Liver and gallbladder, 'pancreas' road forward
Pancreatic cancer is highly malignant and extremely dangerous, and is known as the "king of cancers". The clinical manifestations of pancreatic cancer are very insidious, with rapid onset and difficult treatment. More than 80% of pancreatic cancer patients contacted by clinicians have lost the opportunity for surgery, which means that they have lost the opportunity for potential cure. The overall 5-year survival rate of pancreatic cancer is 5%, and the average survival time is 4-6 months. The incidence of pancreatic cancer in China has increased by 4 times in the past 20 years. The "2019 Henan Province Tumor Registration Annual Report" The incidence of pancreatic cancer in our province is 4.33/100,000 .
01
Introduction to the Pancreas
pancreas anatomy
The pancreas is about 15.24 cm long and is located in the abdomen, between the stomach and the spine, surrounded by the liver, intestines, etc. It is the second largest gland in the human body and the organ with the strongest digestive function.
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function of the pancreas
Endocrine
Produce and secrete somatostatin, insulin, glucagon, etc.
Exocrine
Produces pancreatic juice that helps digest food. Neutralizes stomach acid and digests sugar, protein and fat.
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"King of Cancer" - Pancreatic Cancer
Pancreatic cancer refers to a malignant tumor that occurs in the pancreas in a broad sense, and refers to pancreatic ductal epithelial carcinoma in a narrow sense.
They died of pancreatic cancer
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morbidity, mortality
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Pancreatic cancer high-risk groups
non-genetic risk factors
Long-term smoking, advanced age, high-fat diet, excess 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.
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pancreatic cancer symptoms
Unexplained abdominal pain
It is the most common symptom, and most patients with pancreatic cancer only present with upper abdominal discomfort or dull pain, dull pain and distending pain. Easily confused with symptoms of gastrointestinal and hepatobiliary diseases. If there is still obstruction of pancreatic juice outlet, pain or discomfort may worsen after eating. Persistent severe abdominal pain may occur when the tumor invades the celiac plexus in the middle and advanced stages.
weight loss, fatigue
80% to 90% of pancreatic cancer patients have weight loss, fatigue, and weight loss in 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 and can cause gastrointestinal obstruction or bleeding.
jaundice
It is the most important clinical manifestation of pancreatic cancer and is related to biliary obstruction. It may be accompanied by skin itching, dark brown urine and clay-like stool.
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Pancreatic cancer related tests
physical examination
In addition to abdominal tenderness, weight loss, and skin and scleral jaundice, doctors can feel an enlarged liver and gallbladder during physical examination, and sometimes a firm mass in the upper abdomen.
laboratory test
When the tumor involves the liver and blocks the bile duct, corresponding biochemical indicators, such as alanine aminotransferase, aspartate aminotransferase, bile acid, and bilirubin, may increase. 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 most valuable tumor marker, which 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, intuitiveness, non-invasiveness and non-radiation, and multi-axial observation. CT examination has good spatial and temporal resolution, and is currently the best non-invasive imaging 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 the tumor, and has obvious advantages in detecting extrapancreatic metastasis and evaluating the systemic tumor load.
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.
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Differential Diagnosis of Pancreas-Related Disorders
chronic pancreatitis
Chronic pancreatitis is a progressive and extensive pancreatic fibrotic lesion that occurs repeatedly, leading to narrowing and obstruction of the pancreatic duct, obstruction of the drainage of pancreatic juice, and dilation of the pancreatic duct. The main symptoms are abdominal pain, nausea, vomiting and fever. Clinical manifestations such as epigastric discomfort, indigestion, diarrhea, loss of appetite, and weight loss can be associated with pancreatic cancer.
Ampullary cancer
Ampullary carcinoma occurs where the common bile duct meets the pancreatic duct. Jaundice is the most common symptom, and jaundice can appear in the early stages of tumor development.
Pancreatic cystadenoma
Cystic tumors of the pancreas are rare in clinic and mostly occur in female patients. Imaging examination is an important means to distinguish it from pancreatic cancer, and the tumor marker CA19-9 was not elevated. Ultrasound, CT and EUS can show cystic lesions in the pancreas with regular cystic cavity, while pancreatic cancer has cystic changes and irregular cystic cavity only when there is central necrosis.
common bile duct stones
Common bile duct stones often recur repeatedly, have a long history, fluctuate greatly in the level of jaundice, and are often accompanied by the triad of abdominal pain, chills, fever, and jaundice, and most of them are not difficult to identify.
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Pancreatic Cancer Treatment
Multidisciplinary comprehensive diagnosis and treatment is the basis for the treatment of any stage of pancreatic cancer. A multidisciplinary consultation mode can be adopted. According to different patients' physical conditions, tumor location, extent of invasion, and clinical symptoms, the existing diagnosis and treatment methods should be applied in a planned and reasonable manner. It can radically cure, control tumors, reduce complications and improve the quality of life of patients.
surgical treatment
Surgical resection is the only effective way for patients with pancreatic cancer to gain a chance of cure and long-term survival. However, more than 80% of pancreatic cancer patients miss out on surgery due to advanced 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 have been carried out on the medical treatment of pancreatic cancer 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, and it runs through all stages. For patients with surgically resected localized pancreatic cancer, such as patients who cannot tolerate surgery or refuse surgery due to medical diseases, precise radical radiotherapy is recommended, which is a new option to provide these patients with long-term survival.
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, thromboembolism treatment.
supportive care
The goals of supportive care are to prevent or relieve suffering, improve nutritional status, and improve quality of life.
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Department introduction
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 number of outpatient visits is about 23,000, more than 6,200 discharged patients, and about 1,850 surgeries in 2019.
The department has large-scale medical equipment such as radio frequency ablation system, radio frequency hemostasis system, super suction knife (CUSA), laparoscope, argon knife, ultrasonic knife, high-intensity ultrasonic focusing therapy instrument.
The department carries out various difficult operations such as pancreaticoduodenectomy, laparoscopic radical resection of liver cancer, radical resection of bile duct (cystic) cancer, and resection of pancreatic body and tail cancer.
The department undertakes 3 projects of the National Natural Science Foundation of China and 5 provincial scientific research projects. Won 4 first prizes for department-level scientific and technological achievements.
Editor: Zhao Min Review: Zhao Fan
Health Care Office of Henan Cancer Hospital