Would pancreatic cancer show up on MRI

Pancreatic cancer

Brief overview

  • What is pancreatic cancer? Malignant tumor of the pancreas. Is relatively rare in Germany (around 16 out of 100,000 people develop it every year). The mean age of onset is 70 years (men) and 76 years (women). Despite its rarity, pancreatic cancer is the third most common tumor of the gastrointestinal tract (after colon and stomach cancer).
  • Risk factors: Smoking, alcohol consumption, obesity, diabetes (diabetes mellitus), hereditary breast cancer or ovarian cancer, etc.
  • Symptoms: no complaints for a long time; later epigastric pain, back pain, weight loss, loss of appetite, jaundice, diabetes mellitus, nausea and vomiting, indigestion, fatty stools, etc.
  • Investigations: Blood tests (with determination of tumor markers), abdominal ultrasound, endoscopic ultrasound (endosonography), computed tomography (CT), magnetic resonance imaging (MRT), magnetic resonance cholangiopancreatography (MRCP; special MRI examination), removal and analysis of a tissue sample, possibly a laparoscopy ( Laparoscopy), chest x-ray (chest x-ray) and other examinations
  • Treatment: Surgery, possibly chemotherapy, radiation therapy (only in certain cases), pain therapy
  • Forecast: Healing is only possible if the tumor is still locally limited. Because pancreatic cancer is often discovered late and usually grows rapidly and aggressively, the prognosis is generally poor.

Pancreatic cancer: symptoms

The pancreatic cancer symptoms are affected by the Type and location of the tumor influences:

The pancreas, which consists of the head, body and tail, is located in the upper abdomen behind the stomach and immediately in front of the spine. It consists of two different types of glandular tissue:

  • That makes up the largest part exocrine tissue. It produces digestive juice containing enzymes that is passed into the small intestine.
  • Interspersed in the exocrine gland tissue are groups of cells endocrine tissue, the so-called Langerhans Islands. These gland cells produce hormones such as the blood sugar lowering insulin and its counterpart glucagon. They are released into the blood.

About 95 percent of all pancreatic tumors develop from the exocrine gland tissue. In the remaining cases, the tumor arises from hormone-producing (endocrine) gland cells. Depending on the type of cell, one speaks of an insulinoma or a glucagonoma, for example.

The most common form of cancer is pancreatic cancer in the head part of the pancreas.

Common symptoms in pancreatic cancer

With any form of pancreatic cancer, those affected usually do not notice the disease for a long time. As soon as symptoms appear, the cancerous tumor often presses on neighboring structures (bile duct, stomach, small intestine, etc.) or grows into them. It is not uncommon for daughter resettlements (metastases) to be present. Symptoms of the following types are common at this advanced stage of pancreatic cancer:

  • persistent pain in the upper abdomen and back: The back pain can increase if you lie on your back.
  • Loss of appetite
  • Weight loss: If the exocrine tissue produces too few or no digestive enzymes as a result of pancreatic cancer, the nutrients in the intestine can only be broken down to a limited extent or not at all. The impaired supply of nutrients leads to weight loss.
  • Digestive disorders and fatty stool: The lack of digestive enzymes from the diseased pancreas causes, among other things, that the fat from food can no longer be properly absorbed in the intestine. It is then excreted undigested with the stool - the resulting fatty stool is light, shiny, and has a pungent odor.
  • Nausea and vomiting
  • Jaundice (jaundice): Pancreatic cancer in the head of the pancreas can press on the bile duct or block it (it runs a little way through the head of the pancreas). The bile then builds up, which causes jaundice: the skin, mucous membranes and the white dermis in the eye turn yellow. The urine is dark, the stool light.
  • Diabetes (diabetes mellitus): Sometimes the tumor produces too little or no insulin at all. It is then usually an endocrine tumor. The lack of insulin leads to diabetes.

The symptoms of pancreatic cancer are similar to those of inflammation of the pancreas (pancreatitis). Sometimes both diseases occur together. Both can make diagnosis difficult.

An endocrine pancreatic tumor sometimes produces an increase in the gastric acid-stimulating hormone gastrin. That can lead to the formation of a Gastric ulcer because too much acid in the stomach irritates the stomach lining. However, since stomach ulcers can also have other causes, they are no more specific symptoms of pancreatic cancer than back pain.

Smaller blood clots form less often in pancreatic cancer as a result of pressure on surrounding vessels. These can clog the affected vessel (thrombosis). This often happens, for example, in the splenic vein, which runs near the pancreas.

The pancreas also contains a high concentration of the blood clotting factor thrombokinase. The organ changes caused by cancer can disrupt the blood coagulation system, so that small clots form all over the blood vessels (disseminated intravascular coagulopathy, DIC). The coagulation factors are used up, which increases the risk of bleeding. In addition, clots can peel off and block a vessel elsewhere (embolism).

If the pancreatic cancer spreads to the peritoneum (peritoneal carcinosis), the cancer cells release fluid into the abdominal cavity - a "Ascites"(Ascites). Possible signs are a bulging or enlarged abdomen, unwanted weight gain and indigestion.

Pancreatic cancer: treatment

A pancreatic carcinoma discovered at an early stage is attempted to be cured as completely as possible. Unfortunately, however, pancreatic cancer is often discovered very late. A cure is then usually no longer possible. The treatment then serves to alleviate the symptoms of the patient and to slow down or stop the further spread of the tumor (palliative therapy).

In principle, the doctor has various options for treating pancreatic cancer. When which therapy is useful depends on the individual case.

Operative therapy

Surgery is only an option for 10 to 20 percent of pancreatic cancer patients. The procedure is only really effective if the surrounding tissue is still free of cancer. If the tumor can be completely removed during the operation, a cure may be possible.

The most common pancreatic cancer develops in the head of the pancreas. Then generally a Kausch-Whipple operation performed: The surgeon removes the head of the pancreas as well as the gallbladder, bile duct, small intestine, the lower part of the stomach and regional lymph nodes. An alternative is that pylorus-conserving pancreatic head resection. The lower part of the stomach (pylorus = stomach outlet) is retained.

In the case of pancreatic cancer in the tail of the pancreas, the spleen often has to be removed as well.

In some cases of pancreatic cancer, it is not enough to cut the diseased tissue out of the pancreas - it has to whole pancreas removed become.

After the operation, many patients have to do the missing ones Pancreatic digestive enzymes in capsule form take in. This is the only way that digestion can continue to function.

chemotherapy

As a rule, the pancreatic cancer operation is followed by chemotherapy (adjuvant chemotherapy). Special drugs (cytostatics) are administered to prevent the rapid division of cells. The aim is to eliminate cancer cells that may still be in the body after the operation. If possible, chemotherapy should be started within six weeks after the operation and should last six months.

Sometimes chemotherapy is given before the operation. These neoadjuvant chemotherapy is intended to shrink the tumor so that it can then be cut out more easily.

radiotherapy

Radiation therapy (radiotherapy) for pancreatic cancer is not generally recommended. However, it can be used in controlled studies. For example, one can try in such a study to support pancreatic cancer treatment with combined radiation and chemotherapy (radiochemotherapy). This can be considered in the case of locally advanced pancreatic carcinoma that cannot be operated successfully.

In the case of pancreatic cancer that is no longer curable, radiation can also be used specifically to alleviate symptoms (such as tumor pain).

Pain management

Many people with pancreatic cancer experience severe abdominal pain. These are treated by means of pain therapy according to the World Health Organization (WHO) level scheme:

First you try to relieve the pain with non-opioid drugs such as paracetamol or ASA. If that is not enough, the doctor will also prescribe weakly effective opioids such as tramadol. If the pain cannot be brought under control, the non-opioid level 1 painkillers are combined with highly effective opioids (such as morphine). These have the strongest analgesic effect.

In some patients with incurable pancreatic cancer, this drug-based pain therapy does not help sufficiently. Then you can try one Block the nerve plexus in the abdomen, the so-called celiac plexus. This prevents the transmission of pain stimuli to the brain.

Other measures

Particularly in palliative pancreatic cancer treatment (i.e. in the case of cancer that is no longer curable), further measures are often taken for the benefit of the patient. The aim is to ensure that the patient can spend the rest of his life without any (severe) discomfort as possible.

This can often be achieved with individually tailored pain therapy (as described above). If necessary, additional palliative measures can be added. For example, if the tumor constricts or closes the bile duct, those affected will suffer from jaundice. Then one can endoscopic intervention help: With the help of a thin, tubular instrument (endoscope), the doctor inserts a small plastic tube (stent) into the bile duct to keep it open.

A gastric outlet enclosed by the tumor can also be widened using an endoscope. In the event of severe constriction, it can make sense to supply the patient with the necessary nutrients via a feeding tube in the future (enteral feeding). One is also possible parenteral nutrition - the administration of nutrient solutions directly into the blood.

In addition to doctors, physiotherapists, masseurs, social workers, psychologists and pastors can effectively support the palliative treatment of pancreatic cancer patients.

For all palliative therapy measures for pancreatic cancer, the doctor and patient must bear in mind that the mean life expectancy for inoperable tumors is only three to five months after diagnosis. Therefore, measures that have serious side effects should be avoided here.

Diet in pancreatic cancer

Pancreatic cancer can destroy the tissue so that the Organ function disturbed is. This also applies after an operation in which surgeons have removed the pancreas or parts of it. On the one hand, the pancreas produces important digestive enzymes. On the other hand, it controls the blood sugar balance with hormones such as insulin.

Cancer - eleven old wives' tales

  • Eleven cancer myths checked

    The fear of cancer fires the imagination and drives bizarre flowers. The cancer information service has questioned the rumors. From truth to old wives' tales: the biggest cancer myths in the science check.
  • Cancer from deodorant?

    Deodorants reduce perspiration. And this is supposed to reduce the exudation of pollutants and thus increase the risk of cancer. In fact, however, it is primarily the kidneys, bladder and intestines that transport harmful substances out of the body. Whether ingredients in cosmetics such as parabens or aluminum are harmful is at least doubtful. At the moment this seems unlikely.
  • Vitamin pills instead of fruit?

    Do vitamin pills protect better than fruit? Many people seem to believe this and take vitamin pills on a daily basis. However, dietary supplements are expressly not recommended for cancer prevention. Much more important is a balanced diet, say experts. In the case of a proven deficiency, however, a sensible supplement should be provided in consultation with the doctor.
  • Unhealthy Vegetables?

    There is a grain of truth in every myth. Even vegetables can make you sick: Green tomatoes and raw potatoes still contain alkaloids, which are described as slightly toxic. Ripe tomatoes and cooked potatoes, on the other hand, are healthy.
  • Breast cancer from skimpy bras?

    There is a persistent rumor that bras that are too tight promote breast cancer. But that belongs in the realm of old wives' tales. However, large breasts may be more prone to cancer. American studies suggest that women with cup sizes C and D have a higher risk of breast cancer than women with smaller breasts.
  • Is Cancer Contagious?

    Many are afraid of contracting a deadly disease. In the case of cancer, however, this concern is unjustified - cancer itself cannot be infected. However, pathogens play a role in the development of cancers such as cervical and stomach cancer. And you can very well become infected with it. The former was protected by a vaccination, the latter by an antibiotic cure.
  • Deserved Punishment?

    In the past it was often preached that illness (especially cancer) was the punishment for moral offenses. But that's just a myth that was used to enforce norms. However, one's own behavior can actually influence the risk of cancer. The decisive factor, however, is not a moral attitude, but a healthy lifestyle. It can help reduce the risk.
  • Just starve the cancer?

    One hears again and again about cancer diets. Can you starve cancer by starving it out of sugar and carbohydrates? Experts do not agree with this. They recommend a balanced diet and the achievement or maintenance of normal weight. However, being underweight can be very dangerous, especially for cancer patients.
  • Are the hormones to blame?

    Yes and no. Hormones actually affect the development of some types of cancer. But artificial feeding can have both protective and harmful effects. Contraception with estrogens and progestins can slightly increase the risk of breast cancer, but protects against uterine and ovarian cancer. Data on hormone replacement therapy for menopausal symptoms are clearer - it is riskier.
  • Do OPs wake up tumors?

    Biopsies and surgery are standard in cancer diagnosis and treatment. However, some patients fear that needles and knives will shake the cancer cells awake and make them even more aggressive. Others believe that the air that comes to the tumor in this way gives it the opportunity to develop even more. However, there is currently no evidence of this.
  • Miracle pill for cancer?

    Time and again, self-appointed healers offer supposed miracle pills and cures for cancer. The only ones who benefit from it, however, are the quacks themselves. In the worst case, the desperate sick neglect conventional medical therapy, which could perhaps save their lives. A secret recipe against cancer is not in sight. But there are also alternative healing methods that support cancer therapy or can alleviate its side effects.
  • Injuries as a cause?

    Sometimes the connection seems clear: some time after an injury, the doctor finds a tumor in the same part of the body. In fact, assumptions that bumps, bruises, blows, bruises, and other trauma promote cancer development go back to outdated beliefs from centuries ago. The exception: lymphedema or burn scars can be the cause of certain tumors. But that happens very rarely.
  • By Dr Varinka Voigt

Diet in cancer of the head of the pancreas

If the cancer has affected the head of the pancreas or if it has been removed, this is mainly the cause Digestive problems. Mushy, fatty stools are the result. To replace the missing enzymes, doctors prescribe special drugs. These contain a Enzyme mixture (Pancreatin), which makes up for the deficiency. Affected people take the capsules with a meal.

If you have cancer of the pancreas or after its operation, it is advisable to adjust your diet. Nutritional tips in pancreatic cancer are:

  • No big meals: It is better to eat several times throughout the day (five to eight times) and in smaller quantities.
  • No high fat meals: Also use special fats when cooking, so-called MCT fats (= medium-chain triglycerides). You can find these in a health food store, for example.
  • Easily digestible: Eat light whole foods. Avoid large amounts of raw vegetables or flatulent foods such as cabbage, onions or legumes. Heavily smoked, grilled or fried meat products are also less on the menu.
  • Chew well: This means that enough saliva mixes with food. This is because it contains substances that have a similar effect to the enzymes in the pancreas.
  • Drink the right thing: Above all, drink water, tea, or vegetable juices. When it comes to pancreatic cancer, it's best to leave the alcohol aside. He puts a lot of strain on the organ.

The general rule is: Eat what you can tolerate best. A food diary can help to find out.

Diet in pancreatic tail cancer

If the tail of the pancreas is affected, digestion is often only slightly affected. However, it is Insulin production mostly disturbed by it. So become patients diabetic (pancreatic diabetes) and have to inject insulin. Special diabetes and nutritional advice can then help those affected.

Because in addition to injecting insulin, they must now also learn to recognize the signs of hypoglycaemia, for example. Symptoms include, for example:

  • Tremble
  • Cravings
  • sweat
  • Racing heart
  • Circulatory disorders
  • fatigue
  • confusion
  • Fainting, coma

Those affected should always carry glucose or special sugar solutions with them in an emergency. Also inform the people in your area so that they know what is going on in an emergency and can help accordingly.

Nutrition with removal of the whole pancreas

If the cancer has destroyed large parts of the pancreas or if doctors have completely removed the organ, both important digestive proteins and hormones are missing. Those affected then also receive medication with enzymes and from then on inject themselves with insulin. Here, too, are the treating Doctors and nutritionists the most important contact persons.

In severe cases in particular, oncological rehabilitation makes sense after treatment has been completed. Here trained specialists help, among other things, to successfully implement new eating habits.

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Pancreatic cancer: causes and risk factors

It is not yet fully understood why pancreatic cancer develops. Presumably one is playing hereditary predisposition a certain role. Smoke and Alcohol consumption are considered to be certain risk factors: According to experts, the so-called cotinine value is increased in heavy smokers. This substance is produced when nicotine is broken down in the body and is considered to be carcinogenic. Regular alcohol consumption often causes the pancreas to become inflamed - and chronic inflammation makes the glandular tissue more susceptible to pancreatic cancer.

Metabolic changes can also contribute to a type of chronic inflammation very overweight and belly fat to lead. Therefore, obese people are more likely to develop pancreatic cancer. There at Diabetes mellitus-Patient's pancreatic tissue is also damaged, they are also more prone to pancreatic cancer.

Certain diseases are other established risk factors. So have women with you hereditary breast cancer or ovarian cancer and their relatives have an increased risk of pancreatic cancer. Some rare hereditary diseases also make you more susceptible to a malignant pancreatic tumor (e.g. Peutz-Jeghers syndrome).

In addition, there are some factors that are thought to increase your risk of pancreatic cancer. These include the frequent consumption of sugar as well as smoked or grilled food and frequent contact with certain chemicals and toxins (chromium and chromium compounds, chlorinated hydrocarbons, herbicides, pesticides, etc.).

Tip: To reduce the risk of pancreatic cancer, one should not smoke, avoid alcohol as much as possible and maintain a healthy body weight. A diet rich in fruits and vegetables may also reduce the risk of the disease.

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Pancreatic cancer: examinations and diagnosis

If pancreatic cancer is suspected, the doctor will first have a detailed discussion with the patient to find out Collect medical history (Anamnese). Among other things, he has all complaints described in detail, asks about any previous illnesses and any known pancreatic carcinoma diseases in the family.

Follow the anamnesis interview various examinations. They serve to clarify the suspicion of pancreatic cancer and to rule out diseases with similar symptoms (such as pancreatitis). If the suspicion of pancreatic cancer is confirmed, the examinations also help to determine the spread of the tumor in the body.

  • Physical examination: For example, the doctor feels the abdomen to determine any swelling or hardening in the abdomen.
  • Blood test: A blood analysis gives the doctor information about the general health of the patient and the function of various organs (such as the liver). In addition, so-called tumor markers are determined. These are certain substances that can be increased in a tumor disease (CA 19-9, CA 50, CEA). Using the tumor markers, the tumor stage can be determined and the course of the disease assessed.
  • Abdominal ultrasound: