Pancreas Treatment

The main tasks of pancreas concern digestion and sugar metabolism. An inflammatory disease of the pancreas is called pancreatitis.

Pancreatic cancer (pancreatic carcinoma) only accounts for three to four percent of all tumor diseases, but is responsible for around six percent of all cancer deaths due to its high degree of malignancy. According to Statistics Austria, more than 1,500 new cases and deaths from pancreatic cancer are counted in Austria each year, and the trend is rising. The mean age of onset is 71 years for men and 75 years for women.

Pancreatic cancer is often discovered by chance during an examination (e.g. ultrasound of the abdomen). The therapy depends mainly on the affected organ parts, the stage of the disease and the general health of the patient. Complete healing can only be achieved if the tumor can be completely removed surgically.

The pancreas is located behind the stomach in the abdominal cavity. Their main tasks concern digestion and sugar metabolism. The causes of pancreatic cancer are not known. Certain factors can increase the risk of the disease. Because pancreatic cancer rarely causes symptoms in its early stages, it is important to watch out for warning signs.

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The pancreas is located in the back wall of the abdominal cavity just behind the stomach. Their main tasks concern digestion and sugar metabolism. An inflammatory disease of the pancreas is called pancreatitis. 2021-10-23 Pancreas Treatment
More About Pancreas Treatment

Treatment of the pancreas

Acute pancreatitis

In acute pancreatitis, the digestive enzymes produced by the pancreas are activated too early. This triggers self-digestion of the organ and damages the tissue. These processes can also spread to neighboring structures in the abdomen and lead to inflammation and tissue damage. This creates typical complaints that can range from pain in the upper abdomen to life-threatening complications.

The most common causes are - in addition to high alcohol consumption (alcohol-induced pancreatitis) - biliary tract diseases such as bile duct stones (biliary pancreatitis). These can lead to a narrowing or to a closure of the common mouth of the pancreas and the bile duct in the duodenum and thus to a backlog of pancreatic juice. Less common causes of acute pancreatitis include:

  • endoscopic retrograde display and examination of the bile and pancreatic ducts (endoscopic retrograde cholangiopancreatography, ERCP),
  • Complications after abdominal surgery,
  • Infections,
  • Disorders in lipid metabolism (hyperlipidemia),
  • Disorders in the metabolism of the thyroid gland (e.g. hyperparathyroidism),
  • Medication,
  • Autoimmune processes,
  • genetic causes (hereditary pancreatitis),
  • Injuries,
  • Tumors,
  • certain secretion drainage disorders due to anatomical deviations.

In acute pancreatitis, the digestive enzymes produced by the pancreas are activated too early. This triggers self-digestion of the organ and damages the tissue. These processes can spread to neighboring structures in the abdomen and lead to inflammation. This can lead to ascites, pleural effusion and massive stress on the circulatory system and kidneys. Dead tissue and accumulations of fluid can subsequently become infected and lead to sepsis. Furthermore, fluid-filled chambers (pseudocysts) can develop in the pancreas. These often regress on their own.

What are the symptoms of acute pancreatitis?

The following symptoms can indicate acute pancreatitis:

  • Upper abdominal pain: often onset suddenly, violent, piercing or dull, radiating into the back in a belt shape,
  • possibly right-sided, colicky upper abdominal pain (with biliary pancreatitis),
  • Nausea,
  • Vomit,
  • Bloated stomach (meteorism),
  • Constipation,
  • Fever,
  • In severe cases, jaundice, ascites, pleural effusions, and signs of sepsis and shock can occur.

What complications can arise?

Acute inflammation of the pancreas is a serious condition that requires hospitalization. The course can be very different: In many patients, the inflammation subsides after one to two weeks. However, a severe course with complications can take weeks to months. Acute inflammation of the pancreas can sometimes be fatal. The following complications can occur, among others:

  • Dehydration of the body: If the body loses too much fluid, electrolyte disturbances can occur with potentially serious consequences such as severe limitations in physical and mental performance, heart problems, circulatory collapse and kidney failure.
  • Pseudocysts: Here, vesicles filled with secretion form in or on the pancreas, which cause mild symptoms such as stomach pain, but can also go unnoticed. In many cases they resolve on their own. Sometimes infection or bleeding can occur.
  • Infected pancreatitis: The inflammation can lead to the death of tissue in the pancreas, bacteria can colonize and in turn lead to an infection. This can spread in the abdomen.
  • Systemic Inflammatory Response Syndrome (SIRS): can occur as a result of a severely tissue-damaged pancreas. The infection affects the entire body and can lead to multiple organ failure.

How is the diagnosis of acute pancreatitis made?

In a detailed discussion (anamnesis), the doctor collects the symptoms and possible causes and carries out a physical examination. The upper abdomen is palpated and attention is paid to bluish to greenish discoloration of the skin (Cullens or Gray-Turners signs), which may indicate pancreatitis. The following examinations may be necessary for more detailed clarification:

  • Laboratory blood test
  • Pancreatic enzymes (amylase, lipase)
  • Inflammation values (especially CRP)
  • Liver parameters (GPT, GOT)
  • Biliary parameters (bilirubin)
  • Urinalysis (urinalysis)
  • Possibly puncture of the abdomen if infection is suspected

If necessary, imaging procedures are used to confirm the diagnosis and to clarify the causes, especially:

  • Ultrasonic,
  • X-Ray (roentgen),
  • endoscopic examination of the biliary and pancreatic ducts (endoscopic retrograde cholangiopancreatography, ERCP),
  • Computed Tomography,
  • MRI (Magnetic resonance imaging),
  • Endosonography

How is acute pancreatitis treated?

Since no prognosis can be made about the course of acute pancreatitis at the beginning, all patients are initially admitted to a hospital for a few days. The focus is on intravenous fluid and electrolyte replacement, the administration of antibiotics in the event of infection and the inhibition of gastric acid secretion (proton pump inhibitors) as well as pain relief with medication. Any bile duct stones are removed endoscopically, infected necroses are repaired surgically or endoscopically. If there is ascites or pleural effusion, drainage is carried out using drains. If pseudocysts do not resolve on their own over the course of several weeks, they are removed endoscopically or surgically.

Tube feeding is usually started on the second day in the hospital. As soon as the patient is free of pain, a slow diet is built up. Alcohol abstinence is recommended in any case to avoid a relapse.

Whom can I ask?

To clarify pancreatic complaints, the first point of contact should be a general practitioner. A visit to the following doctors may be necessary for further clarification and therapy:

  • Specialist in internal medicine (gastroenterology and hepatology),
  • Specialist in surgery.

Chronic pancreatitis

The most common cause of chronic pancreatitis is high alcohol consumption over a long period of time. The second most common cause is gallstones. Smoking, congenital malformations and genetic and autoimmune causes are also responsible for the disease. In some cases, the pancreas is gradually destroyed for unexplained causes. Typical complaints are upper abdominal pain and indigestion. Therapy ranges from eliminating the causes to replacing missing digestive enzymes.

What are the symptoms of chronic pancreatitis?

A recurring, rarely persistent epigastric pain that can radiate into the back is typical. The pain often occurs during or after eating. This is accompanied by impaired digestion (maldigestion) with nausea, bloating and flatulence.

In advanced cases, the following symptoms may occur as a result of the inadequate pancreatic function:

  • Weight loss,
  • sometimes very light, foul-smelling, voluminous stool (so-called fatty stool),
  • Diabetes mellitus,
  • Jaundice.

Possible complications

Pseudocysts: Here, vesicles filled with secretion form in or on the pancreas, which cause mild symptoms such as stomach pain, but can also go unnoticed. In many cases they resolve on their own. Sometimes infection or bleeding can occur.Narrowing of the duodenum or bile duct.

Splenic vein thrombosis with enlargement of the spleen.

Pancreatic cancer appears to be slightly more common in people with chronic pancreatitis.

How is the diagnosis made?

The anamnesis is followed by a physical examination by the doctor as well as pancreatic function tests (e.g. elastase-1 concentration, fluorescein dilaurate test, secretin-pancreozymin test) and stool examinations. If necessary, imaging procedures such as the endoscopic examination of the bile and pancreatic ducts (endoscopic retrograde cholangiopancreatography, ERCP), x-rays of the bile ducts (cholangiogram), ultrasound, magnetic resonance tomography, computed tomography and endosonography are used.

How is chronic pancreatitis treated?

The following measures are used to treat chronic inflammation of the pancreas:

  • Painkiller,
  • Replacement of digestive enzymes with every meal (balanced mixed diet),
  • Insulin in diabetes mellitus,
  • Removal of obstructions to the drainage caused by bile duct stones or constrictions (stenoses),
  • Endoscopic or surgical drainage of pseudocysts,
  • In the event of complications or persistent pain, parts of the pancreas can be removed or additional drains can be created for the pancreatic secretion into the intestine.
  • It is important to abstain from alcohol for life and avoid drugs that are toxic to the pancreas (e.g. diuretics, steroid hormones, etc.).

Whom can I ask?

To clarify pancreatic complaints, the first point of contact should be a general practitioner. A visit to the following doctors may be necessary for further clarification and therapy:

  • Specialist in internal medicine (gastroenterology and hepatology),
  • Specialist in surgery.

Pancreatic insufficiency

The pancreas is the only organ in the body that has a double function. In the case of pancreatic insufficiency, it can no longer adequately fulfill its functions. In the case of so-called endocrine pancreatic insufficiency, there is a lack of hormones that regulate blood sugar levels. In the case of exocrine pancreatic insufficiency, not enough digestive secretions are formed - this leads to problems in particular with fat digestion. Both forms can also occur together.

What is endocrine pancreatic insufficiency?

The endocrine part of the pancreas - the so-called islet apparatus, which consists of the islets of Langerhans - normally produces the hormones insulin and glucagon, which regulate the sugar level. In the case of endocrine pancreatic insufficiency, these hormones can no longer be produced in sufficient quantities. The result is usually diabetes. For more information, see Diabetes mellitus.

What is Exocrine Pancreatic Insufficiency (EPI)

The exocrine part of the pancreas produces an average of 1.5 liters of fluid with important digestive enzymes every day. They break down the proteins, fats and carbohydrates contained in the food into the smallest building blocks. These get from the intestines into the blood and are distributed throughout the body. Pancreatic exocrine insufficiency occurs when the pancreas does not produce enough digestive enzymes.

What are the causes of EPI?

Pancreatic exocrine insufficiency (EPI) can have a number of causes, including:

  • Cystic fibrosis: The inherited metabolic disease damages not only the bronchial system but also the digestive system, especially the pancreas. It becomes clogged with thick mucus. As a result, the digestive enzymes can no longer be released into the small intestine in sufficient quantities.
  • Chronic pancreatitis: The pancreatic cells are slowly destroyed by recurring inflammation. As the disease progresses, the damaged tissue becomes scarred.
  • Pancreatic cancer,
  • Surgical removal of the stomach (gastrectomy), e.g. due to stomach cancer: After the operation, the chyme gets into the intestine too quickly. As a result, the pancreas is often unable to deliver its digestive enzymes to the small intestine in time. You can therefore not mix sufficiently with the chyme. In addition, there is no communication from the stomach via the intestines to the pancreas, so that the gland is not sufficiently stimulated to produce enzymes.Smoking and alcohol can make pancreatic insufficiency worse.

What symptoms can I experience with EPI?

Pancreatic disorders often go undetected for a long time. The symptoms usually appear in phases and sometimes only after years in their entirety. Many symptoms are only clearly recognizable when 90 percent of the digestive function has already been lost.

Classic symptoms of exocrine pancreatic insufficiency include:

  • violent belt-shaped radiating epigastric pain,
  • Nausea,
  • Vomit,
  • Flatulence,
  • Diarrhea or constipation

Treatment for pancreatic cancer

What types of pancreatic cancer are there?

Pancreatic cancer can in principle occur in any area of the organ. The various forms of cancer are based on different types of tissue:

  • Exocrine tumors (common):Ductal exocrine tumors originate from cells that line the small ducts of the saliva-forming gland.
  • Acinar tumors originate from the enzyme-producing end pieces of the glands in the pancreatic duct system.Endocrine tumors (rare): can originate, among other things, from the hormone-producing cells of the islets of Langerhans, which are scattered within the glandular lobules.

What are the risk factors?

The causes of pancreatic cancer are not known. Certain factors can increase the risk of the disease, especially when they are combined, e.g .:

  • Smoking;
  • high alcohol consumption;
  • frequent contact with certain pollutants, e.g. pesticides, weed or fungicides, chlorinated hydrocarbons, chromium and chromium compounds, solvents (2-naphthylamine, benzidine or benzene derivatives), nickel, electromagnetic fields and fuel vapors;
  • Obesity;
  • Previous illnesses: e.g. inflammation of the pancreas, diabetes mellitus;
  • genetic predisposition to pancreatic diseases.

How to prevent pancreatic cancer

First and foremost are a healthy lifestyle and the avoidance of possible risk factors (especially smoking and alcohol). It is not yet fully understood which nutritional factors play a role in the development of pancreatic cancer. Large studies have shown that a diet rich in fruits and vegetables, high in fiber and vitamins, can lower the risk of cancer in general. A balanced diet also helps to maintain or achieve a healthy body weight.

Pay attention to warning signs

Pancreatic cancer rarely causes symptoms in the early stages. They usually only occur when the tumor is so large that it hinders the production of digestive enzymes or their drainage into the duodenum, or when it has already spread to other organs such as the stomach, duodenum, liver or peritoneum. Among other things, the following complaints arise:

  • Weight loss,
  • Pain in the abdomen or back,
  • Jaundice,
  • Loss of appetite,
  • Nausea,
  • Vomit,
  • Diabetes mellitus.

If these complaints occur, a doctor should be consulted immediately for a detailed clarification. The earlier a pancreatic cancer is discovered, the greater the chances of recovery.

How is the diagnosis made?

If pancreatic cancer is suspected, the doctor initiates the necessary diagnostic steps. Important examinations for the detection of pancreatic cancer are:

  • physical examination;
  • laboratory tests: urine, stool, blood, including tumor markers such as CA 19-9 (CA = cancer antigen), as well as CEA (carcinoembryonic antigen);
  • if an endocrine tumor is suspected, also chromogranin A, NSE (neuron-specific enolase), insulin, glucagon, gastrin, VIP (vasoactive intestinal polypeptide), PP (pancreatic polypeptide);
  • ultrasound examination;
  • Computed tomography (is the most suitable X-ray examination for the initial diagnosis);

If pancreatic cancer is diagnosed, further examinations are necessary to determine the extent of the tumor, for example:

  • Lung x-ray,
  • Endoscopy of the stomach and duodenum,
  • endoscopic representation of the pancreatic duct and biliary tract using X-rays (ERCP), endosonography,
  • MRI,
  • Tissue puncture,
  • Laparoscopy,
  • PET-CT,
  • Skeletal or octreotide scintigraphy.

How is pancreatic cancer treated?

The treatment strategy depends primarily on the type of tumor, the stage of the disease and the patient's general state of health. Complete healing can only be achieved if the tumor can be completely removed surgically. Therefore, if pancreatic cancer is suspected, the investigation must be carried out quickly. All other therapy options serve primarily to reduce the size of the tumor before a planned operation, to limit further tumor growth or to alleviate symptoms.

Pancreas cancersurgery

The aim is to eliminate the tumor tissue and the surrounding lymph nodes as completely as possible. The operation used to be considered very complicated. The postoperative results have improved significantly, not least due to specialization in pancreatic surgery, so that the procedure can now be rated as safe.

Pancreatic head carcinoma: With the head of the pancreas, the gallbladder, the lower part of the bile duct, the duodenum and sometimes also part of the stomach are removed (so-called Whipple operation). The interrupted connections are then re-established. A hospital stay of several weeks and a longer recovery phase are required after the operation.

Pancreatic tail carcinoma: Usually the spleen has to be removed as well.

Total pancreatectomy: In some cases, the entire pancreas must be removed.

Lymph nodes: In the course of the operation, lymph nodes (at least twelve) are also removed from the immediate vicinity of the pancreas. If they do not contain cancer cells, this indicates that the tumor has not spread. The number of affected lymph nodes also gives an indication of the later course of the disease.

Chemotherapy

Cytostatics are designed to kill cancer cells throughout the body, but cannot cure the tumor on their own. An adjuvant chemotherapy, i.e. performed after the operation, can have a beneficial effect on the course of the disease and improve the chance of recovery. Above all, gemcitabine, erlotinib, nab-paclitaxel, 5-FU / folinic acid, irinotecan and oxaliplatin are available. In the case of locally advanced tumors that cannot be safely removed by surgery, chemotherapy is carried out before the operation (neoadjuvant) in order to reduce the size of the tumor and achieve a better starting position for the surgery. If a tumor is no longer curable, palliative chemotherapy is carried out to possibly reduce the size of the tumor and alleviate the symptoms.

Radiotherapy

In the case of locally advanced tumors that could not initially be operated successfully, radiation can be carried out in combination with chemotherapy before the planned operation (neoadjuvant chemoradiotherapy). The tumor and the tumor extensions in the surrounding tissue are thereby reduced in size. This increases the chance that the tumor can be completely removed during the subsequent operation.In addition, radiation therapy is also used to eliminate tumor symptoms (e.g. pain) (palliative treatment).

Targeted drug therapies

These drugs (e.g. the tyrosine kinase inhibitor Erlotinib) target malignant tissue and largely spare healthy tissue. For example, they are directed against factors that promote tumor growth, cut off the blood supply to the tumor or prevent the transmission of signals between tumor cells.

Palliative therapy

It is used when the disease has progressed so far that a cure or effective tumor treatment is no longer possible. Palliative treatment includes, among other things, the relief of tumor-related complications and complaints, pain therapy, nutrition and psychosocial counseling or care for those affected, e.g. in the context of self-help groups or special psycho-oncological facilities or through psychotherapy.

Enzyme and hormone therapy

A tumor or surgery-related destruction of the pancreas can lead to digestive enzymes and hormones no longer being formed in sufficient quantities. Severe digestive disorders (exocrine pancreatic insufficiency) and / or diabetes mellitus can result. The missing enzymes or hormones (insulin) can be permanently supplied to the body in the form of medication.

Aftercare & rehabilitation

Regular check-ups should be carried out after tumor therapy. Tumor aftercare pursues the following goals:

  • Detect and treat a recurrence of the cancer in good time if the tumor can be surgically removed;
  • Identify, treat and, if necessary, alleviate the consequences of the operation and comorbidities;
  • generally to help with physical, mental and social problems.

Follow-up treatment (rehabilitation) is often recommended in order to accelerate the recovery and recovery process. There are specially set up aftercare clinics that can also carry out certain parts of a chemotherapy cycle if necessary. In addition, help is provided in matters of nutrition and in coping with psychological or social problems.

Whom can I ask?

Several medical specialties are involved in the diagnosis and treatment of pancreatic cancer. If you have any abnormalities or warning signals, contact your general practitioner. This / the latter initiates the further clarification in which, among other things, specialists in nuclear medicine, internal medicine and surgery can be called in. If you are already undergoing treatment or follow-up care, regular appointments will be made with the treating doctor.

When hospitalization is required?

Hospitalization is usually required for the diagnosis and treatment of pancreatic cancer. The hospital costs are billed for. The patient has to pay a contribution to the costs per day. Further medication treatment at home takes place by prescription from the general practitioner or specialist.

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