Defeating the “king of cancers” in the bile and pancreas

April 15 to 21 is the National Tumor Awareness Week. The tumors referred to here are malignant tumors. Since GI tumors account for about 50% of current malignant tumors, coupled with fashionable lifestyle, especially irregular work and rest and diet, GI tumors, including biliary pancreatic tumors, have targeted many young people. Therefore, we ask authoritative experts here to talk about how to treat these tumors. Common GI malignant tumors include esophageal cancer, stomach cancer, colon cancer, liver cancer, bile duct cancer, pancreatic cancer, etc. Among them, the incidence of bile duct cancer and pancreatic cancer is gradually increasing in recent years, which is a serious threat to human health. Bile duct cancer and pancreatic cancer are both highly malignant tumors with insidious onset and lack of specific symptoms and diagnostic indicators in the early stage of development, so early diagnosis is difficult. However, due to the complicated anatomy of bile duct and pancreas and the easy invasion of surrounding large blood vessels, nerves and lymphatic tissues in the early stage, the surgery is difficult and the surgical resection rate is low. However, due to the complex anatomy of bile duct and pancreas, early invasion of surrounding blood vessels, nerves and lymphatic tissues, surgery is difficult and the rate of surgery is low. Happily, with the development of science and the improvement of surgical techniques, the treatment of bile duct cancer and pancreatic cancer has been improved by aggressive surgical resection in recent years. It is one-sided and wrong to think that “if you have bile duct cancer and pancreatic cancer, you can only wait for death”. Early detection of some symptoms and manifestations, as well as active and effective early diagnosis and treatment, are very meaningful to improve the survival rate and cure rate of patients. The most common early symptoms of bile duct cancer are: progressive jaundice with upper abdominal discomfort, loss of appetite, emaciation and itching; if combined with gallstones and biliary tract infection, there may be chills and fever, and paroxysmal abdominal pain and vague pain; if the cancer is located in one side of the hepatic duct, it is often asymptomatic at the beginning, and obstructive jaundice appears only when it affects the opening of the opposite side of the hepatic duct; if it is cancer in the middle of the bile duct, it is not accompanied by gallstones and infection. If the cancer is in the middle of the bile duct and is not accompanied by gallstones and infection, it is mostly painless progressive obstructive jaundice, and progresses faster. If the tumor breaks down and bleeds, there may be black stool or positive fecal occult blood test, anemia and other manifestations. Therefore, progressive jaundice of unknown origin should be promptly seen. The common clinical manifestations of pancreatic cancer are: abdominal pain, jaundice and wasting. Risk factors are as follows: age > 40 years; non-specific discomfort in the right upper abdomen; family history of pancreatic cancer; patients with sudden onset diabetes mellitus, especially atypical diabetes mellitus; age above 60 years, lack of family history, no obesity, and soon developing insulin resistance; patients with chronic pancreatitis, etc. The above groups of people with unexplained abdominal pain, low back discomfort, jaundice and wasting should be promptly examined and treated in regular hospitals. Cutting biliopancreatic tumors for potential cure Domestic bile duct cancer and pancreatic cancer are already in the middle and late stages when they are diagnosed, and these patients should not be abandoned, but should be actively examined and evaluated for resectability. If surgical opportunities and conditions are available, surgery should be aggressively performed, because for biliary-pancreatic tumors, resection is equal to potential cure. Combined multivisceral resection and vascular resection and reconstruction techniques should be applied to achieve negative margins and improve resection rates to improve the prognosis and outcome of tumor patients. For example, the 5-year survival rate of patients with negative margins after surgical resection of bile duct cancer is about 8%~47%, especially for early stage tumors, the prognosis is better. Even for progressive stage tumors, through aggressive surgery, combined with organ resection and revascularization, the prognosis of patients can be significantly improved if they can achieve negative margins, which is now an international consensus. He is currently the Deputy Director of the Biliary and Pancreatic Surgery and Laparoscopic Surgery Center of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. He is also the National Young and Middle-aged Member of the Minimally Invasive Surgery Branch of the Chinese Medical Association, the Reviewer of the National Natural Science Foundation of China in the field of tumor, the Reviewer of the Research Start-up Fund for Returned Overseas Students of the Ministry of Education, and the Editorial Board Member of the Journal of Clinical Surgery. From 2008 to 2010, he studied and worked at Heidelberg University Hospital in Germany, Nagoya University Hospital in Japan, and Strasbourg International Center for Laparoscopy in France. He has accumulated rich experience in the diagnosis and treatment of hepatobiliary and pancreatic, gastrointestinal, breast and thyroid surgical diseases, especially in the surgical treatment of biliary tumors, pancreatic tumors and the management of difficult biliary tract diseases, surgical treatment of obstructive jaundice, gallstone disease, pancreatitis and laparoscopic surgery.