Pancreatic Exocrine Insufficiency in Pancreatic Cancer

Abstract

Cancer patients experience weight loss for a variety of reasons, commencing with the tumor’s metabolism (Warburg effect) and proceeding via cachexia to loss of appetite. In pancreatic cancer, several other factors are involved, including a loss of appetite with a particular aversion to meat and the incapacity of the pancreatic gland to function normally when a tumor is present in the pancreatic head. Pancreatic exocrine insufficiency is characterized by a deficiency of the enzymes secreted from the pancreas due to the obstructive tumor, resulting in maldigestion. This, in turn, contributes to malnutrition, specifically a lack of fat-soluble vitamins, antioxidants, and other micronutrients. Patients with pancreatic cancer and pancreatic exocrine insufficiency have, overall, an extremely poor prognosis with regard to surgical outcome and overall survival. Therefore, it is crucial to be aware of the mechanisms involved in the disease, to be able to diagnose pancreatic exocrine insufficiency early on, and to treat malnutrition appropriately, for example, with pancreatic enzymes.

Differences in Gut Microbiota Profiles between Autoimmune Pancreatitis and Chronic Pancreatitis

“…Pancreatic diseases such as pancreatic cancer, chronic pancreatitis (CP) and autoimmune pancreatitis (AIP) are often accompanied by pancreatic exocrine insufficiency (Hart et al 2015;Ramsey et al 2017;Vujasinovic et al 2017), which could affect the gut microenvironment and microbiota. AIP is a rare type of pancreatitis with a hypoth-esized autoimmune mechanism (Hart et al 2015;Okazaki et al 2017).…”

Total pancreatectomy for recurrent acute and chronic pancreatitis: a critical review of patient selection criteria

“…Although chronic pancreatitis is the most frequent cause of PEI, there are other pancreatic diseases in which PEI occurs because of the loss of pancreas parenchyma including pancreatic necrosis, pancreatic cancer, partial surgical resection of the pancreas, cystic fibrosis, and obstruction of the pancreatic duct [51–53]. However, the pancreas has a large functional reserve, and malabsorption leading to steatorrhea is not expected until lipase output is reduced to less than 10% of normal [54].…”

Pancreatic Enzyme Replacement Therapy in Pancreatic Cancer

“…Despite advancements in disease detection and management, more than 80% of patients receive a diagnosis in the advanced stage of the disease [5]. A similar number of patients suffer from significant weight loss at diagnosis, which can result in severe cachexia [6]. A major cause of weight loss is malnutrition.…”

“…Tumour cell-triggered factors include: (i) The Warburg effect, characterised by an increased lactate production as a consequence of glycolysis rather than oxidative phosphorylation of glucose, which results in acidosis. This, in turn, leads to an acid-mediated tumour invasion and the impairment of mitochondrial functions in cancer cells, (ii) the production of tumour-specific factors such as islet amyloid polypeptide (IAPP), which contributes to cachexia and the loss of appetite, and (iii) the location of the tumour itself, most often in the head of the pancreas, resulting in the reduction of the secretion of pancreatic enzymes during meals [6]. The latter is referred to as pancreatic exocrine insufficiency (PEI), leading to maldigestion and secondary malnutrition.…”