Diagnostik und Therapie des Pankreaskarzinoms

Ihsan Ekin Demir; Christoph Schlag; Rami Abbassi; Hana Algül; Rickmer Braren; Güralp O. Ceyhan

doi:10.1055/a-0957-2642

Der Klinikarzt, Inhaltsverzeichnis

Der Klinikarzt 2019; 48(06): 242-249
DOI: 10.1055/a-0957-2642

Schwerpunkt

Diagnostik und Therapie des Pankreaskarzinoms

Neue Ansätze bei einem aggressiven Krankheitsbild

Ihsan Ekin Demir

¹Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München

,

Christoph Schlag

²II Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München

,

Rami Abbassi

²II Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München

,

Hana Algül

²II Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München

,

Rickmer Braren

³Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München

,

Güralp O. Ceyhan

¹Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München

› Institutsangaben

Abstract

ZUSAMMENFASSUNG

Das Pankreaskarzinom weist eine weltweit steigende Inzidenz auf, wobei die Gründe hierfür bis dato nicht bekannt sind. Die NCCN-Leitlinie von 2017 empfiehlt zur Diagnose und Beurteilung der Resektabilität des pankreatischen duktalen Adenokarzinoms (PDAC) die Computertomografie (CT) als primäre Bildgebung. Bei fehlendem Nachweis und Verdacht eines Tumors wird die Magnetresonanztomografie (MRT) zur Abklärung kleiner Tumoren sowie zur Diagnostik einer eventuellen Lebermetastasierung empfohlen. Durch den Einsatz von neoadjuvanten Chemotherapieregimes konnte die Anzahl der insgesamt resezierbaren Tumoren deutlich gesteigert und somit auch die Prognose dramatisch verbessert werden. Inzwischen sind neue Therapiekonzepte etabliert, die zu einer signifikanten Verbesserung der Prognose beim inoperablen Pankreaskarzinom in der palliativen Situation geführt haben. Im Rahmen der Erkrankung mit einem Pankreaskarzinom kann es zu einer Verlegung der Gallenwege und konsekutiv zu Cholestase und Cholangitis kommen. In einem solchen Fall sollte, sofern möglich, der Galleabfluss wiederhergestellt werden. Eine adäquate Therapieoption stellt hierbei die Durchführung einer ERCP mit Stentanlage dar. Auch bei Obstruktion des Duodenums ist eine endoskopische Stentanlage zur Wiederherstellung der Passage eine Option.

Volltext

Referenzen

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