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Pancreatic head cancer
Last reviewed: 23.11.2021
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Periampular cancer - the cancer of the pancreatic head region develops frequently. It can come from the very head of the gland (more often from the epithelium of the ducts than from the cells of the acini), from the epithelium of the distal sections of the common bile duct, from the phater ampoule and the fater nipple, and less often from the mucous membrane of the duodenum. Tumors developing from any of these formations cause similar clinical manifestations. Therefore they are united in one group under the general name "cancer of the head of the pancreas". However, according to their prognosis, these tumors vary considerably. Resultivity in ampulla cancer is 87%, with cancer of the duodenum - 47%, and with cancer of the head of the pancreas - 22%.
Risk factors for developing tumors include smoking, unbalanced nutrition, resection of the stomach in history, diabetes mellitus. In a number of cases, a burdened family history is revealed, which allows one to think about a possible hereditary predisposition. There is no reliable connection with the use of coffee or alcohol.
Changes at the molecular level
In many cases, pancreatic cancer compares more often than other tumors with a mutation of the K-ras gene , especially in its codon 12. Mutation can be detected by polymerase chain reaction on paraffin tissue sections fixed with formalin and material obtained by puncture biopsy. In 60% of cases of pancreatic cancer, there is an unusually increased expression of the p53 gene, especially in ductal tumors.
Pathogenesis of cancer of the head of the pancreas
In men, pancreatic head cancer is 2 times more common. Mostly sick people aged 50 to 69 years.
Symptoms of cancer of the head of the pancreas consist of symptoms of cholestasis, pancreatic insufficiency, and also from general and local manifestations of the malignant process.
Symptoms of pancreatic head cancer
Diagnosis of pancreatic head cancer
In 15-20% of cases of pancreatic head cancer, glucosuria develops; while glucose tolerance is also reduced.
Biochemical examination of blood. The activity of alkaline phosphatase is significantly increased. In ampoule cancer, the activity of amylase and lipase is sometimes steadily increased. Possible hypoproteinemia, which subsequently leads to peripheral edema.
Diagnosis of pancreatic head cancer
Treatment of pancreatic head cancer
The decision to perform a pancreatoduodenal resection is taken based on the results of a clinical examination of the patient and visualization methods of the study, allowing to establish the stage of cancer. The operation is complicated by limited access to the pancreas, which is located on the back wall of the abdominal cavity near the oi vital organs. Only a small part of the patients are operable.
Treatment of pancreatic head cancer
Prognosis of pancreatic head cancer
The prognosis for pancreatic cancer is unfavorable. After the imposition of biliodigestive anastomosis, the average survival is about 6 months. The prognosis for acinar-cell cancer is worse than in the case of protocol, because the regional lymph nodes are affected earlier. The tumor is resectable only in 5-20% of patients.
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