Be honest and brave, move forward on the 'pancreas' road
Pancreatic cancer is highly malignant and extremely dangerous, known as the "king of cancer". The clinical manifestations of pancreatic cancer are very hidden, the onset is rapid, and the treatment is difficult. More than 80% of the pancreatic cancer patients that clinicians come into contact with have lost the chance of surgery, that is to say, they have lost the potential chance of cure. The overall 5-year survival rate of pancreatic cancer is 5%, and the average survival period is 4-6 months. The incidence rate of pancreatic cancer in China has increased by 4 times in the past 20 years. According to the "2019 Henan Provincial Tumor Registration Annual Report", the incidence rate of pancreatic cancer in our province is 4.33/100,000 .
01
Introduction to pancreas
Anatomical location of the pancreas
The pancreas is about 15.24 cm long and is located in the abdomen, between the stomach and the spine, surrounded by liver, intestines, etc. It is the second largest gland in the human body and the organ with the strongest digestive function.
02
Pancreas function
endocrine
Produce and secrete somatostatin, insulin, glucagon and so on.
exocrine
Produces pancreatic juice, which helps digest food. Neutralizes stomach acid, digests sugar, protein and fat.
03
"King of Cancer" - Pancreatic Cancer
In a broad sense, pancreatic cancer refers to malignant tumors that occur in the pancreas. In a narrow sense, it refers to pancreatic ductal epithelial carcinoma, which is very malignant and difficult to diagnose and treat.
They died of pancreatic cancer
04
Morbidity, Mortality
05
Pancreatic Cancer High Risk Group
non-genetic risk factors
Long-term smoking, advanced age, high-fat diet, excessive body mass index, chronic pancreatitis or concomitant diabetes and other groups.
family genetic factors
About 10% of pancreatic cancer cases run in families. Patients with familial malignant melanoma and other hereditary neoplastic disorders have a significantly increased risk of pancreatic cancer.
06
Pancreatic Cancer Symptoms
unexplained abdominal pain
It is the most common symptom. Most patients with pancreatic cancer only present with epigastric discomfort or dull pain, dull pain, and distending pain. It is easy to be confused with the symptoms of gastrointestinal and hepatobiliary diseases. If there is also obstruction of the outlet of pancreatic juice, pain or discomfort may worsen after eating. Middle-advanced tumors invading the celiac plexus may cause persistent severe abdominal pain.
weight loss, fatigue
80% to 90% of pancreatic cancer patients suffer from emaciation, fatigue, and weight loss at the early stage of the disease, which are related to lack of appetite, anxiety, and tumor consumption.
Gastrointestinal Symptoms
When the tumor blocks the common bile duct and pancreatic duct, bile and pancreatic fluid cannot enter the duodenum, and symptoms of indigestion often occur. Impairment of pancreatic exocrine function may lead to diarrhea. Advanced pancreatic cancer invades the duodenum, which can lead to gastrointestinal obstruction or bleeding.
jaundice
It is the main clinical manifestation of pancreatic cancer, related to biliary obstruction, and may be accompanied by skin itching, dark brown urine and clay-like stools.
07
Pancreatic cancer related examination
physical examination
In addition to abdominal tenderness, weight loss, and jaundice of the skin and sclera, doctors can feel enlarged liver and gallbladder during physical examination, and sometimes hard lumps can also be felt in the upper abdomen.
lab test
When the tumor involves the liver and blocks the bile duct, it can cause corresponding biochemical indicators, such as alanine aminotransferase, aspartate aminotransferase, bile acid, bilirubin, etc. to increase. The commonly used clinical tumor markers related to the diagnosis of pancreatic cancer include carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), etc., among which CA19-9 is used in pancreatic cancer The tumor marker with the highest value can be used for auxiliary diagnosis, curative effect monitoring and recurrence monitoring.
Film degree exam
Ultrasonography is an important examination method for the diagnosis of pancreatic cancer because of its simplicity, flexibility, intuition, non-invasiveness, radiation-free, and multi-axis observation. CT examination has better spatial and temporal resolution, and is currently the best non-invasive imaging examination method for examining the pancreas. It is mainly used for the diagnosis, differential diagnosis and staging of pancreatic cancer. PET-CT shows the metabolic activity and metabolic load of tumors, and has obvious advantages in finding extrapancreatic metastases and evaluating systemic tumor burden.
Pathological examination
This is the gold standard for diagnosing pancreatic cancer. In addition to surgery, methods for obtaining pathological specimens include endoscopic ultrasonography or CT-guided biopsy, ascites cytology, and laparoscopic exploratory biopsy.
08
Differential diagnosis of pancreas-related diseases
chronic pancreatitis
Chronic pancreatitis is a recurrent progressive and extensive pancreatic fibrotic lesion, resulting in narrowing and obstruction of the pancreatic duct, obstructed discharge of pancreatic juice, and dilatation of the pancreatic duct. The main symptoms are abdominal pain, nausea, vomiting and fever. Both pancreatic cancer and pancreatic cancer can have clinical manifestations such as epigastric discomfort, indigestion, diarrhea, loss of appetite, and weight loss.
ampullary cancer
Ampullary carcinoma occurs at the junction of the common bile duct and the pancreatic duct. Jaundice is the most common symptom, and jaundice can appear in the early stage of tumor development.
Pancreatic cystadenoma
Pancreatic cystic tumors are rare in clinical practice and mostly occur in female patients. Imaging examination is an important means to distinguish it from pancreatic cancer, and the tumor marker CA19-9 did not increase. Ultrasound, CT, and EUS can show cystic lesions in the pancreas with regular cystic cavities, while pancreatic cancer only has cystic changes and irregular cystic cavities when the center is necrotic.
Choledocholithiasis
Choledocholithiasis often occurs repeatedly, with a long medical history, and the level of jaundice fluctuates greatly. During the attack, it is often accompanied by the triad of abdominal pain, chills and fever, and jaundice. Most of them are not difficult to identify.
09
Pancreatic Cancer Treatment
Multidisciplinary comprehensive diagnosis and treatment is the basis of any stage of pancreatic cancer treatment. Multidisciplinary consultation mode can be adopted, and existing diagnosis and treatment methods can be applied in a planned and reasonable way according to different patients' physical conditions, tumor location, invasion range, and clinical symptoms. Radical cure, control tumor, reduce complications and improve patient's quality of life.
surgical treatment
Surgical resection is the only effective way for patients with pancreatic cancer to have a chance of cure and long-term survival. However, more than 80% of pancreatic cancer patients lose the chance of surgery due to late disease. Surgery should try to implement radical resection.
Medical treatment
The efficacy of chemotherapy for pancreatic cancer is limited. In recent years, a large number of clinical studies on the medical treatment of pancreatic cancer have been carried out at home and abroad. Chemotherapy can not only improve the survival of patients, but also improve pain and quality of life.
Radiation Therapy
Radiation therapy is an important treatment for pancreatic cancer, which runs through all stages. Surgical resectable localized pancreatic cancer, such as patients who cannot tolerate surgery or refuse surgery due to medical diseases, recommend precise radical radiotherapy, which is a new option for long-term survival of these patients.
interventional therapy
For the interventional therapy of pancreatic cancer and pancreatic cancer metastases and the treatment of pancreatic cancer-related complications, the main treatment methods include transarterial infusion chemotherapy, ablation therapy, percutaneous transhepatic biliary drainage (PTCD), biliary stent implantation, intestinal Stent implantation, hemorrhagic embolization therapy.
supportive care
The goals of supportive care are to prevent or relieve suffering, improve nutritional status, and improve quality of life.
10
Department Profile
Hepatobiliary and Pancreatic Surgery was established in 2002. It is a key specialty in the hospital. Now it has 3 wards and 150 beds. There are 11 experts, including 5 chief physicians, 8 deputy chief physicians, 12 attending physicians, and 8 master tutors. , 9 doctors and 15 masters. The annual outpatient volume is about 23,000, and the number of discharged patients is more than 6,200. In 2019, there will be about 1,850 operations.
The department has large-scale medical equipment such as radiofrequency ablation system, radiofrequency hemostasis system, ultra-suction knife (CUSA), laparoscope, argon knife, ultrasonic knife, high-intensity ultrasonic focus therapy instrument, etc.
The department carries out pancreaticoduodenectomy, laparoscopic radical resection of liver cancer, radical resection of cholangiocarcinoma, resection of pancreatic body and tail cancer and other difficult operations.
The department undertakes 3 National Science and Nature Fund projects and 5 provincial scientific research projects. Won 4 first prizes for scientific and technological achievements at the departmental level.
Editor: Zhao Min Reviewer: Zhao Fan
Health Office of Henan Cancer Hospital