Pancreatic cancer treatment in Switzerland: diagnosis, surgery and therapy

Late diagnosis, limited therapeutic options and a poor prognosis force foreign patients to seek pancreatic cancer treatment in Switzerland as a last chance.

Pancreatic cancer is a malignant tumor of the pancreas.

The tumor usually occurs in the pancreatic head near the bile duct. In more than 95% of cases it affects the so-called exocrine gland, which produces and secretes digestive enzymes. This is called exocrine pancreatic carcinoma.

Hormone-producing neoplasms (the so-called endocrine carcinomas of the pancreas) are much less common. An example of such a tumor is insulinoma, in which the tumor tissue produces an excess amount of insulin.

Pancreatic cancer is a relatively rare disease in Switzerland.

It accounts for about 3.2% of all cancers in this country. It is considered a disease of the elderly: the average age of onset is 70 years for men and 76 years for women. Every year about 850 people in Switzerland develop pancreatic cancer. Only 5% of cases occur before the age of 50; about 60% of all diagnoses are made after 70.

It is extremely important to detect the tumor at an early stage.

In this case the chances of recovery and survival are greatly improved.

In 10–20% of patients, timely diagnosis opens the way for surgical removal of the tumor. In most cases, pancreatic cancer is usually detected too late, when secondary tumors have already occupied distant organs. Metastases in this disease are often found in the liver, lungs and bones.

In the late stages of pancreatic cancer, surgery is usually no longer possible. Such patients receive mainly chemotherapy and radiotherapy. The goal of treatment is to slow the disease progression, relieve symptoms and improve the quality of the patient's life.

In general, pancreatic cancer is associated with very low survival rates.

Where to go for treatment in Switzerland?

The leading academic centers in Switzerland are working to improve the protocols for treating pancreatic cancer, so foreign patients can get expert opinion and first-class cancer care in these centers.

We can recommend medical institutions such as the University Hospital Zurich or the University Hospital Basel (the best center in the north-western part of Switzerland). Large private hospitals, such as the Hirslanden Clinic in Zurich and the Generale-Beaulieu Clinic in Geneva, are also an excellent choice. These hospitals are not inferior in quality of medical services to leading clinics in the United States, but the cost of diagnosis and treatment is much lower.

In addition to high technology and professionalism of medical staff, this country offers excellent opportunities for rehabilitation and recreation at the best mountain resorts in Europe after treatment.

Causes and risk factors

The exact causes of the disease are not yet known.

Swiss doctors are still investigating triggers for pancreatic cancer.

Undoubtedly, certain factors increase the risk of developing the disease. For example, smoking and drinking alcohol. In addition, obesity (body mass index more than 30) is a risk factor. Similarly, experts discuss a wide range of nutritional habits, such as a high-fat diet.

Chronic pancreatitis increases the risk of developing the disease. Patients with type 2 diabetes are also more likely to develop pancreatic cancer than healthy people. However, it should be noted that diabetes can also be caused by cancer itself.

A disease in a first-degree relative (parents or children) doubles the risk compared to the general population. This should be distinguished from familial pancreatic cancer. Since the risk of developing family cancer is many times higher, Swiss oncologists recommend genetic counseling to all relatives of patients.

Symptoms of pancreatic cancer

For a long time, pancreatic cancer does not manifest itself or shows only non-specific symptoms that can also occur in "harmless" diseases. Since there are no typical warning symptoms at an early stage of the disease, pancreatic cancer is usually detected very late. If you already have symptoms such as jaundice or pain in the upper abdomen, this usually indicates an advanced stage of the disease.

When a tumor disrupts the secretion of digestive enzymes, it can lead to an increased release of undigested food particles and fat in the stool. If the cancer has already spread to nearby organs, such as the stomach, liver, or intestines, the following symptoms may occur:

• Pain and discomfort in the upper abdomen
• Bad appetite and weight loss.

• Nausea and vomiting
• Jaundice and itching

Approximately two thirds of all malignant neoplasms develop in the pancreatic head near the bile duct. As soon as such a tumor presses on the bile duct, it prevents the flow of bile.

As a result, symptoms such as jaundice (unnatural yellowish coloring of the mucous membranes, skin and eyes) and intense skin itching appears. Urine darkens, and the stool becomes pale, clay-colored.

These symptoms can occur even at an early stage of the disease, when the chances of recovery are higher. However, jaundice is also found in other diseases.

Due to changes in the pancreas, patients may experience insulin deficiency. The result is diabetes.

Due to the close proximity of the organ to the spine, diseases of the pancreas in some cases are manifested by back pain.

Diagnosis of pancreatic cancer in Switzerland

In this disease, early diagnosis is of great importance. Suspicious symptoms should prompt the doctor to go in search of the underlying disease. If it is actually pancreatic cancer, then in the second stage, the doctor must determine the exact location and spread of the tumor in order to plan the subsequent therapy.

Overview of diagnostic methods:

• Physical exam
• Blood tests (laboratory tests)
• Ultrasound examination (sonography)
• CT (Computed tomography)
• MRI (Magnetic Resonance Imaging)
• Chest X-ray (chest radiograph)
• ERCP (endoscopic retrograde cholangiopancreatography)
• Endoscopic ultrasonography (endoscopic ultrasound examination)
• Biopsy (tissue sample to secure the diagnosis)
• Laparoscopic examination to visualize the tumor and surrounding tissues
• Skeletal scintigraphy (for bone metastases)
• PET (Positron emission tomography)

Swiss oncologists use different methods to diagnose pancreatic cancer. The order and choice of laboratory tests and studies depends on how clear the previous results are and whether the appropriate methodology is available in the clinic.

Pancreatic cancer treatment options in Switzerland

In this disease, several treatment options are available, and many of them are combined to achieve an optimal clinical outcome:

• Surgical removal
• Cytotoxic chemotherapy
• Targeted therapy using erlotinib (Tarceva)
• Radiation therapy (radiotherapy)

Surgical removal of the tumor is the most important part of the treatment: it is the only method that gives a chance for a full recovery. After surgery, Swiss doctors usually prescribe chemotherapy to destroy the remaining tumor cells.

The cost of such a promising comprehensive treatment, including surgery and recovery, can reach $50,000-60,000 and more, depending on the clinical situation.

If there are already secondary tumors (metastases) in distant organs or lymph nodes, surgery is no longer considered. In case of metastatic pancreatic cancer, palliative treatment is applied.

Doctors try to support the patient and improve the quality of life. Despite all the achievements of Swiss oncology, recovery in these cases is impossible. Palliative treatment consists of chemotherapy or a combination of radiotherapy and chemotherapeutic drugs (the so-called chemoradiation).

The cost of palliative treatment varies widely depending on the drugs and procedures used. Treatment continues until the end of life and may require prolonged hospital stay.

Surgery

It should be understood that only surgery can completely cure the disease. The earlier pancreatic cancer is found, the better the chances. As long as the tumor does not cross the borders of the pancreas, it can be surgically removed. Thanks to new methods, the removal of tumors is possible even when neighboring organs are already involved (not in all cases).

According to Swiss surgeons, the patient's age is not important for making a decision about pancreatic cancer surgery. The main limitation is the health condition of the patient. For example, in the case of severe heart, lung, or liver disease, such interventions are considered too risky. The extent of the surgery depends on the size, location and histological type of the tumor.

The surgeon gently removes the tumor, adjacent healthy tissue and lymph nodes, which may contain cancer cells.

This approach reduces the risk of disease recurrence.

Depending on the results, the pancreas is partially or completely removed. In addition, it may be necessary to (partially) remove other organs and structures (for example, the gallbladder, part of the bile ducts and duodenum, part of the stomach and spleen).

If possible, the surgeon maintains a healthy part of the pancreas. In this case, surgical experience is crucial, because with the complete loss of an organ the patient will depend on the intake of hormones and digestive enzymes for the rest of his life.

If the surgeon completely removes the pancreas, insulin deficiency and diabetes mellitus develop. Therefore, the patient will have to regularly inject insulin to maintain the blood sugar concentration within the normal range.

After surgery, digestive enzymes produced by the pancreas should be taken together with food in the form of tablets or capsules. In order to learn how to properly take enzymes and control blood sugar levels with insulin, you need professional advice and experience.

Whipple procedure

One of the most common surgical methods for tumors of the head of the pancreas is Whipple procedure (technical term: partial pancreatoduodenectomy). The surgery is performed in two versions, with or without removal of the stomach. During the procedure, the surgeon removes the head of the pancreas, part of the stomach, duodenum, gallbladder, and nearby lymph nodes.



The surgeon must have high skill and experience to connect the lower part of the small intestine with the stomach, as well as to ensure the normal functioning of the remaining part of the pancreas and bile duct. The Whipple procedure is considered to be technically difficult and risky, since it is associated with high mortality and the risk of complications.

If the tumor is located in the distal part (in the tail of the pancreas), the surgeon usually removes only the affected part and the spleen. This is the so-called distal resection of the pancreas.

The approximate cost of the Whipple procedure in Switzerland exceeds $40,000.

When choosing a clinic and a surgeon for such a complex and risky intervention, we recommend asking about the number of procedures performed. The experience of the surgeon and the operating team is a crucial success factor.

Chemotherapy

Chemotherapy for pancreatic cancer in Switzerland is used in different contexts. The basis of standard chemotherapy is the so-called cytostatics. These are non-selective drugs that inhibit the reproduction of rapidly dividing cells, including some types of healthy cells. If treatment is started early enough, six-month chemotherapy may be prescribed after the operation in order to achieve complete cure of the disease and the destruction of the last tumor cells.

In addition, chemotherapy as well as radiation therapy for pancreatic cancer is used as part of palliative treatment. The goal is to reduce pain and discomfort by improving the quality of life for patients when there is no longer any hope for a cure.

In particular, gemcitabine is widely used. The combination of capecitabine with the targeted drug erlotinib (Tarceva) can prolong life. In cases of inoperable pancreatic cancer, chemotherapy may be combined with radiation therapy.

Radiation therapy

Radiation therapy plays a minor role, although it is used for pancreatic cancer treatment in Switzerland. If the surgeon was able to completely remove the tumor, irradiation is usually not required. When complete recovery is not possible, radiation therapy becomes a useful part of palliative treatment.

Radiotherapy is present in various protocols for the treatment of metastases in the brain and bones. Radiation destroys actively dividing tumor cells, helping to control the growth of secondary tumors and the associated symptoms (including neurological symptoms).

Despite all scientific progress, undesirable effects of radiotherapy cannot be completely prevented. The effectiveness and safety of treatment largely depends on the technical level of the clinic and the professionalism of the medical staff.

© Analytical reviews and oncology news by K. Mokanov: clinical pharmacist and professional medical translator