Pancreatic head cancer
Introduction
Introduction to pancreatic head cancer Pancreatic head cancer is a highly malignant tumor of the digestive system that originates in the head of the pancreas. In pancreatic malignant tumors, we usually refer to pancreatic cancer, which refers to the exocrine tumor of the pancreas. It accounts for more than 90% of pancreatic malignant tumors, accounting for 1-2% of systemic malignant tumors. In recent years, the incidence rate has increased significantly at home and abroad. trend. Pancreatic cancer has a high degree of malignancy and rapid development. It is difficult to detect early, has a low resection rate, and has a poor prognosis. The 5-year survival rate of resectable patients is less than 5%, ranking fourth in the cause of malignant tumor death. Internationally, it is called "the stubborn fortress of medicine in the 21st century." basic knowledge The proportion of illness: 0.005% Susceptible people: no special people. Mode of infection: non-infectious Complications: gastrointestinal bleeding
Cause
Cause of pancreatic head cancer
The cause of pancreatic head cancer is still not fully understood, but some factors have been found to be closely related to the pathogenesis of pancreatic cancer. A large number of studies support pancreatic cancer associated with the following factors:
Genetic (35%):
Relatives of patients with pancreatic cancer have an increased risk of developing pancreatic cancer. According to a large number of experimental results, the chances of identical twins suffering from pancreatic cancer are twice as high as those of fraternal twins. Cancer patients have a greater chance of getting malignant tumors in their offspring, and many people in the same family can have cancer of the head of the pancreas.
Smoking (10%):
As early as 1985, the International Association for Cancer Research pointed out that smoking is one of the important causes of pancreatic cancer. Since then, a large number of epidemiological and laboratory studies have continually provided new supporting evidence for this conclusion. A 1993 cohort study in the United States showed that people who smoked more than 25 cigarettes a day were four times more likely to develop pancreatic cancer than nonsmokers. A case-control study in Japan in 2003 also suggested that smoking is a risk factor for pancreatic cancer, and the younger the age at which smoking begins, the greater the amount of smoking and the closer the incidence of pancreatic cancer. There is also a significant correlation between smoking and pancreatic cancer mortality. The risk of death from pancreatic cancer in smokers is 1.6 to 3.1 compared with non-smokers, and the mortality rate increases with the increase in smoking.
Fat meal (10%):
It is thought to be related to pancreatic cancer in the experimental model, and a higher body mass index is also associated with increased risk.
Other (10%):
Occupational exposure to chemicals such as beta-naphthylamine and p-diaminobiphenyl is also associated with an increased risk of pancreatic cancer. In patients with diabetes, chronic pancreatitis and cholelithiasis, the incidence of pancreatic cancer is 2-4 times higher than that of normal people.
Prevention
Pancreatic cancer prevention
Although the exact cause of pancreatic cancer is unclear, it is certain that its pathogenesis is closely related to lifestyle. In recent years, the rapid growth of pancreatic cancer has been associated with improved living conditions and increased lifestyles. Therefore, to prevent pancreatic cancer, it is necessary to pay attention to lifestyle.
People should ensure a reasonable mix of meat, eggs, vegetables, fruits and food in the diet, not partial eclipse, picky eaters, eat less fried, fried, baked foods, and appropriately increase the intake of coarse grains, vegetables and fruits.
First, avoid high animal protein and high fat diets. Studies have shown that excessive intake of such foods, the incidence of pancreatic cancer is significantly increased. The incidence of pancreatic cancer among residents in developed countries such as Europe and the United States is relatively high, and this is related to this.
Second, do not smoke. Tobacco contains a variety of carcinogens, which increases the risk of pancreatic cancer.
Third, persist in exercising and maintaining good emotions also have a role in fighting cancer.
Fourth, avoid overeating and drinking. Overeating and alcohol abuse are the main causes of chronic pancreatitis, and the pancreas increases the risk of cancer by long-term stimulation of chronic inflammation.
Fifth, less exposure to harmful chemicals such as naphthylamine and aniline. Studies have shown that people who have been exposed to these chemicals for a long time are about five times more likely to develop pancreatic cancer than normal people. If the work requires long-term exposure to these chemicals, it should be protected.
Complication
Pancreatic head cancer complications Complications, gastrointestinal bleeding
Diffuse lesions may occur, which may cause gastrointestinal bleeding.
Symptom
Pancreatic head cancer symptoms Common symptoms Abdominal pain with jaundice Upper abdominal pain Loss grayish gray stool Disgusting dyspepsia Defecation frequency Abnormal diarrhea Lymph node enlargement Sclera yellow stain
Most patients with pancreatic cancer lack specific symptoms and initially only show upper abdominal discomfort, dull pain, and are easily confused with other digestive diseases. When the patient has low back pain for the tumor to invade the retroperitoneal plexus, it is a late manifestation. 80-90% of patients with pancreatic cancer have weight loss and weight loss at the beginning of the disease. Patients with pancreatic cancer often have symptoms such as indigestion, vomiting, and diarrhea. The symptoms of pancreatic head cancer mainly include mid-upper abdominal discomfort discomfort, dull pain, dull pain, pain; nausea, loss of appetite or eating habits; weight loss; jaundice, itchy skin, yellow urine, light stool or even white clay Defecation habit change, steatorrhea; depression; pancreatitis episode; diabetes symptoms; gastrointestinal bleeding; anemia, fever; thrombophlebitis or arteriovenous thrombosis, facet joint redness, swelling, heat, pain, subcutaneous fat around the joints Necrosis; unexplained testicular pain. Most patients with pancreatic head cancer have no significant positive signs in the early stage. The signs of pancreatic head cancer mainly include skin, sclera yellow staining, liver, gallbladder, splenomegaly; tenderness or mass in the upper abdomen. Ascites, abdominal mass, superficial lymphadenopathy, etc. often suggest advanced lesions.
Examine
Examination of pancreatic head cancer
Auxiliary inspection
(1). Routine and biochemical tests :
a. blood routine: due to some cases of anemia, in some cases with acute cholangitis, acute pancreatitis as the main symptoms, there will be changes in white blood cells, for perioperative management and the development of treatment options can provide meaningful information.
b. Urine routine and urinary tricholinal test: urine sugar can be screened for diabetes, urinary bilirubin positive, urinary biliary negative is strongly suggestive of obstructive jaundice.
c. Undigested muscle fibers and fat droplets appear in the feces, indicating that the exocrine function of the pancreas is damaged. The occult blood positive and the ampulla lesions have differential diagnosis significance or the tumor invades the duodenum and duodenal papilla.
d. Serum biochemical examination: serum obstruction (ALT), alkaline phosphatase (AKP), -glutamyltransferase (GGT) and lactate dehydrogenase (LDH) are elevated when serum biliary obstruction occurs, serum bile The erythromycin is progressively elevated, with a direct increase in bilirubin. Trypsin includes amylase, lipase, elastase, trypsin and the like. 20% to 30% of pancreatic cancer can be seen as an increase in pancreatic enzyme, which is considered to be concomitant pancreatitis caused by pancreatic duct stenosis caused by pancreatic cancer. Pancreatic enzyme examination plays an important role in the diagnosis of pancreatic diseases, but lacks specificity for pancreatic cancer. Long-term jaundice patients will have biochemical changes in renal dysfunction. Patients may have elevated blood glucose and abnormal glucose tolerance.
e. Pancreatic exocrine function test: About 80% of patients with pancreatic cancer may have exocrine function.
f. Tumor Marker Examination: A serum marker that is very satisfactory for the diagnostic sensitivity and specificity of pancreatic cancer has not been found so far. At present, the accuracy of detecting single tumor markers for pancreatic cancer diagnosis is not very high. Clinically, combined detection methods are used to improve sensitivity and improve the diagnosis rate of pancreatic cancer.
g.CA19-9 Level >100 U/ml The accuracy of diagnosis of pancreatic cancer is approximately 90%. CA19-9 is also used to predict prognosis and treatment process monitoring.
Note: CA19-9 is commonly expressed in pancreatic and hepatobiliary diseases as well as many other malignant tumors. It is not a specific marker for pancreatic cancer. However, the rising level of CA19-9 is helpful for the differentiation of pancreatic cancer from pancreatic inflammatory disease. The continuous decline of CA19-9 level is related to the survival of pancreatic cancer patients after surgery or chemotherapy. It is worth mentioning that when obstructive jaundice occurs, the value of CA199 will increase significantly, leading to false positive results. Therefore, it is necessary to review the CA199 value after yellowing, and if it is still elevated, it has certain significance.
h. Other pancreatic cancer tumor markers include: CA242, CEA, CA50, CA125, Span-1, Dupan-2, PGGT, POA, mucins (MUC), pancreatic carcinoembryonic antigen, amylin, and the like.
(2). Imaging examination :
a. Abdominal color Doppler ultrasound examination: the first choice for initial screening of pancreatic cancer, has the advantages of non-invasive, simple operation and low price, but the detection rate of early lesions is greatly affected by the experience of the doctor.
b. Multi-slice spiral CT multi-phase scan: routine and preferred examination of preoperative diagnosis and staging of pancreatic head cancer, the diagnosis rate of pancreatic cancer can reach more than 90%, combined with multi-phase scanning, three-dimensional angiography, vascular perfusion imaging The technique can be used to evaluate the size, location, local lymph node infiltration, peripheral vascular invasion, distant organ metastasis, and to identify pancreatic inflammatory masses and other benign pancreatic lesions. CT-guided fine needle aspiration biopsy can obtain pathological evidence of the tumor. With the popularity of multi-slice spiral CT, CT is the preferred method for preoperative resectability assessment of pancreatic head cancer. According to the relationship between tumor and portal vein and mesenteric vessels, the possibility of tumor resection is judged, and unnecessary laparotomy is avoided. Switch surgery.
c. ERCP: usually severe stenosis and significant expansion of the proximal pancreatic duct suggest a malignant lesion. In the case of inoperability or delay in surgery, ERCP can be used to reduce biliary obstruction. In the ERCP process, pancreatic duct brushing or biopsy can be performed to diagnose pancreatic cancer by finding tumor cells. Endoscopic ultrasonography: can be used for staging and diagnosis of pancreatic cancer. It is possible to evaluate the mass around the ampulla and distinguish between invasive and non-invasive lesions. Especially in the diagnosis of pancreatic cystic lesions have a good effect.
d. Endoscopic ultrasound guided fine needle aspiration biopsy can obtain pathological evidence of tumor, compared with percutaneous puncture can reduce the risk of peritoneal implantation, so the lesion can be resected when endoscopic ultrasound guided fine needle aspiration biopsy is better than CT guidance puncture. At the same time, some treatments (such as celiac plexus block, ascites removal, etc.) can be performed with endoscopic ultrasound assistance.
e. MRI examination: MRCP examination using the characteristics of T2 sequence water imaging can clearly show the pancreatic duct and intrahepatic bile duct, and can be used for patients who cannot tolerate invasive examination or have iodine allergy and cannot receive CT enhanced scan.
f. PTCD: used in patients with hyperbilirubinemia, biliary tract infections, and patients requiring extended surgery for external drainage and yellowing.
g. Pancreaticoscopic: It can directly observe the pancreatic duct, and can also collect pancreatic juice for cytological examination, which can confirm early pancreatic cancer.
h. Laparoscopy: Peritoneal implantation and scattered micro-hepatic metastases missing from CT examination can be found. Laparoscopy can also be used for additional staging.
i. PET examination: can show early pancreatic cancer, and can show the transfer of liver and distant organs, the metastatic lymph nodes as small as 0.5cm can be detected in the abdomen.
(3). Pathological diagnosis : preoperative ERCP pancreatic duct cell brush or biopsy; endoscopic ultrasonography (preferred) or CT-guided fine needle percutaneous biopsy; intraoperative fine needle biopsy, or direct biopsy.
Diagnosis
Diagnosis and diagnosis of pancreatic head cancer
Differential diagnosis
Pancreatic cancer originates from the pancreatic ductal epithelial cells, so it is easy to cause obstruction and dilation of the pancreatic duct. Pancreatic cancer often infiltrates the lower end of the common bile duct, and obstructive bile duct dilatation causes jaundice. The metastatic cancer is the transfer of the primary cancer cells to the pancreas through blood or lymphatic, and the cancer cells do not originate from the glandular epithelium, so generally do not cause pancreatic duct dilatation, nor infiltrate the common bile duct wall, unless the tumor is more Large, external pressure bile duct can cause obstructive expansion.
Metastatic pancreatic cancer: Cancer of the lungs, breast, ovary, prostate, liver, kidney, and gastrointestinal tract can be transferred to the pancreas. The pancreas is a good site for metastatic cancer. The CT manifestations of metastatic pancreatic cancer are diverse and can be roughly divided into three cases, namely, single-shot irregular mass, multiple tumors, and diffuse enlargement of the pancreas. Among them, a single lumps are most common, while a single lumps are mostly located in the head of the pancreas. The size of the metastases varies from morning to evening depending on the time of examination. Most of the shapes are irregular, some are lobulated, and the density is low density and equal density, but low density. There is no obvious specificity in the change of morphology and density, but it is difficult to distinguish from the primary tumor from local manifestation. It must be closely combined with clinical and other indirect signs to distinguish. The primary lesion is clearly a prerequisite for diagnosis, so the diagnosis is not very difficult.
Multiple tumors in the pancreas are more likely to cause metastasis, and if the primary lesion is determined, it can be diagnosed. However, pancreatic cancer should be differentiated from acute pancreatitis and pancreatic cancer. Acute necrotic pancreatitis sometimes has a diffuse metastasis of pancreas due to low-density necrosis and pancreatic parenchyma. However, after consolidation, the parenchymal border is unclear, and there is a low-density edema around the pancreas. Clinical symptoms can be identified. When partial pancreatic cancer is characterized by multiple lesions of the pancreas and diffuse enlargement of the foci, the identification of the two is difficult, and it is necessary to closely combine the clinical history.
In addition, some chronic pancreatitis manifests as a localized enlargement of the pancreas, especially the enlargement of the pancreas at the head of the pancreas is very similar to that of the pancreatic head cancer. The following points can be identified:
1 The head of the pancreas is enlarged, and the shape is smooth without lobulation.
2 enhanced performance as uniform density.
3 The common bile duct is normal or dilated, but the shape is regular.
4 There was no obvious invasion of the peri-pancreatic vessels or organs.
5 calcification can be seen in the head of the pancreas.
diagnosis
In short, the appearance of pancreatic head cancer is diverse, and it must be closely combined with the clinic to improve the diagnosis rate. CT is still an important examination method.
