1.First of all, is the incidence rate of pancreatic cancer high?
In recent years, the incidence rate of pancreatic cancer has been increasing year by year. According to statistics, the incidence rate of pancreatic cancer in 1963 was one in 100,000, which has been increasing year by year, and the incidence rate rose to 13/100,000 in 2000, which has doubled as much as ten times. Currently in China, pancreatic cancer has become one of the top ten malignant tumors that kill our population. Moreover, the trend of young pancreatic cancer patients has increased significantly compared with 10 years ago, and the malignancy degree is higher and the prognosis is worse.
2.What is the cause of pancreatic cancer?
The cause of pancreatic cancer is still unknown, but some environmental factors have been found to be related to the development of pancreatic cancer. However, the primary risk factors are smoking, diabetes, gallstone disease, alcohol consumption (including beer) and chronic pancreatitis, consumption of high-fat and high-protein diet and refined flour foods, and gastrectomy are also risk factors for pancreatic cancer.
3.What are the risk groups for pancreatic cancer?
(1) Those who are older than 40 years old and have non-specific discomfort in the upper abdomen.
(2) Those who have a family history of pancreatic cancer.
(3) Those with sudden onset of diabetes, especially atypical diabetes, age over 60 years, lack of family history, no obesity, and insulin resistance soon developed.
(4) Chronic pancreatitis is an important precancerous lesion in a small group of patients, especially chronic familial pancreatitis and chronic calcific pancreatitis.
Intraductal papillary mucinous neoplasm is also a precancerous lesion
(1) Those with familial adenomatous polyposis.
(2) Those who have undergone major distal gastrectomy for benign lesions, especially those who are more than 20 years postoperative
(3) Smoking, heavy alcohol consumption, long-term exposure to harmful chemicals, etc.
4.What are the main clinical manifestations of pancreatic cancer?
(1) Abdominal pain: mostly located in the upper abdomen, around the umbilicus or right upper abdomen, colic or dull pain, mostly radiating to the lower back, aggravated in the lying position and at night, and relieved when sitting, standing, leaning forward or walking.
(2) Jaundice: Generally, jaundice is more common in pancreatic head cancer and appears earlier, with progressive deepening, accompanied by itching of the skin, urine color like strong tea, and feces of clay color.
(3) Weight loss: About 90% of patients have rapid and significant development of weight loss.
(4) Weakness and loss of appetite are common: it may also be accompanied by gastrointestinal symptoms such as diarrhea and constipation, abdominal distention, and nausea. In some cases, steatorrhea, hyperglycemia and diabetes may occur.
(5) Fever: due to ulceration or infection of the cancer, and also secondary to bile duct infection.
(6) Thrombophlebitis of limb veins can be seen in some pancreatic body and tail carcinomas, resulting in local limb swelling.
(7) Symptomatic diabetes mellitus: A few patients initially show symptoms of diabetes mellitus. If a patient with diabetes mellitus develops persistent abdominal pain, or if diabetes mellitus suddenly appears in the elderly, or if the original diabetes mellitus suddenly worsens recently, one should be alert to the possibility of pancreatic cancer.
However, since the pancreas is located deep in the abdominal cavity, pancreatic cancer can be asymptomatic in the early stage because the lesion is small and confined to the pancreas. As the disease progresses, the tumor gradually increases and involves the gallbladder, pancreatic duct and peripancreatic tissues before the above symptoms appear.
5.So, do pancreatic cancer have early symptoms?
(1) The early symptoms of pancreatic cancer are atypical, similar to many chronic diseases of the digestive tract, which can be manifested as loss of appetite and wasting. In fact, this is not an early symptom. Some people believe that loss of appetite, nausea and vomiting, change in bowel habits and weight loss are the four early symptoms of pancreatic cancer. (2) Discomfort and pain in the upper abdomen The early symptoms of pancreatic cancer may be pain and indefinite discomfort in the upper abdomen, stuffy feeling, sometimes light, sometimes not, usually more obvious at night.
6. The symptoms of pancreatic cancer are so atypical, so when should we be alert to pancreatic cancer?
Some researchers believe that pancreatic cancer should be suspected in patients aged 40 years or older with any of the following clinical manifestations: (1) obstructive jaundice; (2) recent unexplained weight loss of more than 10%; (3) recent unexplained pain in the upper abdomen or lower back; (4) recent indistinct and unexplained dyspepsia with normal gastrointestinal tract on barium meal examination; (5) sudden onset of diabetes mellitus with no factors contributing to its development. (5) sudden onset of diabetes without contributing factors, such as family history or obesity; (6) sudden onset of unexplained steatorrhea; (7) spontaneous episodes of pancreatitis. The suspicion should be doubled if the patient is a smoker.
7. What tests should be done if pancreatic cancer is suspected?
(1) The first diagnostic test is CT scan, which can show the correct location and size of pancreatic tumor and its relationship with surrounding blood vessels, and can detect tumors of about 25px in diameter. (2) Ultrasound is more effective than the conventional ultrasound.
(2) Ultrasonography is less expensive than CT, easier to obtain, and can visualize tumors of the liver, intrahepatic and extrahepatic bile ducts with a sensitivity and specificity of more than 90%. Often, ultrasound is used as a supplement to CT.
(3) Magnetic resonance imaging (MRI) can show abnormal pancreatic contours and can determine early local invasion of metastases. It is superior to CT scan in determining pancreatic cancer, especially small pancreatic cancers confined to the pancreas and the presence of peripancreatic spread and vascular invasion, and is a better method for pre-surgical prediction of pancreatic cancer.
(4) Retrograde cholangiopancreatography (ERCP) has a high specificity for the diagnosis of pancreatic cancer. In addition to showing main pancreatic duct stenosis, filling defect and occlusion, morphological changes of pancreatic duct stenosis can be clearly observed. It can detect pancreatic duct lesions with tumors smaller than 50px, and is an effective method for diagnosing small pancreatic cancer.
(5) The accuracy of fine needle aspiration (FNA) cytology under CT or ultrasound guidance for pancreatic cancer diagnosis can reach 76%-90%, and its specificity can reach almost 100%. FNA may be particularly useful when surgery is not indicated or is not desired, whether for tail or body damage or metastatic lesions.
(6) Ultrasonography with fiberoptic gastroscopy An ultrasound probe is mounted on the tip of the gastroscope and placed close to the posterior wall of the stomach to provide a comprehensive examination of the pancreas without gas interference, greatly improving the diagnosis of pancreatic cancer, clearly showing the pancreatic structures and detecting early lesions.
(7) Selective angiography (SAG) SAG is an invasive test, but the diagnosis can be made when the tumor is 25px. It can show the morphology of the peripancreatic arteries and is important to determine whether there is vascular invasion of the tumor.
(8) Daughter and mother pancreatic ductoscopy is a new method recently developed and carried out, the diameter of the daughter mirror (pancreatic ductoscope) is only 1mm, and it is not necessary to perform duodenal papillotomy, the mother mirror (fiberoptic duodenoscope) is inserted into the pancreatic duct to directly observe the situation inside the duct and take cell biopsy.
(The sensitivity, specificity and accuracy of CA19-9 in the diagnosis of pancreatic cancer are 83.1%, 73% and 75% respectively, and the cut-off value of CA19-9 is set at 120kU/L, above which pancreatic cancer is highly suspected. It can also determine the prognosis, CA19-9 decreases to normal value after tumor resection, but if the tumor recurrence, metastasis or deterioration of the disease, CA19-9 can be significantly increased again. In addition, CA50 Span-1 Dupan-2 CEA are also tumor markers, which are valuable for the diagnosis of pancreatic cancer.
8.If pancreatic cancer is diagnosed, how should it be treated?
Pancreatic cancer lacks obvious symptoms in the early stage, and most of the cases are already advanced when diagnosed, so there is little chance of surgical resection. Surgical treatment requires different surgical approaches for different stages of disease and the extent of local invasion of tumor lesions. (1) pancreaticoduodenectomy; (2) pylorus-preserving pancreaticoduodenectomy; (3) pancreatic cancer surgery with combined vascular resection; (4) pancreatic tail resection; (5) total pancreatectomy; (6) surgical treatment of unresectable pancreatic cancer
1) biliary drainage; 2) gastrojejunostomy; 3) biliary-intestinal and gastrointestinal anastomosis.
There are also radiotherapy, chemotherapy, immunotherapy and the combination with surgery, but the efficacy of these treatments is not significant yet.
9.What diseases are pancreatic cancer easily confused with?
(1) Various chronic gastric diseases: abdominal pain is mostly related to diet, jaundice is rare, and it is not difficult to differentiate with barium X-ray and fiberoptic gastroscopy. (2) Jaundiced hepatitis: the two are easily confused at first, but there is a history of exposure to hepatitis, and serum transaminases are increased at the beginning of jaundice by dynamic observation, and the jaundice mostly subsides gradually after 2-3 weeks, and serum alkaline phosphatase is not high. (3) Cholelithiasis and cholecystitis: abdominal pain in the form of paroxysmal colic, fever and increased leukocytes during acute attacks, jaundice mostly subsides or fluctuates within a short period of time, without significant weight loss. (4) Primary hepatocellular carcinoma: history of hepatitis or cirrhosis, positive serum alpha-fetoprotein, hepatomegaly, jaundice at a later stage, abdominal pain does not change with position change, ultrasound and radionuclide scan may reveal hepatic occupying lesions. (5) Acute and chronic pancreatitis: Acute pancreatitis has a history of overeating and binge eating, with rapid onset of disease and elevated blood leukocytes and blood and urine amylase. Chronic pancreatitis can present with pancreatic masses (pseudocysts) and jaundice, resembling pancreatic cancer, while deep pancreatic cancer compressing the pancreatic duct can also cause chronic inflammation of the peripancreatic tissues. The pancreatic calcification points found on abdominal radiographs are helpful in diagnosing chronic pancreatitis, but in some cases it is sometimes difficult to differentiate through various examinations, so a pancreatic puncture biopsy with a very fine puncture needle can be performed during the dissection to help differentiate. (6) Peri-pot belly cancer: Peri-pot belly cancer is less common than pancreatic head cancer, and the onset of the disease is more sudden, with symptoms such as jaundice, emaciation, skin itching, and gastrointestinal bleeding. The jaundice caused by periampullary carcinoma is often fluctuating because of its soft and elastic texture; abdominal pain is not significant, often accompanied by cholecystitis, and recurrent chills and fever are more common. However, it is still difficult to differentiate the two, and the combination of ultrasound and CT is needed to improve the diagnosis rate. The resection rate of pancreatic cancer is more than 75%, and the 5-year survival rate after surgery is higher than that of pancreatic head cancer.
10.Is there any preventive measure for pancreatic cancer?
(1) Adopt good lifestyle habits, quit smoking and limit alcohol. (2) Don’t eat too much salty and spicy food, don’t eat food that is too hot, too cold, expired or spoiled; eat cancer prevention food and alkaline food with high alkaline content if you are old and frail or have certain disease genes, and keep a good mental state. (3) Have a good attitude to cope with stress, combine work and rest, and do not overwork. (4) Strengthen physical exercise, enhance physical fitness, exercise more in the sun, sweat more often to discharge acidic substances from the body with sweat, so as to avoid the formation of acidic body. (5) Live a regular life. Irregular living habits, such as singing karaoke all night long, playing mahjong and staying out all night, will aggravate the acidification of the body and make it easier for people to develop cancer. (6) Do not eat contaminated food, such as contaminated water, crops, poultry, fish and eggs, moldy food, etc. Eat some green and organic food to prevent diseases from entering by mouth. (7) By examining the relationship between fat intake and pancreatic cancer, researchers have proved that the high fat content in processed meat and red meat may be the main reason for the increased risk of pancreatic cancer. In addition, the chemical reactions that occur when processing and cooking meat may also produce carcinogenic substances. In addition, it is important to drink more green tea, which contains antioxidants that help delay the development of pancreatic cancer.