Definition of disease. Causes of the disease
Pancreatic cancer is a malignant tumor that develops from altered pancreatic cells.
Incidence of pancreatic cancer
Pancreatic cancer is the sixth most common malignancy in terms of occurrence. Since 1987, the incidence of pancreatic cancer in our country has increased by 30%, the incidence among women is 7.6, among men – 9.5 per 100 thousand people. Experts note that the prevalence of the disease worldwide will increase. According to forecasts, the number of patients with pancreatic cancer in 2020 compared to the past twenty years will be 32% higher in developed countries, and 83% higher in developing countries, reaching 168,453 and 162,401 cases, respectively. In 75% of cases, the disease affects the head of the pancreas.
Anatomy and physiology of the pancreas:
The main risk factors for developing pancreatic cancer are:
- tobacco smoking (1-2% of smokers develop pancreatic cancer);
- diabetes mellitus (the risk of developing the disease in diabetics is 60% higher);
- chronic pancreatitis (pancreatic cancer develops 20 times more often);
- age (the risk of developing pancreatic cancer increases with age. More than 80% of cases develop between the ages of 60 and 80);
- race (studies in the United States have shown that pancreatic cancer is more common in African Americans than in whites. This may be partly due to socioeconomic reasons and cigarette smoking);
- gender (the disease is more common in men than in women);
- obesity (significantly increases the risk of developing pancreatic cancer: 8% of cases are associated with it);
- diet (diets with an abundance of meat, high cholesterol, fried foods can increase the risk of developing the disease);
- genetics (a number of inherited cancer syndromes increase the risk of developing the disease, for example, breast cancer, familial atypical multiple melanoma syndrome, hereditary colorectal cancer syndrome).
Symptoms of pancreatic cancer
Often, in the initial stages, the signs of pancreatic cancer are not expressed, and subjective sensations allow suspecting its presence.
The first symptoms of pancreatic cancer may include:
- heaviness or discomfort in the upper abdomen;
- the appearance of signs of diabetes (thirst, increased blood sugar, etc.);
- frequent, loose stools.
The first symptoms of pancreatic cancer also include loss of appetite and fatigue.
As the disease progresses, other symptoms of pancreatic cancer may appear:
- pain in pancreatic cancer occurs in the upper abdomen with irradiation to the back;
- yellowness of the skin and whites of the eyes (due to impaired outflow of bile from the liver to the intestines);
- nausea and vomiting (as a result of compression of the duodenum by the tumor);
- Intoxication – Pancreatic cancer can also interfere with the production of digestive enzymes in the pancreas and interfere with the breakdown of food, which causes bloating, gas, and foul-smelling diarrhea.
- weight loss.
However, all these symptoms of pancreatic cancer are non-specific, and when they appear, a complex of diagnostic procedures is necessary.
Classification and stages of development of pancreatic cancer
Depending on the location of the tumor:
- cancer of the head of the pancreas;
- cancer of the isthmus of the pancreas;
- cancer of the body of the pancreas;
- pancreatic tail cancer.
Also allocate a total lesion of the pancreas.
Depending on the histological form of the disease (determined by the results of histological examination of the tumor):
- ductal adenocarcinoma (occurs in 80-90% of cases);
- neuroendocrine tumors (insulinoma, gastrinoma, glucagonoma, etc.);
- cystic malignant tumors (mucinous, serous);
- other rare histological forms.
Description of the development of oncology according to the TNM system:
|I||The tumor is small, not extending beyond the pancreas. Metastases are absent.|
|II||The spread of the tumor outside the organ, but without the involvement of large arterial vessels in the process. There are metastases to the lymph nodes, but no metastases to other organs.|
|III||Germination of the tumor in large arterial vessels in the absence of metastases to other organs.|
|IV||There are metastases to other organs.|
T (tumor – tumor) – the size of the tumor; N (nodus – node) – the state of the lymph nodes; M (metastasis – metastases) – the presence of metastases  .
Pancreatic cancer with metastases to other organs:
Approximately 2% of pancreatic cancer cases are metastases from other organs. The most common primary foci of cancer, leading to the appearance of metastases in the pancreas:
- kidney cancer ;
- colorectal cancer ;
- melanoma ;
- mammary cancer;
- lung cancer;
Complications of pancreatic cancer
If the formation is located in the body or tail of the pancreas, then the development of complications often occurs at the 4th stage of the disease, and they are primarily associated with cancer intoxication.
When the tumor is located in the head of the pancreas, the following complications may develop:
- Mechanical jaundice
Manifestations: yellowing of the whites of the eyes, skin, darkening of urine, stool becomes light. The first sign of developing obstructive jaundice may be itchy skin. The development of this complication is associated with the germination of the tumor in the ducts, which ensure the delivery of bile from the liver to the duodenum. Most often, before proceeding with radical surgical treatment, it is necessary to stop the signs of jaundice (the most acceptable technique is minimally invasive drainage of the bile ducts under ultrasound scanning).
- duodenal obstruction
Manifestations: nausea, vomiting, feeling of heaviness and fullness of the stomach. This complication develops due to the fact that the tumor from the head of the pancreas spreads into the duodenum, as a result of which the intestinal lumen is blocked, and food cannot exit the stomach into the underlying sections of the small intestine.
- intestinal bleeding
It is manifested by dark-colored vomiting (“coffee grounds”) or the appearance of black stools. This is due to the collapse of the tumor, and, as a result, the occurrence of bleeding.
Diagnosis of pancreatic cancer
The main instrumental diagnostic methods:
- Ultrasound of the abdominal organs (including endoscopic);
- x-ray computed tomography (RCT);
- esophagogastroduodenoscopy (EGDS).
Diagnosis using a blood test and ultrasonic resonance method
Modern ultrasound devices make it possible to clarify the localization of the tumor, its size and relationship with the large vessels of the abdominal cavity. However, a more accurate location of the tumor, the presence of distant metastases, involvement of the abdominal vessels in the tumor process allows us to evaluate computed tomography of the abdominal organs with intravenous contrast.
Of practical importance are the determinations of oncological markers of blood serum: CA 19.9 and CEA (cancer-embryonic antigen), an increase in which may indirectly indicate the presence of a cancerous tumor in a patient. Unfortunately, these tests are not specific, and the rates can be increased in other diseases, such as colon cancer, stomach cancer, etc.
Magnetic resonance imaging
Instead of computed tomography, magnetic resonance imaging is possible, but the use of intravenous contrast is a prerequisite.
Positron emission tomography
There are more expensive diagnostic techniques, for example, positron emission tomography, but its implementation as the first research method is impractical due to the high cost.
Needle biopsy of the tumor
If necessary, the doctor may recommend performing a needle biopsy of the tumor. This may be necessary to determine the histological type of the tumor and select an individual treatment.
Treatment of pancreatic cancer
Treatment of pancreatic cancer involves the use of surgical and chemotherapy methods.
Features of treatment at different stages
When surgery is needed for pancreatic cancer depends on the histological form of the disease and its stage.
With adenocarcinoma of the pancreas, radical surgical treatment (complete removal of the tumor) is possible only in stages I and II, then courses of chemotherapy are performed . At stage III of the disease, chemotherapy is first carried out, and then, if there are positive dynamics, radical surgical treatment is performed. At stage IV, only courses of chemotherapy are carried out, and surgical treatment is aimed at eliminating the complications of the disease.
With neuroendocrine tumors of the pancreas, surgical treatment is possible at any stage of the disease, with further courses of chemotherapy. The volume of surgery for these tumors is determined individually and depends on the prevalence of the disease and the experience of the operating team.
In other histological forms of pancreatic cancer, the tactics are identical to those of treatment for adenocarcinoma.
Whipple operation for pancreatic cancer (pancreatoduodenectomy). If the tumor is localized in the head of the pancreas, then a gastropancreatoduodenal resection (Whipple operation) is performed, during which the head of the pancreas, duodenum 12, part of the stomach, proximal small intestine, gallbladder, bile ducts are removed. Subsequently, fistulas are performed between the remaining part of the pancreas and the digestive tract, bile ducts and intestines, stomach and intestines.
Distal pancreatectomy. When the tumor is localized in the body of the pancreas, a distal resection of the pancreas or an isolated resection of the body of the pancreas is performed, with the formation of an anastomosis between the tail of the pancreas and the gastrointestinal tract.
If the malignancy is located in the tail of the pancreas, the tail of the gland is removed with the removal or preservation of the spleen.
Total pancreatectomy. With a total lesion of the pancreas, the only possible surgical intervention is the complete removal of the pancreas. Recently, due to the availability of good replacement therapy (insulin therapy and correction of enzymatic deficiency), this operation is advisable only in some cases.
Nano-knife in the treatment of pancreatic cancer. The effectiveness of the nano-knife in the treatment of pancreatic cancer has not yet been proven.
All operations on the pancreas are associated with a large number of complications. The only factor that can reliably reduce the incidence of complications is the experience of the surgeon performing this surgical treatment. It has been proven that when performing more than 20 gastropancreatoduodenal resections per year, the death rate is less than 2%, but if 5-15 such operations are performed, the mortality rate is 15-20%.
Thus, the only radical treatment for pancreatic cancer is surgical treatment followed by courses of chemotherapy. 
Radiation therapy for pancreatic cancer
At stage III of the disease, the absence of the effect of chemotherapeutic treatment and the impossibility of surgical intervention, stereotactic radiation therapy is indicated.
Stereotactic radiation therapy (SLT) is a modern method of radiotherapy, in which high doses of ionizing radiation are delivered to the target area in a small number of fractions.
Treatment of malignant tumors of the pancreas with liver metastases
With neuroendocrine tumors of the pancreas, surgical treatment can be performed even in the presence of metastatic foci. In other histological forms of pancreatic cancer with liver metastases, only chemotherapy is indicated.
Pain relief for pancreatic cancer
Taking painkillers for pancreatic cancer is necessary only when pain occurs. First, the patient is prescribed non-narcotic analgesics, if they are ineffective – narcotic drugs.
Diet for pancreatic cancer
There is no specific diet for pancreatic cancer. The diet must be observed after pancreatic surgery (Table No. 5A or Table No. 9 if the patient has diabetes).
The prognosis for pancreatic head cancer depends on the histological form of the disease:
- With adenocarcinoma of the pancreas after radical surgical treatment and courses of systemic chemotherapy, 20-40% of patients live for more than 5 years. Unfortunately, this is the most common and most aggressive pancreatic tumor with a high recurrence rate and prone to early metastasis.
- With neuroendocrine tumors, the prognosis is much better, even at stage IV of the disease. Up to 60-70% of patients live for more than 5 years even in the absence of radical surgical treatment. Many of these tumors grow very slowly, and with the right treatment, a full recovery can occur. [eight]
Probability of relapse
Relapses within a year after surgery occur in 50–60% of cases with pancreatic adenocarcinoma and in 14% with neuroendocrine tumors .
Can pancreatic cancer be prevented
Prevention of the disease is the maintenance of a healthy lifestyle: quitting smoking as a risk factor, the exclusion of alcohol, which is the main factor in the occurrence of chronic pancreatitis. Maintaining an active lifestyle and proper nutrition reduce the risk of developing diabetes and thus the risk of pancreatic cancer.
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