Pancreatic cancer is a malignant tumor originating from pancreatic duct epithelium and acinar cells, which is called the "king of cancer" in the medical field.The cause of the disease is not very clear, but research shows that long-term smoking, bad eating habitsBody mass indexToo high andpancreasThe chronic damage and other factors may increase the risk of pancreatic cancer.The symptoms of pancreatic cancer usually appear when the disease is in advanced stage, includingjaundice, weight loss, and abdominal discomfort or pain.
Treatment methods for pancreatic cancer include surgerychemotherapy、radiotherapy、interventional therapyAnd supportive treatment.In the confirmed cases, most of the patients had no obvious symptoms in the early stage, so they were in the middle and late stages at the time of diagnosis and lost the opportunity of surgical treatment.In the process of treatment plan planning, doctors will develop individualized comprehensive treatment plans according to the patient's physical condition, tumor location and size and other factors.At present, the prevention of diseases is mainly to reduce the risk of pancreatic cancer by maintaining healthy living habits.
Further research on pancreatic cancer is ongoing, and it is hoped that more high-risk factors and early lesions can be found through research in the future to improve the early diagnosis rate and treatment effect of pancreatic cancer.
TCM disease name
pancreatic cancer
Alias
King of Cancer
Visiting department
General Surgery Department, Gastroenterology Department, Oncology Department
Multiple population
For people aged 40-65, males are higher than females
The etiology of pancreatic cancer is not yet fully understood.Epidemiological investigation shows that pancreatic cancer is related to many risk factors.
Pathogenesis
Precancerous lesion
Precancerous lesions are pathological states of tissues, not cancers, but may increase the probability of canceration of tissues and further develop canceration on the basis of precancerous lesions.Atypical hyperplasia of pancreatic duct epithelium is a precancerous lesion of pancreatic cancer.Intraductal papillary myxoma of the pancreas is also a precancerous lesion.
Gene abnormality
In recent years, there have been many studies on pancreatic cancer gene mutations. It has been found that individuals carrying BRCA1, BRCA2, CDKN2A, TP53, MLH1, ATM and other gene mutations have significantly increased risk of pancreatic cancer.CDKN2A, BRCA1/2, PALB2 and other gene mutations have been confirmed to be closely related to the pathogenesis of familial pancreatic cancer.
Genetic factor
More and more evidences show that some pancreatic cancers are related to heredity.If the first-degree relatives have a history of pancreatic cancer, their probability of suffering from pancreatic cancer will greatly increase.In addition, many genetic diseases of the digestive system are closely related to pancreatic cancer, such asPeutz Jeghers syndrome(familial mucosal skin pigmentation gastrointestinal polyposis), Lynch syndrome (hereditary nonpolyposis colorectal cancer), familial adenomatous polyposis, etc.
Predisposing factors
Long term smoking
Long term smoking is recognized as a risk factor for pancreatic cancer. The number of smokers is positively related to the mortality of pancreatic cancer, which may be related to the carcinogens contained in tobacco.After smoking cessation for 20 years, the risk of pancreatic cancer can be reduced to the same level as that of normal people.
Bad eating habits
For example, long-term drinking, high-fat and high-protein diet, and long-term drinking of coffee in large quantities can inducepancreatitis, leading to an increased risk of pancreatic cancer.
Obesity
Especially when body mass index (BMI) ≥ 35kg/m, the risk of pancreatic cancer increased by 50%.
Chronic damage of pancreas
Some chronic diseases involving the pancreas will increase the risk of pancreatic cancer.
Chronic pancreatitis, especially for patients with familial pancreatic cancer, may be the cause of pancreatic cancer.
Diabetic patients with a history of more than 10 years also have a significantly increased risk of pancreatic cancer, but the causal relationship is not clear.Recently occurreddiabetesThe risk of pancreatic cancer is increased in those who are older than 50 years old and have no family history of diabetes.
symptom
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The incidence age of pancreatic cancer is mostly 40~65 years old, and the incidence rate of male is higher than that of female.Its onset is hidden, and there are no special symptoms at the beginning of the disease. Once there are obvious symptoms such as jaundice and emaciation, it indicates that it has entered the late stage.The first symptom often depends on the location and scope of the tumor, for example, obstructive jaundice may occur in the early stage of pancreatic head cancer;The early pancreatic body and tail tumors generally have no jaundice.The patient's condition deteriorated rapidly and died in a short time.
early symptom
The onset of pancreatic cancer is insidious, and the early clinical symptoms of patients are not typical, which can be manifested as upper abdominal discomfort, lumbodorsal pain, dyspepsia or diarrhea, which is easily confused with the symptoms of other digestive system diseases.Some patients may not have any discomfort in the early stage. When there are obvious symptoms, they are already in the middle and late stages.
Typical symptoms
Abdominal discomfort or abdominal pain
It is the most common first symptom of pancreatic cancer. Most patients with pancreatic cancer only show discomfort or dull pain in the upper abdomen, dull pain and distention pain.It can gradually develop into persistent and progressive pain in the upper and middle abdomen, or persistent severe pain in the back and waist. The pain is obvious at night, and the abdominal pain will be aggravated when lying on the back, while prone position, squatting position, bending, curling side lying and other positions can slightly reduce the pain.Persistent severe abdominal pain may occur when the tumor invades the celiac plexus in the middle and late stages.
jaundice
It is manifested as yellowing of skin and sclera, deep yellow urination, clay colored stool, accompanied by skin itching and progressive aggravation.It is the most important clinical manifestation of pancreatic head cancer.
Diabetes related symptoms
New onset diabetes is the early manifestation of the disease, and 50% of patients with pancreatic cancer are accompanied by diabetes when diagnosed.
Emaciation and fatigue
At the beginning of the disease, there was obvious emaciation, weight loss, and cachexia in the late stage. The patient was extremely emaciated, "skin and bone, like a skeleton", anemic, weak, and even completely bedridden, unable to take care of themselves, extremely painful, and systemic failure.
Gastrointestinal symptoms
No appetite, bloating, indigestion, diarrhea, or constipation.Some patients may have nausea and vomiting.If the tumor is compressedduodenum, digestive tract obstruction or bleeding may also occur.
Accompanying symptoms
Manifestations of biliary tract diseases
Caused by cancerBiliary obstructionAt the same time, when combined with infection, symptoms similar to biliary stones may appear, such as pain in the right upper abdomen, chills and high fever,jaundiceEtc.
Mental or emotional disorders
Some patients may have depression, anxiety, mania and other mental or emotional disorders.
Low fever
Continuous or intermittent low heat.
Medical treatment
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Pancreatic cancer patients often seek medical treatment due to symptoms such as anorexia, dyspepsia, abdominal pain or obvious emaciation of unknown reasons, and very few seek medical treatment due to further examination after the physical examination found that tumor markers were elevated.Because the onset of the disease is hidden, and there is no special early symptoms, 80% of the patients are in the middle and late stages of the disease.The doctor will inquire in detail about family history, bad living habits, past pancreatic disease history, etc.
Those over 40 years old with the following recent manifestations should be alert to the possibility of pancreatic cancer and seek medical advice as soon as possible.
Persistent epigastric discomfort, aggravated after eating with decreased appetite;
Unexplained progressive wasting;
Newly discovered diabetes, or diabetes suddenly worsens;
Multiple deep vein thrombosis, or migratory phlebitis;
Family history of pancreatic cancer, heavy smoking, chronic pancreatitis.
Visiting department
Pancreatic cancer should be treated in general surgery department, digestive department or oncology department, and a few patients should be treated in infectious disease department or liver disease department due to jaundice.
Relevant inspection
physical examination
In addition to emaciation, yellowish skin and sclera, and abdominal tenderness, doctors can feel the swollen liver and gallbladder, and sometimes a hard lump in the upper abdomen.
There is no specific tumor marker for pancreatic cancer, but there are several common tumor markers that can be significantly increased, including CEA, CA199, CA125, etc., which can be used for auxiliary diagnosis, monitoring therapeutic effect and recurrence, especially CA199, which is the most commonly used. Serum CA199>37U/ml is used as a positive indicator, and the effect of repeated detection is usually better than that of single detection. Repeated detection should be at least 14 days apart.
Imaging examination
B-mode ultrasonography
It can be used for routine examination of patients at the time of initial diagnosis. Due to the influence of gas in gastrointestinal tract, patient's body shape and other factors, the pancreas is often not clearly displayed. If you see the expansion of biliary tract and pancreatic duct, it can have a certain prompting effect.
Enhanced CT
At present, it is the best non-invasive imaging method to examine the pancreas, which can be used for localization, qualitative diagnosis, differential diagnosis and staging.
MRI and MRCP
Magnetic resonance imagingMagnetic resonance cholangiopancreatography (MRI) and magnetic resonance cholangiopancreatography (MRCP) are not the first choice for the diagnosis of pancreatic cancer. When the differential diagnosis of pancreatic lesions is difficult, they can be used as a useful complement to enhanced CT scanning.
MRCP can more clearly show the location and degree of obstruction and expansion of pancreatic duct and bile duct, help to judge the location of lesions, and thus contribute to the detection and differential diagnosis of tumors around ampulla.
PET-CT
Positron emission computed tomography(PET-CT) can display the metabolic activity and metabolic load of tumors, and has obvious advantages in detecting extrapancreatic metastasis and evaluating the overall tumor load.
Endoscopic ultrasound
Endoscopic ultrasound (EUS) can not only detect small pancreatic cancer, but also, more importantly, conduct puncture biopsy under the guidance of EUS to identify the benign and malignant lesions.
Pathological examination
This is the gold standard for the diagnosis of pancreatic cancer.In addition to surgery, the methods for obtaining pathological specimens also include EUS or CT guided puncture biopsy, ascites cytology, laparoscopic exploratory biopsy, etc.
Its main manifestations are similar to those of pancreatic cancer, such as abdominal pain and insufficient endocrine and exocrine functions of the pancreas.The differential diagnosis depends on imaging examination and biopsy pathology.
Periampullary carcinoma is a general term for carcinoma of the lower end of the common bile duct, duodenal carcinoma and ampullary carcinoma.The anatomical location of these tumors is close to the pancreas, and the main symptoms are easily confused with pancreatic head cancer. The examination method is also the same as that of pancreatic head cancer, but the malignancy is relatively low, and the prognosis is better than that of pancreatic head cancer.The identification mainly depends on imaging examination.
The disease has a long history, repeated attacks, and fluctuations in the level of jaundice. The typical triad of abdominal pain, chills, high fever, and jaundice is mainly present at the time of the attack. Combined with imaging examination, it is easy to identify.
Multidisciplinary comprehensive diagnosis and treatment is the basis of pancreatic cancer treatment.In clinical practice, doctors from multiple departments will develop individualized comprehensive treatment plans for patients through multidisciplinary discussion and cooperation according to the physical condition of each patient, tumor location and size, scope of invasion, jaundice level, liver and kidney functions, etc.
The treatment of pancreatic cancer mainly includes surgery, chemotherapy, radiotherapy, interventional therapy and supportive treatment.
According to the relationship between pancreatic cancer and its surrounding blood vessels and distant metastasis, pancreatic cancer can be divided into resectable pancreatic cancer, resectable pancreatic cancer, and unresectable pancreatic cancer. These three cases have different treatment methods.
For resectable pancreatic cancer, radical surgery should be performed as soon as possible, and adjuvant treatment should be selected according to the pathology and patient conditions after surgery.
For pancreatic cancer that may be resected, neoadjuvant treatment (i.e. chemotherapy before surgery) can be given first, and then the possibility of surgical resection can be evaluated.
For unresectable pancreatic cancer, chemotherapy, radiotherapy and immunotherapy can be taken;For those who cannot tolerate radiotherapy and chemotherapy, nutritional support, pain relief and other best supportive treatment can be given.
medication
The drug treatment here mainly refers to the supportive treatment for pancreatic cancer patients, so that patients can accept surgery, radiotherapy, chemotherapy, etc.
analgesia
The pain of pancreatic cancer patients may be very serious, and doctors will give analgesic drugs according to the situation.
Analgesic drug treatment follows WHO three-step analgesic drug treatment.Opioids are the main drugs.If the drug cannot control the pain or the side effects cannot be tolerated, absolute alcohol injection or surgery can be considered for pain relief.
Anti infection
If the patient has biliary tract infection, the doctor will give anti infection treatment in time.
Control blood sugar
Patients with pancreatic cancer may have blood glucose fluctuations or diabetes at the same time, and these patients should receive standardized hypoglycemic drugs.
nutritional support
For patients with advanced cachexia, parenteral and parenteral nutrition can be given according to their gastrointestinal function and general nutritional status.
other
Pancreatic enzyme replacement therapy can be given to patients with nutritional absorption disorder due to insufficient pancreatic exocrine function.
chemotherapy
Chemotherapy should be given to advanced patients or patients before and after surgery.
Pancreatic cancer is not sensitive to chemotherapy, recommendedGemcitabineFluorouracil (includingCapecitabine, S1) and other single drug regimens for 6 months. For patients with good general conditions, the combination chemotherapy scheme can be adopted.
radiotherapy
Radiotherapy is an important treatment for pancreatic cancer, especially the combination of radiotherapy and chemotherapy, which is the preferred treatment for locally advanced pancreatic cancer.At present, the value of postoperative radiotherapy for pancreatic cancer remains controversial.
Because pancreatic cancer has a high resistance to radiation and adjacent organs have a poor tolerance to radiation, intensity modulated radiation therapy and stereotactic radiation therapy are increasingly used for the treatment of pancreatic cancer, and the radiation dose mode is gradually changing to high dose and small fraction (large fraction radiotherapy), which makes the local control rateThe pain relief rate and survival rate were improved.
surgical treatment
Surgical resection is the only effective way for pancreatic cancer patients to obtain cure and long-term survival, but more than 80% of patients lost the chance of radical surgery due to late diagnosis.
PancreatoduodenectomyWhipple operation is the most commonly used radical surgery for pancreatic cancer, which covers the head of pancreas (including uncinate process), distal stomachduodenum, upper jejunumgallbladderAnd common bile duct, andlymph gland。
Pancreatectomy: Pancreatectomy is feasible when the tumor is large, including the head, neck and body of the pancreas.
Follow up should be carried out regularly according to the doctor's advice after the operation. It is recommended to follow up once every three months in the first year after the operation;Follow up every 3-6 months in the second to third year;After that, they were followed up every 6 months, including blood routine examination, liver and kidney function, tumor marker examination, and imaging examination.
interventional therapy
Arterial infusion chemotherapy and ablation can be conducted under the guidance of X-ray, ultrasound or CT.
For patients with jaundice, obstruction or bleeding, percutaneous transhepatic stent drainage (PTBS), percutaneous transhepatic biliary drainage (PTCD), gastrointestinal stent implantation, vascular embolization and other interventional treatments can be used to alleviate jaundice, stop bleeding, relieve or alleviate obstruction.
TCM treatment
Traditional Chinese medicine can help patients with pancreatic cancer recover their function after surgery, reduce the toxic reaction of radiotherapy and chemotherapy, improve their quality of life, and can be used alone or in combination with other anti pancreatic cancer drugs.However, its specific efficacy in the treatment of pancreatic cancer remains to be confirmed by more studies.
Frontier treatment
Targeting drugs, such as those targeting blood vesselsBevacuzumab, targeting epidermal growth factor and its receptorCetuximab、ErotinibIt has certain curative effect on pancreatic cancer when combined with chemotherapy drugs or used alone.
Immunotherapeutic drugs, such as PD-1 antibody, can be considered for patients with disease progression after first-line chemotherapy, but gene detection (MSI or MMR detection) closely related to tumor occurrence is required before use.
prognosis
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The prognosis of pancreatic cancer is very poor. The overall 5-year survival rate is only about 5%, and the 5-year survival rate of patients undergoing radical resection is not more than 20%.The survival time of untreated pancreatic cancer patients is about 4 months.
complication
Complications directly caused by tumor
Tumor compression can lead to biliary obstruction or bleeding after duodenal invasion.
The tumor leads to abnormal pancreatic function, new diabetes or aggravation of existing diabetes.
The treatment cycle of pancreatic cancer is long, it is difficult to achieve complete remission, and it is difficult to define recurrence.The prognosis of these patients is very poor, and tumor metastasis often occurs when they are found. The most common site of metastasis is the liver.
Related research
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In October 2022,Virginia TechA team of researchers from the University of California studied a bacterium found in pancreatic cancer tumors.The research team found that this bacteria can be transferred to pancreatic cancer tumors, which may help guide the future treatment of pancreatic cancer.This bacterium, called Fusobacterium nucleatum, maycancerOfInvasive growthAnd play a key role in the whole body movement.The research results were published in Science Signaling on October 18.
In July 2023, Hokkaido University of Japan released a press release saying that its researchers found two targets for treating pancreatic cancer through animal experiments.This discovery is expected to help the medical community understand the development process of pancreatic cancer and develop therapeutic drugs.
