What Factors Affect a Pancreatic Adenocarcinoma Prognosis?

Pancreatic cancer is a malignant tumor of the digestive tract that is highly malignant and difficult to diagnose and treat. About 90% of them are ductal adenocarcinomas that originate from the epithelium of the ducts. Its morbidity and mortality have increased significantly in recent years. The 5-year survival rate is <1%, which is one of the worst prognostic malignancies. The early diagnosis of pancreatic cancer is not high, the surgical mortality is high, and the cure rate is low. The incidence of this disease is higher in men than in women, with a male to female ratio of 1.5 to 2: 1. Male patients are far more common than premenopausal women, and the incidence of postmenopausal women is similar to that of men.

Basic Information

English name: pancreatic cancer
Visiting department: Oncology, Surgery

Multiple groups: Patients with diabetes, chronic pancreatitis
Common causes: Not quite clear yet
Common symptoms: Abdominal pain, jaundice, weight loss, abdominal mass and ascites

Causes of Pancreatic Cancer

The cause of pancreatic cancer is not fully understood. Its occurrence is related to smoking, alcohol consumption, high-fat and high-protein diet, excessive drinking of coffee, environmental pollution and genetic factors; survey reports in recent years have found that the incidence of pancreatic cancer is significantly higher in the diabetic population than in the general population; others have noted chronic There is a certain relationship between pancreatitis patients and the incidence of pancreatic cancer. It is found that the proportion of pancreatic cancer in patients with chronic pancreatitis is significantly higher. In addition, there are many factors related to the occurrence of this disease, such as occupation, environment, and geography.

Clinical manifestations of pancreatic cancer

The clinical manifestations of pancreatic cancer depend on the location of the cancer, the course of the disease, the presence or absence of metastasis, and the involvement of adjacent organs. Its clinical characteristics are short duration, rapid development and rapid deterioration. The most common is abdominal distension and pain. Although there is conscious pain, not all patients have tenderness. If there is tenderness, it is the same as the conscious pain.

Abdominal pain

Pain is the main symptom of pancreatic cancer, regardless of whether the cancer is located in the head or tail of the pancreas. Except for pain in the mid-abdomen or left upper abdomen and right upper abdomen, a few cases complain of left and right lower abdomen, umbilical or total abdominal pain, and even testicular pain, which is easily confused with other diseases. When the cancer involves the visceral envelope, peritoneum, or retroperitoneal tissue, tenderness may be present at the corresponding site.

Jaundice

Jaundice is an important symptom of pancreatic cancer, especially pancreatic head cancer. Jaundice is obstructive, accompanied by deep yellow urine and clay-like stool, which is caused by the invasion or compression of the lower end of the common bile duct. Jaundice is progressive and although it may fluctuate slightly, it is unlikely to completely resolve. The temporary reduction of jaundice is related to the subsidence of inflammation around the ampulla in the early stage, and the jaundice produced by ampulla tumors is more likely to fluctuate due to the tumor ulcers and rots in the lower part of the common bile duct in the later stage. Pancreatic body and tail cancer only develops jaundice when it spreads to the head of the pancreas. Some patients with pancreatic cancer develop jaundice due to liver metastases. About a quarter of patients with refractory skin itching are often progressive.

3. Gastrointestinal symptoms

The most common is loss of appetite, followed by nausea, vomiting, diarrhea or constipation or even melena. Diarrhea is often fatty diarrhea. Loss of appetite is related to the obstruction of the lower end of the common bile duct and the pancreatic ducts, and the inability of bile and pancreatic juice to enter the duodenum. Obstructive chronic pancreatitis of the pancreas leads to poor pancreatic exocrine function, which will inevitably affect appetite. A few patients have obstructive vomiting. About 10% of patients have severe constipation. Diarrhea due to poor pancreatic exocrine function: fatty diarrhea is an advanced manifestation, but it is rare. Pancreatic cancer can also occur in upper gastrointestinal bleeding, manifested as vomiting and melena. The splenic vein or portal vein is embolized due to tumor invasion, secondary portal hypertension, and occasional bleeding from esophageal and gastric varices rupture.

4. Wasting and fatigue

Pancreatic cancer is different from other cancers, and often has wasting and fatigue at an early stage.

5. Abdominal mass

The pancreas is deep and difficult to touch in the posterior abdomen. The abdominal mass is the result of the development of the cancer itself. It is located at the location of the lesion. If the mass is felt, it is mostly advanced or advanced. Chronic pancreatitis can also feel the mass, which is difficult to distinguish from pancreatic cancer.

6. Symptomatic diabetes

The onset of a small number of patients is initially the symptoms of diabetes, that is, before the main symptoms of pancreatic cancer, such as abdominal pain and jaundice, develop diabetes, and the accompanying weight loss and weight loss are mistaken for the symptoms of diabetes, regardless of Pancreatic cancer: It can also be manifested in patients who have suffered from diabetes for a long time recently, or the treatment measures that can control the disease for a long time have become ineffective, indicating that pancreatic cancer may have occurred on the basis of the original diabetes.

7. Thrombophlebitis

Patients with advanced pancreatic cancer develop migratory thrombophlebitis or arterial thrombosis.

8. Mental symptoms

Some patients with pancreatic cancer can show anxiety, irritability, depression, personality changes and other mental symptoms.

9. Ascites

It usually appears in the advanced stage of pancreatic cancer, mostly due to the peritoneal infiltration and spread of the cancer. Ascites may be bloody or serous, and late cachexia may also cause ascites.

10. Other

In addition, patients often complain of fever and apparent weakness. May have high fever and even chills and other symptoms similar to cholangitis, so it is easy to be confused with cholelithiasis and cholangitis. Of course, when there is biliary obstruction and infection, there can also be chills and high fever. Some patients may still have small joint redness, swelling, pain, heat, subcutaneous fat necrosis around the joints, and unexplained testicular pain. The supraclavicular, axillary, or groin lymph nodes can also become enlarged and hardened due to pancreatic cancer metastasis.

Pancreatic cancer examination

Intractable epigastric pain, the pain radiates to the lower back, is obvious at night, and becomes worse when supine, and tortuosity or forward sitting can reduce the pain, etc., it is highly suggestive of pancreatic cancer, and further laboratory and other auxiliary examinations are needed.

B-ultrasound, CT, MRI, ERCP, PTCD, angiography, laparoscopy, tumor marker measurement, oncogene analysis, etc., are of great help in determining the diagnosis and judgment of surgical resection of pancreatic cancer. Under normal circumstances, B-ultrasound, CA19-9, and CEA can be used as screening tests. Once pancreatic cancer is suspected, CT examination is necessary. Patients have jaundice and are more severe. When the diagnosis cannot be confirmed after CT examination, ERCP and PTCD can be selected. If the drainage is successful, the operation can be delayed for 1 to 2 weeks in patients with severe jaundice. MRI is not better than CT in the diagnosis of pancreatic cancer. For patients who have been diagnosed with pancreatic cancer but are unable to determine whether they can be surgically removed, angiography and / or laparoscopy are of clinical significance.

For patients with pancreatic cancer or periampullary cancer who cannot be surgically resected and have no indication for palliative surgery, fine needle aspiration to obtain cytology is necessary when chemotherapy and radiation therapy are planned. This test is generally not performed for patients who may have a surgical resection. Because fine needle puncture may cause cancer cells to spread in the abdominal cavity.

Pancreatic cancer diagnosis

Based on the incidence characteristics of patients with pancreatic cancer, it is currently believed that: over 40 years of age, uninducible abdominal pain, fullness and discomfort, loss of appetite, weight loss, fatigue, diarrhea, back pain, recurrent pancreatitis or sudden diabetes without family history It should be regarded as a high-risk group of pancreatic cancer, and the possibility of pancreatic cancer should be watched at the time of consultation.

Attention should be paid to those who have the following clinical manifestations:

1. Unexplained upper abdominal discomfort or abdominal pain, deeper location, blurred nature, and different relationship with diet.

2. Progressive weight loss and fatigue.

3. Unexplained diabetes or sudden increase in diabetes.

Differential diagnosis of pancreatic cancer

Pancreatic cancer should be distinguished from diseases such as gastric disease, jaundice hepatitis, cholelithiasis, cholecystitis, primary liver cancer, acute pancreatitis, ampulla, and gallbladder cancer.

Pancreatic Cancer Treatment

At present, the basic principle of treatment is still surgical treatment, combined with comprehensive treatment such as radiotherapy and chemotherapy.

Surgical treatment

Surgery is the only possible cure. Surgical methods include pancreaticoduodenectomy, enlarged pancreaticoduodenectomy, pylorus-preserving pancreaticoduodenectomy, and total pancreatectomy. However, due to the difficulty in early diagnosis of pancreatic cancer, the rate of surgical resection is low, and the five-year survival rate is also low.

For obstructive jaundice and pancreatic cancer that cannot be removed, gallbladder or bile duct jejunostomy can be selected to reduce jaundice and improve the quality of life of patients. A stent can also be placed under the endoscope to relieve obstruction.

2. Palliative treatment

For cases that are not suitable for radical surgery, obstructive jaundice often needs to be removed. Gallbladder jejunostomy is generally used. Unconditional people can perform external fistula (gallbladder fistula or extra-biliary drainage) reduction surgery. Most patients can reduce symptoms in a short time. , Improve the state of the whole body, the general survival time is about six months.

3. Comprehensive treatment

Pancreatic cancer has a high degree of malignancy, a low resection rate, and a poor prognosis. Although surgery is still the primary treatment, pancreatic cancer is often found late and the opportunity for radical cure is lost, so comprehensive treatment of pancreatic cancer is needed. To date, as with most tumors, there is no comprehensive and effective treatment regimen. The current comprehensive treatment is still based on surgical treatment, supplemented by radiotherapy and chemotherapy, and is exploring new methods of combining biological treatments such as immunity and molecules.

(1) Radiation therapy for pancreatic cancer is a tumor with low sensitivity to radiotherapy.

(2) Chemotherapy can be performed on pancreatic cancer that cannot be surgically removed, or to prevent recurrence after surgery. Chemotherapy for pancreatic cancer is expected to reduce the incidence of recurrence and metastasis of postoperative cancer.

(3) Biological therapy Biological therapy includes immunotherapy and molecular therapy. With the rapid development of immune and molecular biology research, this will be the most challenging research, because refractory tumors such as pancreatic cancer must develop some new methods to treat: gene therapy: most of them remain in clinical In the early stage, few enter clinical phase I or phase II trials. Immunotherapy: The application of immune preparations to enhance the body's immune function is part of comprehensive treatment.

(4) Other therapies Pancreatic cancer is a hypoxic tumor with low sensitivity to radiotherapy and chemotherapy, but has increased sensitivity to heat. In recent years, due to technical improvements, warm therapy has been applied. A common temperature is 44 ° C. However, the methods of heating and temperature measurement need to be improved.

4. Symptomatic supportive treatment

In the advanced stage of pancreatic cancer, due to pancreatic exocrine insufficiency, patients with fatty diarrhea can take pancreatin in meals to help digestion. For refractory abdominal pain, give analgesics, including opioid analgesics; if necessary, use intraperitoneal plexus injection or sympathectomy with 50% to 75% ethanol. Radiotherapy can relieve pain in some patients. Nutrition support should also be strengthened to improve nutritional status.

Prognosis of pancreatic cancer

Pancreatic cancer is a highly malignant tumor with a poor prognosis. The survival time of untreated pancreatic cancer patients is about 4 months, and that of patients undergoing bypass surgery is about 7 months. After resection, patients generally survive 16 months. Early diagnosis and early treatment are the keys to improve and improve the prognosis of pancreatic cancer. Adjuvant treatment such as radiotherapy and chemotherapy after surgery can improve survival rate. For patients with surgery-assisted chemotherapy plus radiotherapy, the 2-year survival rate can reach 40%.