Pancreatic cancer – the tumoral defeat coming from pancreatic canals or a parenchyma of a pancreas. Symptoms of a pancreatic cancer include nausea, loss of appetite, pain in the top part of a stomach, dysfunction of intestines, decrease in body weight, icteric coloring a skler and visible mucous membranes. For detection of a pancreatic cancer also tool diagnostics is used laboratory (definition of biochemical indicators and onkomarker of blood) (ultrasonography, KT, MRT, ERHPG). Radical treatment assumes carrying out a resection of a pancreas in various volume; use of beam and chemotherapeutic treatment is possible.
The concept "pancreatic cancer" includes group of the malignant new growths developing in a pancreas parenchyma: head, body and its tail part. The main clinical displays of these diseases – belly-ache, anorexia, weight loss, the general weakness, jaundice. Every year 8-10 people on each one hundred thousands of population in the world develop a pancreatic cancer. More than in half of cases it arises at elderly people (63% of patients with the diagnosed pancreatic cancer are more senior than 70 years). Men are more inclined to this type of malignancies, their pancreatic cancer develops one and a half times more often.
The malignant tumor of a pancreas is inclined to metastasis in regional lymph nodes, lungs and a liver. Direct growth of a tumor can lead to its penetration into a duodenum, a stomach, adjacent departments of a large intestine.
Reasons of development of a pancreatic cancer
The exact etiology of a pancreatic cancer is not found out, but note the factors promoting its emergence. However in 40% of cases the pancreatic cancer arises for no apparent reason. Considerably the risk of development of cancer in the persons smoking a pack and more cigarettes daily, using a large number of the uglevodsoderzhashchy products which underwent stomach operations increases.
Treat the diseases promoting developing of a pancreatic cancer: diabetes (both the first, and second type), chronic pancreatitis (including genetically caused), hereditary pathologies (a hereditary nepolipozny kolorektalny carcinoma, family adenomatozny polyposes, Gardner's syndrome, Gippelya-Lindau's disease, an ataxy-teleangiektaziya). The probability of development of cancer increases with age.
Classification of a pancreatic cancer
The pancreatic cancer is classified by the international system of classification of malignant new growths of TNM where T – the size of a tumor, by N – presence of metastasises at regional lymph nodes, and M – metastasises in other bodies.
However in this case classification is insufficiently informative concerning operability of cancer and the forecast of efficiency of therapy as the significant role and prospect of curability is played by the general condition of an organism.
Symptoms of a pancreatic cancer
The pancreatic cancer is followed by the following clinical manifestations: belly-ache in a pancreas (the top half, with irradiation in a back, sometimes surrounding). With growth of a tumor the painful symptom amplifies. Its strengthening at an inclination is characteristic of pancreatic pains.
At localization of a tumor of ferruterous fabric in the field of a pancreas head with the vast majority of cases jaundice which can be followed by a skin itch, darkening of urine and decolouration a calla is noted.
One more frequent symptom of a malignant tumor of a pancreas is decrease in body weight. At localization of a tumor in a body and a tail of gland weight loss is noted at all patients, at pancreas head cancer body weight decreases at 92% of patients. This symptom is connected with violation of absorption of fats in intestines as a result of insufficiency of sector function of a pancreas.
In 64% of cases of cancer of a head of a pancreas anorexia (at other localizations of a tumor this symptom is noted only at 30% of patients) is noted. At a sdavleniye vomiting can be noted by a large tumor of a duodenum or a gleam of a stomach. Secondary diabetes develops in 25-50% of cases and, as a rule, is followed by a polyuria and a polidipsiya.
At localization of a tumor in a body or a tail of a pancreas the splenomegaliya, a varicosity of a gullet and stomach can be noted (with episodes of bleedings). Sometimes the clinical picture proceeds as sharp cholecystitis or pancreatitis. At defeat by metastasises of a peritoneum impassability of intestines owing to narrowing of a gleam of a gut is possible.
The course of a pancreatic cancer is characterized by gradual increase of symptomatology, beginning from the low-expressed, weak pain syndrome to pronounced various clinic. In case of the timely address to the doctor and early detection of a tumor the forecast of treatment and further survival considerably improves.
Diagnosis of a pancreatic cancer
Diagnosis of cancer at an early stage presents certain difficulties due to the lack of specific clinical manifestations. Only in 30% of cases the revealed cancer is not more senior than two months.
Methods of laboratory diagnosing:
- The general blood test shows symptoms of anemia, increase in quantity of platelets and acceleration of SOE can be noted. Biochemical blood test shows a bilirubinemiya, increase in activity of alkaline phosphatase, hepatic enzymes at destruction of bilious ways or metastasis in a liver. Also in blood signs of the developed malabsorption syndrome can be noted.
- Definition of onkomarker. The marker of CA-19-9 is defined for the solution of a question of operability of a tumor. At early stages this marker at a pancreatic cancer does not come to light. The cancer embryonic anti-gene is revealed at a half of patients with cancer of a pancreas. However It should be noted that the analysis on this marker can be positive and at chronic pancreatitis (5% of cases), ulcer colitis. SA-125 is also noted at a half of patients. At late stages of a disease tumoral anti-genes can be found: CF-50, SA-242, SA-494, etc.
Methods of tool diagnostics:
- Endoscopic or transabdominal ultrasonografiya. Ultrasonography of abdominal organs excludes diseases of a gall bladder and a liver, allows to find a pancreas tumor. The endoscopic research gives the chance to take a bioptat for a research.
- The computer tomography and MRT allow to visualize tissues of a pancreas and to find tumoral educations from 1 cm (KT) and 2 cm (MRT), and also to estimate a condition of abdominal organs, existence of metastasises, increase in lymph nodes.
- The Positron and Issue Tomography (PIT) allows to reveal malignant cages, to find tumors and metastasises.
- ERHPG reveals tumors of any department of a pancreas from 2 cm in size. However, this procedure is invasive and promotes development of complications.
For identification of small metastasises in a liver, on a bryzheyka of intestines or a peritoneum carry out a diagnostic laparoscopy.
Complications at a pancreatic cancer
Malignancies of a pancreas are complicated by diabetes, a malabsorption syndrome, frustration of system of circulation of bile, trophic frustration owing to violation of sekretorny function of a pancreas. The tumor can sprout in the bodies which are located nearby – a stomach, a small intestine, a thick gut. Large tumors can promote a perezhatiya of intestines and impassability.
Cancer therapy of a pancreas
As most of the patients having a malignant tumor of a pancreas has signs of violation of absorption and anorexia, the diet with the increased content of fats and proteins is shown them. Cancer therapy of a pancreas is a medicamentous technique chemotherapy. Treatment is carried out by the medicines suppressing growth of cancer cells (ftoruratsit, , , etc.). It can be appointed as one medicine, and a little in a complex. Also refer radiation therapy to not surgical methods of treatment. Dosages and duration of a course choose depending on the size of a tumor, a stage of a disease, the general condition of the patient.
Palliative treatment at a pancreatic cancer is directed to removal of the main clinical symptoms: anesthesia, correction of passability of bilious ways for treatment of jaundice. In case of impossibility of restoration of circulation of bile appoint , phenobarbital. Insufficiency of vneshnesekretorny function of a pancreas is corrected by means of fermental medicines (a lipase, amylase, protease, Pancreatinum).
Surgical cancer therapy of a pancreas is carried out by a resection of the changed fabrics of gland and the bodies surrounding it. If there is a possibility of expeditious removal of a tumor, often resort to radical operation (all pancreas, a gall bladder with a bilious channel, a duodenum, the adjacent site of a large intestine and stomach is removed). Survival after such operation makes 25% of patients within five years.
Prevention of a pancreatic cancer
Prevention of a pancreatic cancer includes the following measures: refusal of smoking and abuse of alcohol, timely and full treatment of diseases of a pancreas and biliary tract, due correction of exchange at diabetes, observance of a diet, the balanced diet without overeating and tendency to greasy and spicy food. It is necessary to show consideration for pancreatitis symptomatology the patient who underwent stomach operations.
The forecast at a pancreatic cancer
At detection of a pancreatic cancer in most cases forecast of extremely adverse, about 4-6 months of life. Only 3% of patients reach five-year survival. Such forecast is connected with the fact that in most cases the pancreatic cancer comes to light at late stages and at patients of senile age that does not allow to remove a tumor considerably.