How is pancreatic and liver cancer treated

Pancreatic cancer: therapy

Pancreatic cancer can be treated using several methods:

  • Surgical removal of the tumor
  • chemotherapy
  • radiotherapy
  • Palliative therapy
  • Other methods of treatment

The location and spread of the tumor, the general condition of the patient and the presence of metastases determine the choice of the appropriate treatment method.

With the help of a tube (stent), the bile can also be directed into the small intestine if the tumor blocks the flow of bile. In addition, the missing enzymes or hormones are supplied to the body in the form of medication if the pancreas can no longer produce enough digestive enzymes and hormones due to the tumor.

In the case of hormone-forming tumors of the pancreas, drugs can relieve symptoms. Proton pump inhibitors, for example, lower the acid concentration in the stomach in a gastrinoma. The active ingredient octreotide can lower the glucagon level in a glucagonoma and eliminate rash and loss of appetite. Zinc ointments can also be used for the rash.

surgery

The goal of the surgery is to completely remove the tumor. However, this is only possible if the tumor is discovered early and is still limited to the pancreas. Only 15-20% of all patients are eligible for an operation, in 80% only chemotherapy can stop the tumor growth. If the tumor has already infected the surrounding tissue or even adjacent organs such as the stomach, spleen and liver, an operation is often no longer useful.

The extent of the operation is adjusted depending on the extent and location of the tumor. If possible, only part of the pancreas is removed so that digestive enzymes and hormones can still be produced.

If the tumor is in the head of the pancreas, as is often the case, the operation usually also removes the gall bladder, the lower part of the bile duct, the duodenum and sometimes part of the stomach (so-called Kausch-Whipple operation) . In some cases, the entire pancreas must be removed (total pancreatectomy).

When the duodenum has to be removed, the connection between the stomach and the small intestine is initially broken. In order for the patient to be able to eat again and for the bile to drain into the small intestine, this connection must therefore be restored. This is done by attaching a loop of the small intestine to the stomach or remaining stomach or to the bile duct.

If the entire pancreas is removed during the operation, the patient is given the hormones and digestive enzymes as medication.

chemotherapy

The drugs used in chemotherapy block tumor cells from multiplying and thus reduce the size of the tumor (cytostatic drugs). Gemzitabine, Erlotinib, Oxaliplatin or Capecitabine are primarily used for pancreatic cancer.

Chemotherapy is necessary when surgery may not have removed all of the cancer cells in the body (adjuvant therapy). This is to prevent a relapse (relapse). The medication is taken over certain periods of time (cycles) with breaks in between. The intake must be continuously monitored by a doctor who monitors the effects and side effects of the medication.

The active ingredients of chemotherapy inhibit the cells in the body that divide particularly quickly. As the drugs travel throughout the body through the bloodstream, healthy cells capable of dividing are also damaged, e.g. B. mucosal or hair root cells. This can lead to more or less severe side effects such as anemia, bleeding, infection, nausea, loss of appetite and hair loss. Modern cytostatics, however, are much better tolerated than older preparations.

radiotherapy

The use of radiation therapy for pancreatic cancer is controversial. In certain cases it can sometimes be useful. If the carcinoma has not yet formed daughter tumors (metastases) but has already infiltrated the intestines and blood vessels, it is usually inoperable. In this situation, it is discussed to reduce the size of the tumor by a combination of radiation and chemotherapy in order to then be able to remove the tumor surgically (neoadjuvant radio-chemotherapy).

Palliative therapy

If a cure or effective tumor treatment is no longer possible, the main aim of the treatment is to alleviate the symptoms of the disease (palliative therapy). It should improve the patient's condition or keep it stable for as long as possible. A combination of several chemotherapeutic agents - for example 5-fluoro-uracil, oxaliplatin, irinotecan with vitamin folinic acid (FOLFIRINOX) - or sometimes just the chemotherapeutic agent gemcitabine or nab-paclitaxel (occasionally also in combination with other drugs) is supposed to delay tumor growth and thus also extend survival. Palliative chemotherapy, radiation therapy, or a combination of both procedures can reduce pain and improve your general condition.

Opioid pain relievers are given for severe pain, such as: B. codeine or morphine. In the case of very severe pain, pain perception can also be switched off by injecting a pain reliever directly into the vicinity of a nerve.

Other methods of treatment

Time and again, headlines about allegedly sensational healing successes through alternative healing methods arouse hope in patients and relatives. So-called "holistic" or "biological" methods such as cancer diets or vitamin cures are offered as alternatives to "conventional medicine".

The effectiveness of these treatments has not yet been conclusively proven scientifically. Above all, they can cause harm if patients forego therapies that have been proven to be more effective in their favor. In addition, treatments advertised as "natural" or "herbal" can have side effects.

If an operation, chemotherapy or radiation therapy can positively influence the course of cancer, alternative healing methods should never be used alone. There is a risk that a real chance of recovery will be irrevocably lost! During chemotherapy in particular, additional treatments should only be used in consultation with the attending physician.