Pancreatic cancer

Pancreatic cancer occurs, according to various sources, in 1-7% of all cancer cases; more often in people over 50 years of age, mainly in men.

Pancreatic cancer, primarily ductal adenocarcinoma, accounts for 30,500 cases and 29,700 deaths each year in the United States. Symptoms of pancreatic cancer include weight loss, abdominal pain, and jaundice. Diagnosis is by CT scan. Treatment of pancreatic cancer includes surgical resection and additional radiation and chemotherapy. The prognosis is poor because the disease is often diagnosed at an advanced stage.

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Causes pancreatic cancer

Most pancreatic cancers are exocrine tumors that arise from ductal and acinar cells. Endocrine tumors of the pancreas are discussed below.

Exocrine pancreatic adenocarcinomas of ductal cells are 9 times more common than acinar cell types; the head of the gland is affected in 80%. Adenocarcinomas appear on average at age 55 and are 1.5-2 times more common in men. The main risk factors include smoking, a history of chronic pancreatitis, and possibly long-term diabetes mellitus (especially in women). Heredity plays a role. Alcohol and caffeine consumption are unlikely to be risk factors.

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Symptoms pancreatic cancer

Symptoms of pancreatic cancer appear late; at diagnosis, 90% of patients have a locally advanced tumor with involvement of retroperitoneal structures, damage to regional lymph nodes, or metastases to the liver or lungs.

Most patients present with severe upper abdominal pain, which usually radiates to the back. The pain may be relieved by bending forward or in the fetal position. Weight loss is common. Adenocarcinomas of the head of the pancreas cause mechanical jaundice (often the cause of itching) in 80-90% of patients. Cancer of the body and tail of the gland can cause compression of the splenic vein, leading to splenomegaly, esophageal and gastric varices, and gastrointestinal bleeding. Pancreatic cancer causes diabetes in 25-50% of patients, manifesting as symptoms of glucose intolerance (eg, polyuria and polydipsia), malabsorption.

Forms

Cystoadenocarcinoma

Cystadenocanceroma is a rare adenomatous pancreatic cancer that arises from malignant transformation of a mucinous cystadenoma and presents as a large mass in the upper abdomen. Diagnosis is by abdominal CT or MRI, which typically shows a cystic mass containing debris; the mass may resemble necrotic adenocarcinoma or pancreatic pseudocyst. Unlike ductal adenocarcinoma, cystadenocarcinoma has a relatively good prognosis. Only 20% of patients have metastases at surgery; complete removal of the tumor by distal or proximal pancreatectomy or the Whipple procedure results in a 65% 5-year survival.

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Intraductal papillary mucinous tumor

Intraductal papillary mucinous tumor (IPMN) is a rare cancer that causes mucus hypersecretion and duct obstruction. Histologic examination may indicate benign, borderline, or malignant growth. Most cases (80%) occur in women and are most often localized in the tail of the pancreas (66%).

Symptoms of pancreatic cancer include pain syndrome and recurrent attacks of pancreatitis. The diagnosis is established by CT in parallel with endoscopic ultrasound, MRCP or ERCP. Differentiation between benign and malignant processes is possible only after surgical removal, which is the method of choice. With surgical treatment, 5-year survival for benign or borderline growth is more than 95% and 50-75% for malignant processes.

Diagnostics pancreatic cancer

The most informative methods for diagnosing pancreatic cancer areabdominal spiral CT and pancreatic MRI (MRI of the pancreas). If CT or MRI of the pancreas reveals an unresectable tumor or metastatic disease, percutaneous fine-needle biopsy of the affected area is performed for histological examination of tumor tissue and verification of the diagnosis. If CT demonstrates potential resectability of the tumor or non-tumor formation, MRI of the pancreas and endoscopic ultrasound are indicated for diagnosing the stage of the process and small nodes that are not determined by CT. Patients with mechanical jaundice can undergo ERCP as the first diagnostic study.

Routine laboratory tests should be performed. Elevated alkaline phosphatase and bilirubin levels indicate bile duct obstruction or liver metastasis. Pancreatic-associated antigen (CA19-9) may be used for monitoring of patients diagnosed with pancreatic carcinoma and for screening of those at high risk of developing cancer. However, this test is not sensitive or specific enough to be used for screening large populations. Elevated antigen levels should decrease after successful treatment; subsequent increases indicate tumor progression. Amylase andlipase levels usually remain within normal limits.

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Treatment pancreatic cancer

Treatment of pancreatic cancer is surgical - removal of the tumor and even the entire gland (in the absence of metastases) followed by symptomatic therapy of exocrine and endocrine pancreatic insufficiency. However, radical surgery, due to the still relatively late diagnosis, can be performed only in a minority of patients; in the majority of cases, symptomatic treatment is enough.

In case of pancreatic head cancer, occurring with mechanical jaundice, palliative surgery is performed - a biliodigestive anastomosis is applied, ensuring the outflow of bile from the bile ducts into the intestine. Radiation therapy is ineffective in this cancer localization. Chemotherapy with 5-fluorouracil (including in combination with mitomycin and adriamycin), fluorofur, etc. has a temporary effect in approximately a third of patients. Treatment is performed by oncologists.

Forecast

Pancreatic cancer has a different prognosis. It depends on the stage of the disease, but is always unfavorable (5-year survival rate is less than 2%) due to diagnosis at an advanced stage.