Pancreatic Cancer

Cancerous tumors of the gastrointestinal-, gastropancreatic-, and gastrohepatic region of the body are usually of primary nature, which means they start to grow in the stomach, colon, pancreas, or liver, with the ability to invade or spread to other parts of the body. A neoplasm or also called a tumour is a group of cells that have undergone unregulated growth and may form a mass, but can also be distributed diffusely throughout the body. 

Tumour cells show a number of characteristics, including abnormal cell growth and division absence of programmed cell death, high number of cell divisions, promoting of blood vessel formation, invasion of tissue and metastasis. 

Signs and symptoms of the disease are wide and may include nausea, diarrhea, constipation, blood in the stool, heavy weight loss, or jaundice, and are mostly diagnosed when affected patients seeking for help regarding their symptoms at their GPs. Ultrasound and imaging diagnostics, haemoccult tests for determination of blood in the stool, as well as gastro- and colonoscopies are performed and are investigations of the first choice, and some of are also recommended as preventive check-ups at a certain age. 

These tumors are classified by its histological appearance, as well as whether these tumor are found to be localized, or whether the disease has already metastasized. In early stages these tumors can be surgically removed, sometimes in combination with a chemo-radiotherapy protocol. Sometimes a local therapy with a transarterial chemo-embolization (TACE), followed by a selective internal radiotherapy (SIRT) might be an option. Genetic analysis plays a crucial role in these cancer types, and often these tumors are found to be mutated or have characteristics, for which a number of standardized protocols are available. Heavily pre-treated patients that underwent all these protocols often face chemotherapy resistance. Noteworthy is to mention, that these tumors can have biomarker constellations, that can be treated if known. For instance, human epidermal growth factor 2 (HER2), which belongs to the epidermal growth factor family (EGF-receptor family), a biomarker that is found in breast cancer patients, is also found in some gastrointestinal cancerous diseases and can be treated by immunotherapy with humanized monoclonal antibodies or antibody-drug conjugates (ADCs). Very often, patients with a HER2 positive gastrointestinal tumor face limitations in their home countries, since HER2-targeted therapies are only approved for breast cancer patients, or only available through clinical trials. Other biomarkers include MSI, MSS, tumor mutational burden, cMET, EpCAM, Survivin, NYESO, etc. 

In case of a suspicion of gastrointestinal-, gastropancreatic-, and gastrohepatic cancerous diseases, usually a PET-CT-Scan is performed, which helps to see whether and where tumor masses are located. It shows us whether the cancer has already spread to other tissues (metastasis). If a mass has been confirmed, it should be biopsied in order to determine the dignity of the tumor. A histopathological analysis can determine the exact (cell) type of the tumor. There are many different types of tumors, and each of them presents unique genetic characteristics. 

What most patients do not know is, that when the first examination on the biopsy has been performed (to determine the tumor type), the tissue is kept and stored at the histopathology department of the hospital, where the biopsy has been performed. This stored tissue material can be used for thorough (genetic) tissue analyses and in-depth sequencing. It is known that tumors show the accumulation of several genetic modifications, thus providing cancer cells with the selective growth advantage to initiate expansion. Now, sophisticated high-throughput technologies enable the identification of these mutated genes in cancers that can lead to a potent targeted therapy. 

It is crucial to perform a thorough broad-spectrum screening so that every patient has a chance to explore all possibilities of a targeted treatment, may it be in a private setting or a clinical trial elsewhere. So it is most important to first find a laboratory that looks for all markers and mutations, and second, to find an oncologist who is willing to work with you in the best (and targeted) way possible. 

While some of these tumors can be surgically removed, often mutual with a neoadjuvant chemotherapy, followed by an adjuvant chemotherapy in combination with radiotherapy, an immunotherapy is often underestimated for these cancer types. Immunotherapy can clearly be of value in gastrointestinal-, gastropancreatic-, and gastrohepatic cancerous diseases, and is often used in a synergising therapeutic approach. 

A synergising therapeutic approach is the combination of an immune priming approach, immune activation approach, and a chemotherapy that works in synergy with the immunotherapeutic approaches. Within a synergising concept, one needs to consider all aspects of the patient’s medical history, other diagnosis, and general well-being, as well as the available diagnostic constellations and ongoing treatments. Within a synergising concept, one is highly considering a precision-based combination of therapies that are evaluated for each individual case. 

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Important: Our oncological team is happy to talk to you by phone to get a deeper understanding about your specific case, enabling to provide you with a provisional treatment plan and cost estimate. Our oncologists will provide you all the details on medications, therapeutics and treatments including underlying mechanism and side effects. After a physical examination and an in-depth discussion with you on-site, the definite treatment plan will be discussed. Please understand that complex medical processes as mentioned above can only be explained through a thorough consultation on-site.



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