An early manifestation of pancreatic cancer

1. Abdominal discomfort: About 60% of patients on the early days of abdominal discomfort, easily with the symptoms of gastrointestinal and hepatobiliary disease confused.
     2. Abdominal pain: About 40% ~ 70% of pancreatic cancer patients with abdominal pain as the most current symptoms, causing abdominal pain for two reasons: ① pancreatic duct outlet obstruction caused by its strong contraction, abdominal pain Duocheng paroxysmal, located in the upper abdomen; ② biliary tract or pancreatic duct caused by increased pressure in the internal organs of neuropathic pain, manifested as upper abdominal dull pain, 1 ~ 2 hours after a meal increased, reducing a few hours later; ③ richer innervation of the pancreas, nerve fibers mainly from the celiac plexus, left celiac ganglion, superior mesenteric plexus, the nerve pain is located within a sympathetic, if the tumor invasion and compression of these nerve fiber bundles can be caused by low back pain, and the degree of dramatic, patients often get through the night or the bow seat back side, multi - is a late manifestation.
     3. Jaundice: Painless jaundice is the most prominent symptoms of pancreatic head cancer, accounting for about 30%. Because pancreatic cancer has the biological characteristics of infiltrating Wai tube, jaundice may be the early stage, but not the early symptoms, stool color with jaundice deepened and fades, and finally was clay color, urine color more and more concentrated, showing color of soy sauce, the majority patients, because of obstructive jaundice and skin itching, caused by Bianti scratches.
     4. Gastrointestinal tract symptoms: Most patients have loss of appetite, disgust greasy food, nausea, vomiting, indigestion and other symptoms.
     5. Weight loss and fatigue: Due to reduced food intake, dyspepsia and cancer due to consumption.
     6. Fever: the vast majority of patients with mid-term illness in varying degrees of fever, intermittent low-grade fever usually does not attract attention. Biliary tract infection, chills, high fever can occur.
     7. Thrombophlebitis: Yes, a special performance of pancreatic cancer, about 15% ~ 25% of patients in disease period thrombophlebitis occurs most commonly occurs in the lower extremities for thrombophlebitis.

     What circumstances the need for timely treatment:
     Even without the early pancreatic cancer-specific symptoms and signs, laboratory and other test results lack specificity, Gu Chang delayed treatment. In order to achieve early diagnosis in patients over the age of 40 recent clinical manifestations of the following persons, should be timely treatment and thought of the possibility of pancreatic cancer:
     1. Ruoyouruowu upper abdominal pain or unexplained persistent upper abdomen, lower back pain.
     2. Unexplained anorexia and weight loss.
     3. Unexplained progressive obstructive jaundice.
     4. Steatorrhea.
     5. Recurrent pancreatitis.
     6. No obvious incentive to depression psychosis.
     7. Suspicious symptoms of pancreatic cancer, the recent diabetes.
     8. Unexplained lower extremity thrombophlebitis.

     A variety of inspection methods and attention to:
     1. Physical examination: The purpose of physical examination is to check whether the visible jaundice, left supraclavicular lymph node metastasis and to check on some of the symptoms, such as the liver large, gallbladder enlargement, upper abdominal mass and so on.
     2. Laboratory examination:
     1) The general laboratory examination: head of pancreas cancer cases due to the lower bile duct obstruction, serum bilirubin can be significantly increased, mainly direct bilirubin levels increased, other issues such as elevated serum amylase, fasting blood sugar and so on, but no specific sex.
     2) Special laboratory tests: In recent years at home and abroad are struggling to find pancreatic cancer-specific antigens, such as carcinoembryonic antigen (CEA), pancreatic antigen (POA), pancreatic cancer-associated antigen (PCAA), CA19-9, pancreas cancer-specific antigen (PaA) and leukocyte adherence inhibition test (LAIT), etc. Among them, a high positive rate of CA19-9. Currently used in a variety of clinical pancreatic cancer antigen, although some of the positive rate, but none has a specific, only for clinical reference. Huashan Hospital Center for treatment of pancreatic cancer through a joint determination of CA19-9, CA242, CA724, CA125 and other markers of four kinds of pancreatic cancer found that can significantly improve the diagnosis of pancreatic cancer the sensitivity and specificity, combined with B ultrasound and CT can be used as pancreatic cancer Screening.
     3. Imaging examination:
     1) B Ultra: It is suspected to be pancreatic cancer patients with the preferred method of examination and early detection of bile duct system, this law can be expanded, but also found in pancreatic duct expansion of tumor 1cm in diameter, more than likely to find that the possibility of tumor 2cm in diameter was found more. The benefits of this law is not only safe non-invasive, convenient, and can be repeated several times following the inspection. For the high-risk age group of patients, there is upper abdominal discomfort, unexplained weight loss and loss of appetite who can use this law for screening, suspicious but can not be sure, it can make further CT.
     2) CT: right of suspected pancreatic cancer patients can also use CT as the preferred diagnostic tool, its diagnostic accuracy is higher than B-, diagnostic accuracy rate of up to 80% or more, the acceptance of X-ray dose is very small, is a safe method . Can be found in pancreatic and biliary tract dilatation of more than 1cm in diameter in any part of the pancreas tumor, and can be found in retroperitoneal lymph node metastasis, intrahepatic metastasis and observing whether the retroperitoneal tumor infiltration, helps cancer patients to determine whether pre-cut, because it these advantages, although the inspection fees are high, is still warmly embraced by physicians. In recent years, Huashan Hospital will be applied to helical CT of pancreatic cancer diagnosis and preoperative staging of high accuracy, through the three-dimensional image reconstruction method, can obtain three-dimensional and rotate 360 degrees clear images, thereby enhancing the preoperative staging of reliability.
     3) magnetic resonance imaging (MRI): can be found in the pancreas tumors larger than 2cm, but the overall results were not superior to imaging detection of CT. Magnetic resonance angiography (MRA) with three-dimensional imaging reconstruction can be rotated 360 degrees to provide a clear picture, and can replace angiography. MRCP (magnetic resonance cholangiopancreatography) can be a partial substitute for invasive ERCP (endoscopic retrograde cholangiopancreatography), help to identify pancreatic head cancer.
     4) X-ray: OK hypotonic duodenum contrast barium meal can be found in the duodenum by the pancreatic head cancer invasion and bed images. Selective celiac angiography (DSA) for pancreatic cancer have a certain diagnostic value. ERCP diagnosis of pancreatic cancer the sensitivity and accuracy of up to 95%, because it is invasive examination, it is only in the B-ultrasound and CT diagnosis can not be used, can also be collected by ERCP pancreatic or brush to take cells to be checked. Positron emission tomography (PET) in pancreatic cancer have a higher detection rate, unfortunately checks and expensive.
     5) Radionuclide imaging of the pancreas: the pancreas with 75Se-methionine as imaging agents for larger pancreatic cancer have a certain diagnostic value.
     4. Other examination:
     1) The pancreatic duct endoscopy: With the continuous development of endoscopic techniques in recent years, POPS has entered the clinical application, it can be observed directly into duct lumen, and may collect pancreatic juice analysis of exfoliated cells to detect K-ras genes.
     2) Fine-needle aspiration cytology: In the B-ultrasonography or CT guided fine needle aspiration cytology down more than 80% receive the correct diagnosis.

     A variety of treatment methods and the advantages and disadvantages:
     1. Surgical treatment:
Radical surgery: there is still the only effective cure pancreatic cancer, but the complicated surgery, trauma large, the high incidence of complications.
Pancreatic head cancer: mainly Pancreaticoduodenectomy (Whipple operation), to retain the stomach and pylorus in pancreaticoduodenectomy (PPPD operation), and the expansion of pancreaticoduodenectomy. Whipple surgery is one of the most classic of pancreatic head cancer, radical surgical excision normally encompasses the distal part of the stomach, duodenum, pancreatic head and the lower common bile duct, cleaning before and after the head of pancreas, superior mesenteric artery around the transverse mesocolon root Department and the hepatic artery and around hepatoduodenal ligament lymph nodes. PPPD with preservation of normal physiological function of the stomach, gastrointestinal reflux are part of the block, improved nutritional status; another without partial resection of gastric and duodenal jejunal anastomosis is relatively simple, shorter operation time. However, scholars believe that the operative procedures for Helicobacter pylori and hepatic artery under the surrounding lymph node dissection is not adequate, may affect the postoperative results, and thus advocate only applies to small pancreatic head cancer, duodenal bulb and pylorus is not invaded by the Ministry of ; In addition, the clinic can be found that a small number of patients developed post-operative gastric retention. Duocheng invasive growth of pancreatic cancer, easy to violations of the surrounding adjacent portal vein and superior mesenteric artery and vein, in the past many scholars would be whether the tumor invaded superior mesenteric vein, portal vein resection for judging whether a sign of pancreatic cancer, the resection rate is low. With the recent improvements in surgical methods and techniques, as well as the improvement of perioperative management, some involving the superior mesenteric vessels, portal vein were extended pancreaticoduodenectomy implemented, will be involving the tumor and vascular resection in conjunction with autologous blood vessels or artificial blood vessel reconstruction of vascular access. However, the surgical whether it can improve the survival rate still controversial. Pancreaticoduodenectomy due to the expansion of major surgical trauma, long duration and high technical requirements, may increase the incidence of complications and should choose carefully.
     Pancreatic body and tail cancer: There is a simple resection of pancreatic body and tail, extended resection of pancreatic body and tail and the joint organ resection.
     Total pancreatectomy: pancreatic cancer lines total pancreatectomy-style multi-center incidence of pancreatic cancer based on doctrine, the whole pancreatic resection fundamentally eliminate pancreatic leakage after pancreaticoduodenectomy the possibility of complications, but diabetes and pancreatic exocrine insufficiency due to digestion and absorption disorders after-effects. Studies have shown that near-total pancreatectomy, no significant long-term efficacy advantages, and should be strictly controlled indications, until the whole is an absolute indication for pancreatic cancer.
     Internal drainage surgery:
     Single-bypass surgery: biliary-enteric anastomosis, mainly gallbladder duodenum, gallbladder and common bile duct jejunum anastomosis jejunum anastomosis. Benefits can drain bile to relieve jaundice, to prepare for chemotherapy and radiotherapy; drawback is that some patients with duodenal obstruction may occur in the future, and enteric drainage can not solve the problem.
     Double-bypass surgery: biliary-enteric + gastrointestinal anastomosis for patients with duodenal obstruction. Benefits can be lifted duodenal obstruction; drawback is lack of pancreatic juice, digestive function to reduce internal and external secretory function affected.
     3 bypass surgery: biliary-enteric + GI + Pancreaticojejunostomy. Advantage is that the problem is resolved pancreatic juice; drawback is that surgery is relatively complex and difficult high and postoperative pancreatic fistula problem.
     External drainage surgery:
     Gallbladder fistula or bile duct T tube drainage: can not be used for tumor resection patients, simple operation and the exact effect of drainage. In preparation for radical surgery, in addition can improve the liver and kidney function, improve blood clotting function, reduce the risk of infection, improve immunity, it can also detect cancer in the initial surgery, clear whether the line of two radical surgery.
     Endoscopic biliary stent or drainage (ERCP + ENBD): advantages of trauma; drawback is a serious postoperative edema around the bile duct to increase the two surgical difficulty, and because of intraoperative guide wire, catheter or stent repeated through the tumor site, may lead to tumor metastasis.
PTCD or ITCD: are generally used for relatively poor general condition and can not tolerate surgery, or patients who can not OK ERCP and drainage inaccurate results.
     2. Chemotherapy:
     Intravenous chemotherapy: commonly used chemotherapy drugs 5-Fu, MMC, cisplatin, etc. In recent years, gemcitabine as first-line pancreatic cancer clinical drug began to be used to obtain a better efficacy of drugs than ever before, but whether it is single - drug, or combination therapy, intravenous chemotherapy, the overall effect is not satisfactory.
     Interventional chemotherapy: Huashan Hospital, the first in China will be involved in chemotherapy used in the treatment of pancreatic cancer found that the treatment can increase the local drug concentration to reduce the systemic toxicity of chemotherapy drugs. We also based on many years of clinical practice, was found involved in pancreatic cancer chemotherapy can not only improve the effectiveness of postoperative adjuvant therapy, but also can improve the preoperative application of large pancreatic cancer resection rate and prolong patient's survival, is the preferred adjuvant therapy for method.
     3. Radiotherapy: can be used either before or after surgery, especially for unresectable pancreatic body and tail cancer after irradiation can relieve intractable pain.
     4. Immune therapy: tumor occurrence and development of immune function associated with lower cancer, pancreatic cancer is no exception, therefore, improve the patient's immune system is also an important part of the treatment of pancreatic cancer through immune therapy of patients with cancer-fighting ability can be increased to extend the survival. Commonly used drugs are: thymosin, IL-2, a high agglutinative staphylococcin, interferon and tumor necrosis factor and so on.
     5. Gene therapy: Gene therapy cancer treatment research, is still in an experimental stage.
     6. Other treatment: Chinese medicine, hyperthermia, endocrine therapy can be used in the treatment of pancreatic cancer, but the effects are imprecise, generally used in advanced tumors or as a supplementary measure to radiotherapy and chemotherapy.