Pancreatic cancer

Pancreatic cancer is a malignant tumor that arises from the epithelium of the glandular tissue of an organ. The pancreas is conventionally divided into 3 parts, in each of which abnormal cells can develop. In 60% of cases, the tumor is localized in the head of the gland, in the body of the organ – 10%, in the tail – up to 10%. In 20% of cases, cancer affects the entire organ at once. The disease is difficult to diagnose by standard methods, therefore, patients often turn to an oncologist at a later stage.

Pancreatic cancer is the 4th most fatal cancer among all types of cancer. In order to undergo an accurate diagnosis if you suspect pancreatic cancer, you need to contact a modern clinic for the treatment of oncology. Leave your request on the MedTour website so that the coordinating doctor can choose the best hospital for you for examining the pancreas.

Why does pancreatic cancer occur

Scientists still do not know the exact cause of pancreatic cancer (carcinoma). According to the US National Cancer Institute, the disease can develop from two types of cells in the pancreas: exocrine and neuroendocrine cells. The exocrine type is more common and is usually found late. Neuroendocrine neoplasms (islet cell tumors) are less common but have a better prognosis.

Oncologists have identified factors that increase the risk of developing pancreatic cancer:

• Heredity (a similar diagnosis was made to older blood relatives);
• The presence of chronic pancreatitis in the patient’s history;
• Type 2 diabetes mellitus;
• Helicobacter pylori infection;
• Smoking tobacco products and alcohol abuse;
• Nutrition (abundant use of surrogate fats, red meat);
• Overweight.

How quickly pancreatic cancer develops depends on the type of cancer and the reason why it has arisen – it can be a primary or secondary tumor.

Other cancers such as breast, ovarian, bowel, and multiple melanomas can lead to the development of pancreatic carcinoma. If these diseases were diagnosed in the next of kin, then it is necessary to take into account the risks of pancreatic cancer in younger family members.

Pancreatic cancer symptoms

The key symptoms of pancreatic cancer are abdominal pain and jaundice. These signs are detected in 90% of patients with cancer. Often with jaundice, there is light stool and dark urine.

Pancreatic cancer symptoms:

• Yellowing of the skin and whites of the eyes;
• Changed color of urine and stool;
• Pains in the upper or middle part of the abdomen;
• Weight loss for no apparent reason;
• The feeling of fatigue has increased;
• Lack of appetite;
• Nausea and vomiting are regularly disturbed.

In the early stages, pancreatic cancer does not have severe symptoms. Primary symptoms are similar to those of other, less dangerous diseases. Therefore, in the presence of several symptoms, it is necessary to undergo a diagnosis and obtain a conclusion from narrowly specialized specialists – a gastroenterologist and an oncologist.

What symptoms of pancreatic cancer may occur in a patient will depend on the location of the tumor and the degree of damage to adjacent structures.

Pancreatic cancer diagnostics

Pancreatic cancer is the most difficult cancer to diagnose. This is due to the fact that most of the organ is covered by the stomach, bile ducts and intestines. This complicates the process of studying the state of the organ during standard examination procedures for ultrasound or CT.

To make an accurate diagnosis, the oncologist uses the results of modern types of diagnostics:

• Examination of the patient. The doctor takes a history and does an initial examination to look for outward signs of pancreatic cancer.
• Investigation of the chemical composition of blood. A specialist checks a blood sample to measure the amount of certain substances. Unusual (more or less) blood components, such as bilirubin, can be a sign of illness.
• Tumor markers test. A procedure in which a sample of blood, urine, or pancreatic tissue is examined for changes such as CA 19-9 and CEA carcinoembryonic antigen. These substances are associated with certain types of cancer if they are found in high amounts in the body.
• Magnetic resonance imaging. The doctor takes a series of detailed pictures of areas inside the body. This procedure allows to identify internal pathologies of the organs of the gastrointestinal tract.
• Endoscopic ultrasound examination (endosonography). The doctor uses an endoscope – a thin tubular instrument with illumination and a lens for examining internal organs. The probe at the end of the endoscope is used to reflect the ultrasound. This forms a picture (sonogram) of internal tissues and organs.
• Positron emission tomography (PET scan). This is the procedure for the most accurate detection of malignant cells. The doctor injects a small amount of radioactive glucose into the patient’s vein. The PET scanner rotates around the person and takes a picture of the area where glucose is used in the body. Tumor cells appear brighter because they are more active and consume more glucose than healthy cells. PET scans and computed tomography can be done at the same time – this is called PET-CT.
• Endoscopic retrograde cholangiopancreatography (ERCP). The procedure is carried out for X-ray examination of the ducts through which bile is transferred from the liver to the gallbladder and then to the small intestine. Sometimes pancreatic cancer narrows and blocks these ducts, causing jaundice.
• Percutaneous transhepatic cholangiography. The doctor inserts a thin needle into the patient through the skin and into the liver. A special dye is injected into the liver or bile ducts, after which an x-ray is taken. When a blockage is found in the liver, a flexible tube (stent) is sometimes left to drain bile into the small intestine or into a bile collection bag (outside the body). This test is only used if ERCP cannot be performed.
• Laparoscopy. An invasive method for examining the internal organs of the abdominal cavity. Small incisions are made in the abdominal wall, into one of which a laparoscope is inserted – a thin tube with illumination. There may be an ultrasound probe at the end of the laparoscope. Other instruments are inserted through other incisions to collect tissue samples from the pancreas or abdominal fluid to check for cancer.
• Biopsy. Examination of suspicious tissue under a microscope. There are several ways to get a biopsy for pancreatic cancer. For example, during laparoscopy.

In some cases, patients develop cysts that can develop into malignant tumors. Only experienced specialists know how to distinguish a cyst from pancreatic cancer, because it can be a benign neoplasm. Specialized diagnostics plays an important role, since it is impossible to distinguish pancreatic cancer from pancreatitis under the conditions of standard examinations in a regular clinic.

Examples of the cost of PET-CT for pancreatic cancer in clinics around the world:

• Ukraine – от $400;
• Turkey – от $800;
• South Korea – от $1 000;
• Germany – от $2 400.

To reliably diagnose the stage of pancreatic cancer, the doctor must receive the results of all necessary examinations of the patient. The earlier the diagnosis is made, the greater the chances of a favorable prognosis in treatment.

Pancreatic cancer survival

The overall prognosis for survival in pancreatic cancer is influenced by the individual parameters of the patient: age, general condition, stage of cancer and concomitant diseases. Also, the group to which the cancer belongs determines the effectiveness of a particular treatment method. The main groups of doctors include: operable, borderline and inoperable pancreatic cancer.

General projections for five-year survival, depending on the stage and group of the disease:

• Stage 1 resectable cancer – 61%;
• Stage 1 inoperable cancer – IA 14%, IB 12%;
• Stage 2 resectable cancer – 52%;
• Stage 2 inoperable cancer – IIA 7%, IIB 5%;
• Stage 3 resectable cancer – 41%;
• Stage 3 inoperable cancer – 3%;
• Stage 4 operable (Nano-knife) cancer – up to 16%.

Stage 4 thyroid cancer with an inoperable group of the disease has a poor prognosis. The five-year survival rate does not exceed 1%.

According to the averaged statistical data, after complete removal of the pancreas followed by the use of replacement therapy, about 10% of patients live at the 5-year mark without relapse. How long you can live with pancreatic cancer without surgery will depend on the rate of progression of the disease and the occurrence of complications.

How long people with pancreatic cancer live depends on the results of surgical and therapeutic techniques. It is possible to combine the most effective methods of treatment in TOP oncology clinics that operate according to new protocols and have access to innovative drugs.

Pancreatic cancer stages

The earliest stage of cancer is 0 (carcinoma in situ). The disease then progresses to stage 4 pancreatic cancer.

How to stage pancreatic cancer according to clinical presentation:

• At stage 1, the tumor size is up to 2 cm (ІA) or more than 2 cm (ІB). The neoplasm does not go beyond the pancreas, there are no metastases.
• At stage 2, the tumor has a size of 4 cm or more. It crosses the borders of the gland and affects the duodenum and bile duct. Malignant neoplasm can spread to regional lymph nodes.
• In stage 3, the tumor spreads to the spleen, stomach and large intestine. The process can affect the nearest lymph nodes. There are risks of spreading the oncological process to vital nerves and blood vessels.
• At stage 4, the process of metastasis begins. Cancer cells travel to the lungs, liver, and other organs.

In addition to the stages of cancer, the way the cancer spreads plays an important role in diagnosis and treatment. The tumor can spread in the following ways:

• Through tissues – cancer passes from the place where it originated into nearby structures;
• Through the lymphatic system – cancer cells spread through the lymphatic vessels to other parts of the body;
• Through blood – cancer spreads through the blood vessels to other organs.

A metastatic tumor is the same type of cancer as the primary tumor. For example, if pancreatic cancer spreads to the liver, the abnormal cells in the liver are actually pancreatic cancer cells. As a result, the disease is metastatic pancreatic cancer, not liver cancer.

What is the treatment for pancreatic cancer

An effective treatment method that increases the survival rate for pancreatic cancer is surgery – pancreatoduodenal resection followed by chemotherapy.

Depending on the stage of the cancer, doctors can combine modern methods of oncology treatment. There are treatment standards that are most effective in oncological practice for pancreatic carcinoma.

Pancreatic cancer surgery

In modern pancreatic surgery, doctors use one of three types of surgery. The choice of intervention technique will depend on the size and location of the tumor.

Operation Whipple

Pancreatoduodenectomy (or Whipple surgery) is done to treat cancer of the head of the pancreas. An experienced doctor can carry out all the manipulations through 4-5 thin incisions laparoscopically. The surgeon removes the head of the organ, part of the bile duct, gallbladder, duodenum and part of the stomach. This eliminates the further spread of cancer cells to neighboring organs.

Operation Whipple is one of the most difficult in abdominal surgery. The effectiveness of treatment and the duration of the patient's rehabilitation depend on the clinical experience and qualifications of the doctor.

Total pancreatectomy

The operation is indicated for removal of a tumor in pancreatic cancer.

The surgeon removes not only the organ itself, but also a segment of the small intestine, part of the stomach, bile duct, gallbladder, spleen, regional lymph nodes. This helps prevent cancer recurrence.

Distal resection

The operation is performed to remove neoplasms in cancer of the tail of the pancreas. The surgeon removes the entire gland and spleen. The resection is performed by an open or laparoscopic method. In some clinics, such operations are performed on a Da Vinci robot.

If the tumor is inoperable, foreign surgeons perform other types of interventions to alleviate the patient's condition. If the tumor is blocking the bile duct, biliary bypass surgery or bile drainage stent placement may be done. If a tumor blocks the flow of food from the stomach, the organ can be sutured directly into the small intestine so that the patient can eat normally.

Methods for treating pancreatic cancer

Any option of surgical treatment must be supplemented with therapy – this helps to reduce the size of the tumor before the intervention and destroy the remnants of metastases after the operation. In some cases, therapy is the only treatment that can be used to improve the patient’s quality of life.

Radiation therapy for pancreatic cancer

Radiation therapy is a treatment for tumors that uses high-energy X-rays or other types of radiation to completely kill or prevent the growth of cancer cells. External beam therapy uses a device outside the body to precisely direct the radiation to the area affected by the cancer.

Abroad, doctors often use the CyberKnife, a robotic radiosurgical unit for precise irradiation of pancreatic tumors. The system can be used as an alternative to traditional surgery for inoperable tumors.

Pancreatic cancer chemotherapy

Chemotherapy is a treatment that uses drugs to stop the growth and division of cancer cells. Chemotherapy drugs are taken orally, injected into a vein or muscle. This is how drugs enter the bloodstream and can reach cancer cells throughout the body – this is called systemic chemotherapy. Combination chemotherapy is treatment using several types of anticancer drugs.

Targeted therapy for pancreatic cancer

Targeted therapy is a type of treatment that uses drugs to identify and target certain cancer cells. This treatment does less harm to healthy cells than chemotherapy or radiation therapy.

Whether grade 4 pancreatic cancer can be cured will depend on the patient's individual response to treatment. As a rule, a combination of modern methods of targeted, radio and other types of therapy gives good results in combination with surgery.

Modern methods of treating pancreatic cancer abroad

Doctors of foreign clinics can supplement the main treatment according to the protocols with innovative methods. Thanks to the modern equipment of hospitals and access to modernized drugs, foreign oncologists are using new ways to fight pancreatic cancer at different stages.

Pancreatic cancer immunotherapy

Immunotherapy drugs activate the patient’s immune system so that the body knows what to do if pancreatic cancer has invaded healthy tissue. Similar drugs are used in some clinics in the CIS countries, but no more than 20 types of them are available. In hospitals in Europe and Turkey, doctors use more than 70 types of drugs for immunotherapy. This makes it possible to choose the most effective medicine individually for each case.

Irreversible electroporation

The NanoKnife is a device that destroys a tumor by using a pulsating electric current. This does not damage the surrounding healthy tissue, blood vessels and bile ducts. Doctors use the Nano Knife to treat pancreatic cancer in combination with chemotherapy or during surgery to completely destroy cancer cells after the tumor has been removed.

Pancreatic cancer radiosurgery

Stereotactic radiation therapy with TrueBeam and Novalis linear accelerators is a non-surgical treatment of pancreatic tumors at different stages. The radiologist enters the parameters of the tumor into the computer and sets the radiation power. Further, the system itself regulates the direction and accuracy of the exposure using high-energy X-rays. This is how the destruction of malignant cells occurs.

Clinics in Turkey, Europe, Israel and South Korea are actively involved in the development of new treatment protocols that will be even more effective. How to deal with pancreatic cancer should be determined by experienced specialists. Therefore, turning to foreign oncologists significantly increases the patient's chances of survival and even a complete cure for cancer.

How much does pancreatic cancer treatment cost?

The cost of treatment is influenced by the volume of diagnostic procedures, the stage of pancreatic cancer, and the methods of surgery and therapy. If the patient presents at a late stage, the treatment process can be more complicated and costly than at an early stage of the disease.

The cost of innovative drugs for targeted, immuno- and chemotherapy in all foreign clinics is the same. Prices for services in medical centers and additional services may differ.

Examples of prices for medicines in foreign hospitals:

• Chemotherapy course for intravenous injection – from $1 000;
• Immunotherapy – from $2 500;
• Targeted therapy drug – from $3 000.

Whipple surgery cost in foreign clinics:

• Turkey – от $25 000;
• Germany – от $30 000;
• Spain – от $40 000.

To choose a clinic where it is better to treat pancreatic cancer, leave a request on the MedTour website. The coordinating doctor will choose the most optimal option for the cost and quality of medical services, and will help you with all organizational issues.

Published: 10.09.2021

Updated: 01.10.2021

Medical author:

Ilona Baidiuk

Information on this webpage verified by the medical expert

Medical Doctor, oncologist, PHD student

Kateryna Maliarchuk