Pancreatic cancer is a common malignant tumor, and it is called the “king of cancers” because of its high malignancy. The reason why pancreatic cancer is so scary is that on one hand, it is difficult to treat, and on the other hand, 80% of patients are already in the middle and late stages when they are diagnosed, missing the best time for treatment. Since the early symptoms of pancreatic cancer are not obvious, it is not easy to attract the attention of patients, and even if the symptoms appear, it is often found to be pancreatic cancer only after long treatment, which seriously affects the survival of patients.
In many countries, especially in fast developing and open countries like China, when people’s lifestyle becomes more westernized, the incidence of pancreatic cancer also rises significantly, with about 200,000 new cases of pancreatic cancer in the world every year. In Europe there are over 40,000 deaths per year and in the United States there are nearly 30,000 deaths per year. The incidence of pancreatic cancer is approximately 10/100,000, equal to the mortality rate, indicating the highly malignant nature of this disease. So, what reactions predict the visit of pancreatic cancer? Who are the people at high risk of pancreatic cancer? What are the preventive measures for this kind of disease? The Guangdong Family Physicians Association invited Professor Chen Rufu, Vice President of the Second Hospital of Sun Yat-sen University, to give us answers.
Lina Zhang: President Chen, the general public does not know much about the pancreas, what is the pancreas? What is the status of the pancreas in the human body?
Chen Rufus: The pancreas is a “worldly man”, why do you say so? There are two main points, one is “hidden deep”, the second is “capable”.
The pancreas is a long strip of glands about 14-18 cm long, “hidden” behind the peritoneum, anatomically located in the middle of the abdominal cavity, the upper right is the liver, the upper left is the spleen, the front is the stomach and colon, the rear is important blood vessels, nerves, muscles and spinal column. When the pancreas is “sick”, it often has a certain relationship with the surrounding organs, giving people the feeling of “plausible but not real”, and at the same time, because of its special location, it is difficult to be found by some ordinary examinations, so it is called “hidden”. It is called “deep”. In addition, although the pancreas is small, but very “capable”, the role of extraordinary. As the second largest digestive gland in the body, the pancreas is divided into two parts: the exocrine gland and the endocrine gland. The exocrine glands secrete pancreatic juice containing a large number of digestive enzymes, which digest the proteins, fats and sugars we consume daily; the endocrine glands are composed of different sized cell groups – islets, which secrete insulin and regulate sugar metabolism. Therefore, the status of the pancreas is extraordinary.
Lina Zhang: What are the main pancreatic diseases? What are the main symptoms?
Rufus Chen: The common pancreatic diseases are mainly inflammatory, cystic and tumor diseases of the pancreas. Inflammatory diseases mainly include acute and chronic pancreatitis; cystic diseases include pancreatic cysts, cystic tumors such as plasmacytoma and mucinous cystadenoma; pancreatic tumors commonly include pancreatic cancer, pancreatic endocrine tumors such as insulinoma and VIP tumor. In addition, some rare pancreatic diseases include congenital diseases of the pancreas, such as annular pancreas and pancreatic separation, multiple endocrine adenopathies involving the pancreas, malignant tumors (such as liposarcoma and malignant nerve sheath tumor), etc. With the improvement of our people’s living standard and the change of lifestyle and diet, the incidence of pancreatic diseases has increased significantly compared with the past, which seriously threatens people’s life and health. However, in fact, pancreatic diseases are not “untraceable”. For example, pancreatitis can cause symptoms such as “upper abdominal discomfort, abdominal pain, nausea and vomiting”, which are sometimes similar to “stomach disease”, but are difficult to be relieved by general treatment and can be differentiated. The onset of pancreatic cancer is very insidious and the early symptoms are not obvious, but if there is “fullness in the upper and middle abdomen, soreness in the back, sudden increase in blood sugar, jaundice”, then it is important to track it down!
Lina Zhang: Is the incidence of pancreatic cancer high? How to prevent it in the general population?
Rufus Chen: Pancreatic cancer is known as “the king of cancer” and is one of the malignant tumors with the worst prognosis. The incidence rate of pancreatic cancer in China has increased 6 times in the past 20 years and is now about 5.1/100,000. In some developed cities, such as Shanghai, the incidence rate of pancreatic cancer is close to that of European and American countries. The incidence of pancreatic cancer usually occurs in people over 45 years old, and the ratio of men to women is 1.5 to 1.9:1, with the incidence rate of men being higher than that of women. The early detection rate of pancreatic cancer is very low. Overall, the early detection rate of pancreatic cancer is less than 5%, and most of them are found in the middle and late stages. The chance of surgery for early stage pancreatic cancer is more than 50%, and the 5-year survival rate after surgery is more than 80%, while the chance of receiving surgery for middle and late stage pancreatic cancer is not more than 20%, and the 5-year survival rate after surgery is less than 10%. Therefore, we place great emphasis on early diagnosis and early treatment of pancreatic cancer.
Many diseases are closely related to genetic factors, but pancreatic cancer only accounts for 5% to 10% of genetic-related factors, that is, less than 10% of patients have a genetic relationship. It is a widely accepted view that pancreatic cancer is a kind of “lifestyle cancer”, and some bad habits such as smoking, alcoholism, high-fat diet, and some disease factors such as diabetes, gallstone disease, chronic pancreatitis, etc. are all high-risk factors for pancreatic cancer. These high factors are the entry point to prevent pancreatic cancer.
Lina Zhang: Who are the high-risk groups that are prone to pancreatic cancer?
Rufus Chen: It is difficult to investigate the exact cause of pancreatic cancer, but statistical data can tell us who are the “high-risk group” for developing pancreatic cancer. At present, we believe that the high-risk groups of pancreatic cancer include the following.
(1) Patients older than 40 years old with non-specific symptoms in the upper abdomen;
(2) Those with family history of pancreatic cancer, it is believed that genetic factors account for 5-10% of the incidence of pancreatic cancer;
(3) Patients with sudden onset diabetes mellitus, especially atypical diabetes mellitus, aged 60 years or older, lacking family history, without obesity, and quickly developing insulin resistance. 40% of pancreatic cancer patients have diabetes mellitus at the time of diagnosis;
(4) Patients with chronic pancreatitis, which is now considered to be an important precancerous lesion in some patients, especially chronic familial pancreatitis and chronic calcific pancreatitis;
(5) Patients with intraductal papillary mucinous tumors of the pancreas need to be reviewed regularly to be alert for cancer;
(6) Smokers, the chance of pancreatic cancer is 2~3 times higher in smokers than in non-smokers.
(7) Certain patients who have undergone surgery, such as those who have undergone major gastrectomy, especially those who are more than 20 years after surgery, have 1.65-5 times higher incidence of pancreatic cancer.
For the above-mentioned high-risk groups, they need to be more alert to pancreatic cancer, and the examination can be done in three steps, early ultrasound examination of the abdomen plus blood sampling for tumor markers (such as CA19-9); if elevated tumor marker CA19-9 or abnormal ultrasound examination is found, further MR or CT examination or ultrasound endoscopy should be done; when it is difficult to identify, PET-CT or laparoscopy can be done. -CT or laparoscopy. Usually, after these examinations, most of the early pancreatic cancers can be detected.
Lina Zhang: As an ordinary person, how to take good care of our pancreas and prevent pancreatic diseases?
Rufus Chen: The pancreas is like a part that cannot be replaced, it needs to be used reasonably and maintained regularly. To maintain the pancreas, I have three suggestions: First, life should be regular: some people are usually busy with work, three meals a day casually “deal with”, to the holidays to overeat. The consequence is that the lighter one causes indigestion, bloating and discomfort, and the heavier one causes acute pancreatitis, which is even life-threatening and leaves a hidden danger for pancreatic cancer. Secondly, to strengthen exercise, weight control and avoid obesity is a great treasure to keep away from diabetes and pancreatic cancer. The third is to adjust the dietary structure. According to the principle of “food pyramid”, we should adjust the diet structure, keep the daily intake of cereals, beans, sweet potatoes and other coarse grains as the main part of the diet, eat more fresh vegetables and fruits, and eat less food with high fat, oil and salt, which can reduce the occurrence of pancreatic cancer by more than 2/3.
In general, the prevention of pancreatic diseases requires us to deepen our understanding of “pancreas” and pay more attention to early detection and a good lifestyle. “If we exercise more, keep our mouths shut, keep our legs open, and have regular medical checkups, the health of the pancreas will always be with us.