BEHIND THE SCENES OF A TUMOR: EXOCRINE PANCREATIC INSUFFICIENCY IN PANCREATIC CANCER OR UPPER GASTROINTESTINAL CANCER

Abstract

Pancreatic exocrine insufficiency (PEI) often accompanies the course of neoplastic lesions of the pancreas and upper gastrointestinal tract (UGT), seemingly hiding in the shadow of a confirmed oncological diagnosis. PEI exacerbates the signs of malabsorption and nutrient deficiencies that occur in the setting of a neoplastic process, negatively affecting health, contributing to the development of complications, reducing the effectiveness of anticancer treatment, and increasing mortality. The article discusses the possible overlap of clinical signs of PEI with nonspecific manifestations of the neoplastic process, masquerading as cardiovascular disease, anxiety, and depression, which complicates the timely diagnosis of this prognostically significant syndrome. The provisions of modern international guidelines United European Gastroenterology (UEG), European Pancreatic Club (ЕРС), American Gastroenterological Association (AGA), Great Britain on the diagnosis and correction of PEI, which arose and progresses against the background of malignant tumors of the pancreas and UGT, are presented. The article emphasizes the importance of prescribing optimal pancreatic enzyme replacement therapy (PERT) immediately after diagnosis or in case of suspected PEI in patients with pancreatic cancer. Modern PERT is based on the administration of enterosoluble microspheres (UEG / EPC, 2025), and Creon is recognized as the optimal drug for oral PERT (AGA, 2023). Particular attention is paid to the prescription of appropriate doses of PERTN, the starting doses of which in patients with pancreatic cancer exceed the standard initial doses. Presented data confirm that early initiation of optimal PERT, even at the preoperative stage, and the inclusion of PERT in palliative care regimens help to improve health, normalize nutritional status, preserve muscle strength, improve quality of life and prognosis. Properly informing physicians and patients about the optimal correction of PEI can improve the quality and effectiveness of PERT in patients with pancreatic cancer and UGT tumors.