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Gastroenterologie up2date 2025; 21(01): 25-41
DOI: 10.1055/a-2267-4079
Leber/Galle/Pankreas

Diagnostik und Therapiekonzepte für das Pankreaskarzinom – Update 2024

Angelika Kestler 
,
Thomas Seufferlein
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Nach wie vor hat das Pankreaskarzinom eine ungünstige Prognose. Präventionsmöglichkeiten und Frühsymptome fehlen, sodass die Erkrankung in der Regel erst in einem fortgeschrittenen Stadium diagnostiziert wird. In dieser Situation ist zumeist eine Systemtherapie indiziert, deren Auswahl durch Zulassung neuer Medikamente und Medikamentenkombinationen in den letzten Jahren zunehmend erweitert werden konnte. Der Beitrag erläutert das aktuelle diagnostische und therapeutische Vorgehen.
Kernaussagen

  • Das duktale Adenokarzinom ist das häufigste Karzinom des Pankreas.

  • Zur Ausbreitungsdiagnostik erfolgt eine CT-Thorax- und -Abdomenuntersuchung.

  • Eine MRT des Abdomens oder eine PET-CT-Untersuchung sind dann notwendig, wenn eine unklare Situation in der Ausbreitungsdiagnostik besteht.

  • Eine histologische Sicherung ist bei resektablem, nicht metastasiertem Tumor vor einer Operation nicht notwendig.

  • Eine adjuvante/additive Therapie wird nach einer Tumorresektion in kurativer Intention empfohlen.

  • Bei metastasierter Erkrankung oder vor neoadjuvanter Therapie ist eine histologische Sicherung obligat.

  • In palliativer Situation wird eine Kombinationschemotherapie unter Berücksichtigung des Aktivitätsindex der Eastern Co-operative of Oncology Group (ECOG), des Patientenalters und der Komorbiditäten durchgeführt.

  • In naher Zukunft kann wahrscheinlich eine erweiterte Molekularpathologie des Tumorgewebes zumindest für definierte Subgruppen neue Therapiemöglichkeiten eröffnen.

Schlüsselwörter

Pankreaskarzinom - Tumorausdehnung - Therapiestrategie - Tumormarker - Bauchspeicheldrüse - duktales Adenokarzinom


Publication History

Article published online:
19 March 2025

© 2025. Thieme. All rights reserved.

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