One cancer that has attracted more and more attention in recent years is pancreatic cancer, which is the “king of cancers”. Chen Minzhang, former Chinese health minister, Wang Daohan, former mayor of Shanghai, president of the Association for Relations Across the Taiwan Strait, Pavarotti, world famous tenor singer, Shen Tianxia, famous Hong Kong entertainer, etc. all died of pancreatic cancer. So what kind of cancer is pancreatic cancer? How can it be called the king of cancer?
First of all, let’s learn about the pancreas
The pancreas is the second largest gland in the body after the liver. It is located behind the stomach, with its long axis slightly curved, and lies across the posterior abdominal wall. It is about 12.5 to 15 cm long, 3 to 4 cm wide, 1.5 to 2.5 cm thick, and weighs about 60 to 100 g. It is divided into four parts: head, neck, body, and tail. Although the pancreas is small, but the role of extraordinary, it can be said that it is one of the most important organs in the human body, because it is a gland with both endocrine and exocrine functions, its physiological role and pathological changes are closely related to life. Several digestive enzymes in the pancreatic juice secreted by the pancreas play a leading role in the process of food digestion, especially the digestion of fats. In terms of endocrine secretion, although the pancreas is small in size, it contains endocrine cells with various functions, such as the secretion of glucagon, insulin, gastrin, gastrin and so on. These cells secrete hormones that are not only involved in digestion and absorption of substances, but are also responsible for regulating the physiological functions of the whole body. If these cells are diseased and the secreted substances are in excess or deficient, the disease will appear.
Pancreatic cancer is a common malignant tumor of the digestive tract and 90% of patients die within one year after diagnosis, with a 5-year survival rate of only 1%-3%. The incidence of pancreatic cancer has increased substantially in China’s major cities in the last 20 years, with a fourfold increase in 20 years in high-incidence areas such as Shanghai and Tianjin. The disease is the most malignant and the number of deaths ranks fourth among malignant tumors. Because of its insidious clinical manifestations and rapid onset, early diagnosis is very difficult and most of them are already in advanced stages once diagnosed.
Risk factors for the development of the disease
At present, the cause of pancreatic cancer is still unclear, but certain genetic and environmental factors are related to the occurrence of pancreatic cancer.
1. Heredity
Familial factors and genetic susceptibility (genetic susceptibility is a genetically determined tendency to develop a disease) play an important role in the development of pancreatic cancer in about 10% of patients, and the incidence of pancreatic cancer in first-degree family members is 18 times higher than that of those without pancreatic cancer.
2. Pancreatitis
A history of pancreatitis increases the incidence of pancreatic cancer by about 2% per decade, and pancreatic changes resulting from chronic pancreatitis increase the patient’s risk of developing pancreatic cancer by a factor of 15.
3. Smoking
Smoking is the most important environmental risk factor for pancreatic cancer worldwide. Nitrosamines in smoking smoke can induce the development of pancreatic cancer and can increase the incidence of pancreatic cancer by two times.
4.Diet
The second most important environmental factor leading to pancreatic cancer is the intake of high-calorie foods. Animal studies have proven that fat and protein diets are promoters of pancreatic cancer, while fresh fruits and vegetables and a multi-fiber diet are protective factors. People who consume protein mainly in the form of meat have a 2.5-fold increased risk of pancreatic cancer. The risk of pancreatic cancer may also be increased when consuming more than 3 cups of coffee per day.
In conclusion, the causes of pancreatic cancer are not yet fully understood.
Clinical manifestations of pancreatic cancer
Pancreatic cancer is insidious in its onset and usually has no special manifestations in its early stages. When symptoms are diagnosed, the disease has already reached an advanced stage and only less than 20% of patients can be surgically removed. The manifestation of pancreatic cancer depends on the location, size, duration and metastasis of the lesion.
1. Abdominal pain
Most of the patients may have abdominal pain, which may be mild dull pain or distension with vague location in the early stage and fixed in the upper abdomen in the later stage, often aggravated after meals. Cancer in the caudal part of the body of the pancreas compressing or invading the retroperitoneal plexus can cause severe low back pain, leading to inability to lie in a flat position, overnight, affecting sleep and diet.
2.Jaundice
80-90% of patients with pancreatic head cancer will have jaundice with abdominal pain, and a few patients may show jaundice without pain. Jaundice gradually worsens and may be accompanied by itchy skin, thick tea-like urine and clay-like stools.
3.Diabetes mellitus
Diabetes can sometimes be an early manifestation of pancreatic cancer. Pancreatic cancer is mostly detected within 2 years after the diagnosis of diabetes, and patients are mostly over 50 years old and have no family history of diabetes. Diabetes may be caused by cancer development rather than a risk factor for pancreatic cancer.
4. Gastrointestinal symptoms
Such as loss of appetite, bloating, indigestion, diarrhea or constipation. Some patients may have nausea and vomiting.
5.Loss of weight and weakness
Patients lose weight, fatigue and weight loss due to reduced diet, poor digestion, lack of sleep and tumor depletion.
Diagnosis of pancreatic cancer
Early diagnosis of pancreatic cancer is difficult. So far, there is no sensitive and specific examination method, and it is especially difficult to diagnose small pancreatic cancer. Therefore, it should be taken seriously by patients and doctors.
1. persistent epigastric discomfort, aggravated after meals, accompanied by loss of appetite
2. Unexplained gradual loss of weight.
3. Unexplained diabetes mellitus or sudden aggravation of diabetes mellitus.
4. Those with family history of pancreatic cancer, heavy smoking and chronic pancreatitis should be closely followed up and examined for early diagnosis as possible.
The diagnosis of pancreatic cancer is mainly based on clinical manifestations and imaging examinations, blood CA19-9 is most commonly used for the auxiliary diagnosis of pancreatic cancer and post-surgical follow-up, and is also one of the indicators of daily physical examination. It can detect tumors larger than 2 cm in diameter. Magnetic resonance imaging (MRI) is slightly more sensitive than CT in the diagnosis of pancreatic cancer, and there are several invasive tests that can help in the diagnosis of pancreatic cancer.
Treatment of pancreatic cancer
The treatment of pancreatic cancer is based on striving for radical surgery. For patients who cannot be treated radically, palliative surgery, chemotherapy, radiotherapy and symptomatic support can be performed. Although there are advances in chemotherapeutic agents and targeted therapy, the overall effect is still not satisfactory because the incidence of pancreatic cancer is rapidly increasing and the prognosis is extremely poor, and the current research is very active in the hope of making early breakthroughs.
Prognosis of pancreatic cancer
The prognosis of this disease is extremely poor. Surgery is the only way to cure pancreatic cancer, but currently less than 20% of patients can be surgically removed, and the survival period after surgery is 18-20 months, and the five-year survival rate is only about 15%. There are many factors affecting the prognosis of pancreatic cancer. Small tumors, no lymph node metastasis and highly differentiated have a better prognosis. The average life expectancy is about one year after the appearance of symptoms. The key to improve the prognosis is early detection, early diagnosis and early treatment. Because of the difficulty in diagnosis, poor treatment and poor prognosis, pancreatic cancer is called the “king of cancers”.