Ascites On the one hand, the condition referred to arises from the fact that with increasing tumor growth there is a change in pressure in the blood circulation and in the abdominal cavity and blood and lymph vessels are sometimes strongly compressed. Due to the disturbed blood flow, liquid escapes from the blood and is "filtered" into the abdomen. If the peritoneum is also affected by the tumor cells, it comes to Peritoneal cancer and thereby also to an accumulation of water in the stomach.

On the other hand, disorders of liver function and digestion lead to an imbalance in the necessary protein.

All of these components cause a not inconsiderable amount of ascites to accumulate. This can become so large that it presses on other neighboring organs and affects them. A severely swollen ascites abdomen can also lead to shortness of breath.

Diagnosis of water in the abdomen

Water in the stomach can be recognized very easily and quickly in two different ways:

The patient lying supine would have ascites on the doctor's physical examination undulating movement of the abdominal surface lead if you knocked on a page.

For another, the free fluid in the abdomen is good with that Ultrasonic to see.

Therapy of water in the abdomen

Severe ascites can be punctured to relieve the patient. For this purpose, a small needle is pushed into the area that is particularly affected by ascites under ultrasound control. It is not uncommon for a few liters of the clear liquid to be emptied, which on the one hand relieves the patient immediately, on the other hand there is very often an overflow of the liquid, which makes a new puncture necessary.

Read more on the subject at: Puncture water in the abdomen

course

The pancreas can be removed in the event of cancer. Although this is Surgery a major procedure, especially if the Tumor in the head of the pancreas is localized, as this is somewhat hidden under the intestine and also very close to the aorta and other abdominal structures. Nevertheless, it is possible for those affected to live without this organ without any problems.

For most patients, however, surgery is not enough, or rather one cannot cure the disease with it. These patients get one chemotherapy, radiotherapy or one palliative treatment.

More information can be found here: Therapy pancreatic cancer

If the tumor, however completely removed could be and he no larger than 3 cm was Almost half survived Of the patients longer than 5 years.

More information can be found here: Pancreatic cancer prognosis and Pancreatic cancer chance of survival

End-stage therapy options

Morphine injections can help relieve pain.

Pancreatic cancer is a highly aggressive form of tumor.
Since the first noticeable symptoms usually only appear in the end stage of pancreatic cancer, the prognosis is unfortunately correspondingly poor.

Surgical treatment is often started in which the tumor, if possible, is removed and affected parts of the pancreas are operated on. In order to remove as many tumor cells as possible, adjacent abdominal organs, such as the gall bladder, are usually removed at the same time. Usually chemotherapy is added to or preceded by the operation.

In many cases of the end-stage pancreatic cancer, however, treatment is dispensed with due to the advanced disease. The operation is very large and stressful for the body, chemotherapy and radiation therapies have limited success and place an additional burden on the body, which is unfortunately usually necessary. This is why the prognosis for end-stage pancreatic cancer is not good. These measures would only weaken the body even more and would no longer be beneficial.

Treatment options for advanced pancreatic cancer are palliative measures. This is understood to mean treatment options that no longer aim to cure, but merely measures to alleviate suffering.

Read more on the subject at: Palliative medicine

A small tube (also called a stent) would almost always be inserted into the bile drainage duct, which is supposed to ensure that the bile can drain into the digestive tract. Once this stent is in place, the yellowing of the skin and itching will also go away.

The missing digestive enzymes are also replaced, thereby improving digestion.

Painkillers can also be given as a palliative measure for existing pain.

Morphine as a pain reliever

Morphine is a very potent pain reliever, which is used in the treatment of severe pain. It is also very often used in the treatment of tumor-related pain. In the end-stage of pancreatic cancer, pain develops very late, and is then described as belt-shaped and dull. After the common painkillers no longer help very quickly, drugs such as morphine are used. Often it is already one palliative treatment situation.

Morphine can be in Tablet form in the outpatient area, i.e. at home, or by a Syringe under the skin be given in the inpatient area or by a nursing service.

Side effectsn of morphine can almost always constipation and sometimes fatigue and rarely breathing disorders. Because of the urgent need for treatment of severe pain, the side effects are considered in the palliative treatment situation rather to be considered subordinate.

More information can be found here Morphine