nach oben

Erschienen in:

14.10.2019 | Supportivtherapie | CME Fortbildung

Maligne Tumoren der Bauchspeicheldrüse

Ätiologie, Diagnose und Therapie

verfasst von: Priv.-Doz. Dr. med. Bernhard W. Renz, Priv.-Doz. Dr. med. Jan G. D'Haese, Prof. Dr. med. Jens Werner

Erschienen in: CME | Ausgabe 10/2019

Einloggen, um Zugang zu erhalten

Zusammenfassung

Das duktale Adenokarzinom des Pankreas (PDAC), häufig unscharf als Pankreaskarzinom bezeichnet, stellt mit Abstand die häufigste histopathologische Entität maligner Raumforderungen des Pankreas dar. Im folgenden Beitrag werden Ätiologie, Pathogenes und Genetik des PDAC erläutert. Des Weiteren werden diagnostische Maßnahmen sowie Therapiemöglichkeiten und -ziele dargestellt.

Allum WH, Blazeby JM, Griffin SM et al (2011) Guidelines for the management of oesophageal and gastric cancer. Gut 60:1449–1472. doi: 10.1136/gut.2010.228254CrossRefPubMed

Bailey P, Chang DK, Nones K et al (2016) Genomic analyses identify molecular subtypes of pancreatic cancer. Nature 531:47–52. doi: 10.1038/nature16965CrossRefPubMed

Barreto SG, Loveday B, Windsor JA, Pandanaboyana S (2018) Detecting tumour response and predicting resectability after neoadjuvant therapy for borderline resectable and locally advanced pancreatic cancer. ANZ J Surg. doi: 10.1111/ans.14764

Bosman FT, Carneiro F, Hruban RH, Theise ND (2010) WHO classification of tumours of the digestive system.

Burdelski CM, Reeh M, Bogoevski D et al (2011) Multivisceral resections in pancreatic cancer: identification of risk factors. World J Surg 35:2756–2763. doi: 10.1007/s00268-011-1263-8CrossRefPubMed

Burris HA, Moore MJ, Andersen J et al (1997) Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 15:2403–2413.CrossRefPubMed

Cancer Genome Atlas Research Network. Electronic address: andrew_aguirre@dfci.harvard.edu, Cancer Genome Atlas Research Network (2017) Integrated Genomic Characterization of Pancreatic Ductal Adenocarcinoma. Cancer Cell 32:185–203.e13. doi: 10.1016/j.ccell.2017.07.007

Chari ST, Leibson CL, Rabe KG et al (2005) Probability of pancreatic cancer following diabetes: a population-based study. YGAST 129:504–511. doi: 10.1016/j.gastro.2005.05.007

Conroy T, Desseigne F, Ychou M et al (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364:1817–1825. doi: 10.1056/NEJMoa1011923CrossRefPubMed

10.

Conroy T, Hammel P, Hebbar M et al (2018) FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer. N Engl J Med 379:2395–2406. doi: 10.1056/NEJMoa1809775CrossRefPubMed

11.

de Rooij T, van Hilst J, van Santvoort H et al (2019) Minimally Invasive Versus Open Distal Pancreatectomy (LEOPARD): A Multicenter Patient-blinded Randomized Controlled Trial. - PubMed - NCBI. Annals of Surgery 269:2–9.CrossRefPubMed

12.

Ducreux M, Cuhna AS, Caramella C et al (2015) Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 26 Suppl 5:v56–68. doi: 10.1093/annonc/mdv295CrossRefPubMed

13.

Epstein AS, Soff GA, Capanu M et al (2012) Analysis of incidence and clinical outcomes in patients with thromboembolic events and invasive exocrine pancreatic cancer. Cancer 118:3053–3061. doi: 10.1002/cncr.26600CrossRefPubMed

14.

Ettrich TJ, Schulte LA, Eitel N et al (2017) Surveillance after resection of pancreatic ductal adenocarcinoma with curative intent - a multicenter survey in Germany and review of the literature. Z Gastroenterol 55:657–666. doi: 10.1055/s-0043-105502CrossRefPubMed

15.

Finks JF, Osborne NH, Birkmeyer JD (2011) Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med 364:2128–2137. doi: 10.1056/NEJMsa1010705CrossRefPubMedPubMedCentral

16.

Fitzgerald TL, Hickner ZJ, Schmitz M, Kort EJ (2008) Changing Incidence of Pancreatic Neoplasms: A 16-Year Review of Statewide Tumor Registry. Pancreas 37:134–138. doi: 10.1097/MPA.0b013e318163a329CrossRefPubMed

17.

Ghorani E, Wong HH, Hewitt C et al (2015) Safety and Efficacy of Modified FOLFIRINOX for Advanced Pancreatic Adenocarcinoma: A UK Single-Centre Experience. Oncology 89:281–287. doi: 10.1159/000439171CrossRefPubMed

18.

Golan T, Hammel P, Reni M et al (2019) Maintenance Olaparib for Germline BRCA-Mutated Metastatic Pancreatic Cancer. N Engl J Med NEJMoa1903387. doi: 10.1056/NEJMoa1903387

19.

Hackert T, Niesen W, Hinz U et al (2017) Radical surgery of oligometastatic pancreatic cancer. Eur J Surg Oncol 43:358–363. doi: 10.1016/j.ejso.2016.10.023CrossRefPubMed

20.

Hank T, Hinz U, Tarantino I et al (2018) Validation of at least 1 mm as cut-off for resection margins for pancreatic adenocarcinoma of the body and tail. Brit J Surg 105:1171–1181. doi: 10.1002/bjs.10842CrossRefPubMed

21.

Hartwig W, Hackert T, Hinz U et al (2009) Multivisceral resection for pancreatic malignancies: risk-analysis and long-term outcome. Ann Surg 250:81–87. doi: 10.1097/SLA.0b013e3181ad657b

22.

Hartwig W, Hackert T, Hinz U et al (2011) Pancreatic cancer surgery in the new millennium: better prediction of outcome. Ann Surg 254:311–319. doi: 10.1097/SLA.0b013e31821fd334CrossRefPubMed

23.

Hoff Von DD, Ervin T, Arena FP et al (2013) Increased Survival in Pancreatic Cancer with nab-Paclitaxel plus Gemcitabine. N Engl J Med 369:1691–1703. doi: 10.1056/NEJMoa1304369CrossRef

24.

Hruban RH, Goggins M, Parsons J, Kern SE (2000) Progression model for pancreatic cancer. Clin Cancer Res 6:2969–2972.PubMed

25.

Hu ZI, Shia J, Stadler ZK et al (2018) Evaluating Mismatch Repair Deficiency in Pancreatic Adenocarcinoma: Challenges and Recommendations. Clin Cancer Res 24:1326–1336. doi: 10.1158/1078-0432.CCR-17-3099CrossRefPubMedPubMedCentral

26.

Jones S, Zhang X, Parsons DW et al (2008) Core signaling pathways in human pancreatic cancers revealed by global genomic analyses. Science 321:1801–1806. doi: 10.1126/science.1164368CrossRefPubMedPubMedCentral

27.

Khorana AA, Kuderer NM, Culakova E et al (2008) Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 111:4902–4907. doi: 10.1182/blood-2007-10-116327CrossRefPubMedPubMedCentral

28.

Kim JH, Lee S-C, Oh SY et al (2018) Attenuated FOLFIRINOX in the salvage treatment of gemcitabine-refractory advanced pancreatic cancer: a phase II study. Cancer Commun (Lond) 38:32. doi: 10.1186/s40880-018-0304-1CrossRef

29.

Köninger J, Wente MN, Müller-Stich BP et al (2008) R2 resection in pancreatic cancerdoes it make sense? Langenbecks Arch Surg 393:929–934. doi: 10.1007/s00423-008-0308-4

30.

Krantz BA, O’Reilly EM (2018) Biomarker-Based Therapy in Pancreatic Ductal Adenocarcinoma: An Emerging Reality? Clin Cancer Res 24:2241–2250. doi: 10.1158/1078-0432.CCR-16-3169CrossRefPubMed

31.

Laquente B, Calsina-Berna A, Carmona-Bayonas A et al (2017) Supportive care in pancreatic ductal adenocarcinoma. Clin Transl Oncol 19:1293–1302. doi: 10.1007/s12094-017-1682-6CrossRefPubMed

32.

Le DT, Durham JN, Smith KN et al (2017) Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade. Science 357:409–413. doi: 10.1126/science.aan6733CrossRefPubMedPubMedCentral

33.

Lee J-C, Kim JW, Ahn S et al (2017) Optimal dose reduction of FOLFIRINOX for preserving tumour response in advanced pancreatic cancer: Using cumulative relative dose intensity. Eur J Cancer 76:125–133. doi: 10.1016/j.ejca.2017.02.010CrossRefPubMed

34.

Lemery S, Keegan P, Pazdur R (2017) First FDA Approval Agnostic of Cancer Site - When a Biomarker Defines the Indication. N Engl J Med 377:1409–1412. doi: 10.1056/NEJMp1709968CrossRefPubMed

35.

Li D, Capanu M, Yu KH et al (2015) Treatment, Outcomes, and Clinical Trial Participation in Elderly Patients With Metastatic Pancreas Adenocarcinoma. Clin Colorectal Cancer 14:269–76.e1. doi: 10.1016/j.clcc.2015.05.005CrossRefPubMedPubMedCentral

36.

Lowery MA, Jordan EJ, Basturk O et al (2017) Real-Time Genomic Profiling of Pancreatic Ductal Adenocarcinoma: Potential Actionability and Correlation with Clinical Phenotype. Clin Cancer Res 23:6094–6100. doi: 10.1158/1078-0432.CCR-17-0899CrossRefPubMed

37.

Ma J, Siegel R, Jemal A (2013) Pancreatic cancer death rates by race among US men and women, 1970-2009. J Natl Cancer Inst 105:1694–1700. doi: 10.1093/jnci/djt292CrossRefPubMed

38.

Minsky BD, Hilaris B, Fuks Z (1988) The role of radiation therapy in the control of pain from pancreatic carcinoma. J Pain Symptom Manage 3:199–205.CrossRefPubMed

39.

Moore MJ, Goldstein D, Hamm J et al (2007) Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. Journal of Clinical Oncology 25:1960–1966. doi: 10.1200/JCO.2006.07.9525CrossRefPubMed

40.

Mujica VR, Barkin JS, Go VL (2000) Acute pancreaLiteratur titis secondary to pancreatic carcinoma. Study Group Participants. Pancreas 21:329–332.

41.

Murphy JE, Wo JY, Ryan DP et al (2018) Total Neoadjuvant Therapy With FOLFIRINOX Followed by Individualized Chemoradiotherapy for Borderline Resectable Pancreatic Adenocarcinoma: A Phase 2 Clinical Trial. JAMA Oncol. doi: 10.1001/jamaoncol.2018.0329

42.

Neoptolemos JP, Dunn JA, Stocken DD et al (2001) Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. The Lancet 358:1576–1585.CrossRef

43.

Neoptolemos JP, Palmer DH, Ghaneh P et al (2017) Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet 389:1011–1024. doi: 10.1016/S0140-6736(16)32409-6CrossRefPubMed

44.

Neoptolemos JP, Stocken DD, Bassi C et al (2010) Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA 304:1073–1081. doi: 10.1001/jama.2010.1275CrossRefPubMed

45.

Oettle H, Neuhaus P, Hochhaus A et al (2013) Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA 310:1473–1481. doi: 10.1001/jama.2013.279201CrossRefPubMed

46.

Oettle H, Post S, Neuhaus P et al (2007) Adjuvant Chemotherapy With Gemcitabine vs Observation in Patients Undergoing Curative-Intent Resection of Pancreatic CancerA Randomized Controlled Trial. JAMA 297:267–277. doi: 10.1001/jama.297.3.267CrossRefPubMed

47.

Oettle H, Riess H, Stieler JM et al (2014) Second-Line Oxaliplatin, Folinic Acid, and Fluorouracil Versus Folinic Acid and Fluorouracil Alone for Gemcitabine-Refractory Pancreatic Cancer: Outcomes From the CONKO-003 Trial. J Clin Oncol JCO.2013.53.6995. doi: 10.1200/JCO.2013.53.6995

48.

Pelzer U, Schwaner I, Stieler J et al (2011) Best supportive care (BSC) versus oxaliplatin, folinic acid and 5-fluorouracil (OFF) plus BSC in patients for second-line advanced pancreatic cancer: a phase III-study from the German CONKO-study group. Eur J Cancer 47:1676–1681. doi: 10.1016/j.ejca.2011.04.011CrossRefPubMed

49.

Pelzer U, Stieler J, Roll L et al (2009) Second-line therapy in refractory pancreatic cancer. results of a phase II study. Onkologie 32:99–102. doi: 10.1159/000197769PubMed

50.

Petersen GM (2016) Familial pancreatic cancer. Seminars in Oncology 43:548–553. doi: 10.1053/j.seminoncol.2016.09.002CrossRefPubMedPubMedCentral

51.

Quante AS, Ming C, Rottmann M et al (2016) Projections of cancer incidence and cancer-related deaths in Germany by 2020 and 2030. Cancer Med 5:2649–2656. doi: 10.1002/cam4.767CrossRefPubMedPubMedCentral

52.

Rahib L, Smith BD, Aizenberg R et al (2014) Projecting Cancer Incidence and Deaths to 2030: The Unexpected Burden of Thyroid, Liver, and Pancreas Cancers in the United States. Cancer Research 74:2913–2921. doi: 10.1158/0008-5472.CAN-14-0155CrossRefPubMed

53.

Reames BN, Ghaferi AA, Birkmeyer JD, Dimick JB (2014) Hospital volume and operative mortality in the modern era. Ann Surg 260:244–251. doi: 10.1097/SLA.0000000000000375CrossRefPubMed

54.

Renz BW, Boeck S, Roeder F et al (2017) Oligometastatic Disease in Pancreatic Cancer - How to Proceed? Visc Med 33:36–41. doi: 10.1159/000455027CrossRefPubMedPubMedCentral

55.

Roberts NJ, Norris AL, Petersen GM et al (2016) Whole Genome Sequencing Defines the Genetic Heterogeneity of Familial Pancreatic Cancer. Cancer Discov 6:166–175. doi: 10.1158/2159-8290.CD-15-0402CrossRefPubMed

56.

Seufferlein T, Porzner M, Becker T et al (2013) [S3-guideline exocrine pancreatic cancer]. Z Gastroenterol 51:1395–1440. doi: 10.1055/s-0033-1356220CrossRefPubMed

57.

Shrikhande SV, Barreto SG, Goel M, Arya S (2012) Multimodality imaging of pancreatic ductal adenocarcinoma: a review of the literature. HPB 14:658–668. doi: 10.1111/j.1477-2574.2012.00508.xCrossRefPubMedPubMedCentral

58.

Stein SM, James ES, Deng Y et al (2016) Final analysis of a phase II study of modified FOLFIRINOX in locally advanced and metastatic pancreatic cancer. Br J Cancer 114:737–743. doi: 10.1038/bjc.2016.45CrossRefPubMed

59.

Strobel O, Hank T, Hinz U et al (2017) Pancreatic Cancer Surgery: The New R-status Counts. Ann Surg 265:565–573. doi: 10.1097/SLA.0000000000001731CrossRefPubMed

60.

Strobel O, Neoptolemos J, Jäger D, Büchler MW (2018) Optimizing the outcomes of pancreatic cancer surgery. Nat Rev Clin Oncol 68:7. doi: 10.1038/s41571-018-0112-1

61.

Tamburrino D, Riviere D, Yaghoobi M et al (2016) Diagnostic accuracy of different imaging modalities following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer. Cochrane Database Syst Rev 9:CD011515. doi: 10.1002/14651858.CD011515.pub2PubMed

62.

Tol JAMG, Gouma DJ, Bassi C et al (2014) Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). In: Surgery. S 591–600

63.

Tol JAMG, van Hooft JE, Timmer R et al (2016) Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer. Gut 65:1981–1987. doi: 10.1136/gutjnl-2014-308762CrossRefPubMed

64.

Valle JW, Palmer D, Jackson R et al (2014) Optimal Duration and Timing of Adjuvant Chemotherapy After Definitive Surgery for Ductal Adenocarcinoma of the Pancreas: Ongoing Lessons From the ESPAC-3 Study. Journal of Clinical Oncology JCO.2013.50.7657. doi: 10.1200/JCO.2013.50.7657

65.

van der Gaag NA, Rauws EAJ, van Eijck CHJ et al (2010) Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 362:129–137. doi: 10.1056/NEJMoa0903230CrossRefPubMed

66.

Vogelstein B, Fearon ER, Hamilton SR et al (1988) Genetic alterations during colorectal-tumor development. N Engl J Med 319:525–532. doi: 10.1056/NEJM198809013190901CrossRefPubMed

67.

Waddell N, Pajic M, Patch A-M et al (2015) Whole genomes redefine the mutational landscape of pancreatic cancer. Nature 518:495–501. doi: 10.1038/nature14169CrossRefPubMedPubMedCentral

68.

Wang-Gillam A, Li C-P, Bodoky G et al (2016) Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial. Lancet 387:545–557. doi: 10.1016/S0140-6736(15)00986-1CrossRefPubMed

69.

Werner J, Combs SE, Springfeld C et al (2013) Advanced-stage pancreatic cancer: therapy options. Nat Rev Clin Oncol 10:323–333. doi: 10.1038/nrclinonc.2013.66CrossRefPubMed

70.

Westphalen CB, Kruger S, Haas M et al (2016) Safety of palliative chemotherapy in advanced pancreatic cancer. Expert Opinion on Drug Safety 15:947–954. doi: 10.1080/14740338.2016.1177510CrossRefPubMed

71.

Witkiewicz AK, McMillan EA, Balaji U et al (2015) Whole-exome sequencing of pancreatic cancer defines genetic diversity and therapeutic targets. Nat Commun 6:6744. doi: 10.1038/ncomms7744CrossRefPubMed

72.

Wittekind C (2016) TNM: Klassifikation maligner Tumoren.

73.

Yachida S, Iacobuzio-Donahue CA (2013) Evolution and dynamics of pancreatic cancer progression. Oncogene 32:5253–5260. doi: 10.1038/onc.2013.29CrossRefPubMed

Titel: Maligne Tumoren der Bauchspeicheldrüse
Ätiologie, Diagnose und Therapie
verfasst von: Priv.-Doz. Dr. med. Bernhard W. Renz
Priv.-Doz. Dr. med. Jan G. D'Haese
Prof. Dr. med. Jens Werner
Publikationsdatum: 14.10.2019
Verlag: Springer Medizin
Schlagwörter: Supportivtherapie
Pankreaskarzinom
Pankreaskarzinom
Erschienen in: CME / Ausgabe 10/2019
Print ISSN: 1614-371X
Elektronische ISSN: 1614-3744
DOI: https://doi.org/10.1007/s11298-019-7095-9

Leitlinien kompakt für die Allgemeinmedizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Facharzt-Training Allgemeinmedizin

Die ideale Vorbereitung zur anstehenden Prüfung mit den ersten 24 von 100 klinischen Fallbeispielen verschiedener Themenfelder

Mehr erfahren

Neu im Fachgebiet Allgemeinmedizin

25.04.2024 | Hypotonie | Nachrichten

Update Allgemeinmedizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Maligne Tumoren der Bauchspeicheldrüse

Ätiologie, Diagnose und Therapie

Zusammenfassung

Leitlinien kompakt für die Allgemeinmedizin

Facharzt-Training Allgemeinmedizin

Neu im Fachgebiet Allgemeinmedizin

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Metformin rückt in den Hintergrund

Myokarditis nach Infekt – Richtig schwierig wird es bei Profisportlern

Update Allgemeinmedizin

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 10/2019

Zu viel Alkohol geht auf die Hoden

Weitgehender Freispruch für Säureblocker

Vorsicht vor DSGVO-Abmahnung!

Unterzucker — das unterschätzte Risiko

Akute Intoxikation beim Erwachsenen

Neue Empfehlungen zur Lungenembolie

Leitlinien kompakt für die Allgemeinmedizin

Facharzt-Training Allgemeinmedizin

Neu im Fachgebiet Allgemeinmedizin

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Metformin rückt in den Hintergrund

Myokarditis nach Infekt – Richtig schwierig wird es bei Profisportlern

Update Allgemeinmedizin