What Is a Pancreatic Neoplasm?

Pancreatic tumors are one of the common malignant tumors of the digestive tract. They are the most common malignant tumors and occur in the pancreatic head. There may be pancreatic sarcoma, pancreatic cystadenomas, and pancreatic cystadenocarcinomas.

Basic Information

English name: pancreatictumor
Visiting department: Oncology

Common locations: Pancreatic head
Common symptoms: Pancreatic sarcoma, pancreatic cystadenoma, pancreatic cystadenocarcinoma
Contagious: no

Causes of pancreatic tumors

The cause is not very clear. 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 tumors in patients with diabetes is significantly higher than that of the general population; it has also been noticed There is a certain relationship between patients with chronic pancreatitis and the incidence of pancreatic tumors. It is found that the proportion of patients with chronic pancreatitis has a significantly higher incidence of pancreatic tumors. In addition, there are many factors related to the occurrence of this disease, such as occupation, environment, and geography.

Clinical manifestations of pancreatic tumors

Pancreatic sarcoma

Early stage tumors can be without symptoms. Occasionally, pancreatic space-occupying lesions were found on ultrasound or CT scans. Most pancreatic sarcomas are large when they are found.

Patients may experience pain and discomfort in the upper abdomen, back pain caused by compression of the lesions or invasion of the abdominal plexus, and half of the patients may have a palpable mass in the upper abdomen at the time of consultation, with a hard texture and poor mobility. Patients may experience nausea and vomiting, and may have low fever and weight loss in the later stages.

2. Pancreatic cystadenoma

(1) Abdominal pain Abdominal pain is an early-onset symptom, which can be uncomfortable pain, bloating, or bloating. A tumour that grows can compress the stomach, duodenum, transverse colon, etc., causing it to shift and show symptoms of intestinal obstruction. In addition to abdominal pain, it can be accompanied by loss of appetite, nausea, vomiting, indigestion and weight loss.

(2) Abdominal masses are the main signs. The mass is mostly located in the middle of the upper abdomen or the left upper abdomen. The small one can only touch it. The large one can occupy the entire abdominal cavity. It is round or oval in shape and tough. The large mass has a sac-like sensation and no tenderness. A small number of cystic tumors in the head of the pancreas develop jaundice due to cyst compression of the common bile duct. When the tumor compresses the spleen vein or invades the spleen vein, it can cause embolism. The spleen enlarges and can cause varicose veins in the bottom of the stomach and lower esophagus, and even vomiting.

3. Pancreatic cystadenocarcinoma

The main symptoms of pancreatic cystadenocarcinoma are upper and lower abdominal pain or low back pain, and upper abdominal mass. Abdominal pain is not severe, and some patients are just fullness and discomfort; other symptoms may include decreased appetite, nausea, indigestion, weight loss, jaundice, etc. A few patients may have gastrointestinal bleeding.

The abdominal mass is generally not tender, and can be cystic or firm. When secondary intravesical hemorrhage occurs, abdomen mass can suddenly increase, abdominal pain intensifies, and tenderness is obvious. Jaundice can occur when the tumor infiltrates or oppresses the common bile duct.

Pancreatic tumor 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 tumors, 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 tumors. However, the surgeon still cannot ignore the patient's medical history inquiry and comprehensive physical examination. To assess the safety of patients undergoing radical surgery, detailed information from a medical history and careful physical examination is more important than a single heart and lung function test. Under normal circumstances, ultrasound, CA19-9, and CEA can be used as screening tests. Once pancreatic tumors are suspected, CT examination is necessary. Patients have jaundice and are more severe. When the diagnosis cannot be determined 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. In cases where a pancreatic tumor has been diagnosed but it is impossible to judge whether it can be surgically removed, in order to avoid unnecessary surgical exploration, the choice of angiography and / or laparoscopy is of clinical significance.

Pancreatic tumor diagnosis

Diagnosis can be confirmed based on clinical manifestations and related examinations.

Pancreatic tumor treatment

Pancreatic sarcoma

Surgery is preferred. Pancreaticoduodenectomy for pancreatic head tumors, pancreatic body and tail splenectomy for tumors of the pancreatic body and tail, partial gastric and colon resections can be combined when invading surrounding organs such as the stomach and colon. Pancreatic sarcomas rarely have distant metastases or lymph node metastases.

2. Pancreatic cystadenoma

Surgery is the only treatment for pancreatic cystic tumors. Cystic adenomas often have a complete envelope and are prevalent in the body and tail of the pancreas. Small cystadenomas can be removed; in most patients, pancreatic body and tail excision is required, including the spleen. Cystic tumors of the head of the pancreas can be treated with pancreaticoduodenectomy.

3. Pancreatic cystadenocarcinoma

(1) Surgical resection of pancreatic cystadenocarcinoma, including part of the normal pancreas where the tumor is located, is the preferred method for treating this disease. In principle, most pancreatic cystadenocarcinomas should be treated for radical resection. According to the location and extent of the lesion, the relationship between the cancer and adjacent organs, and the degree of metastasis and invasion, you can choose a simple cystectomy, pancreatic body tail plus splenectomy, pancreaticoduodenectomy or pancreas Resection and so on.

(2) For pancreatic cystic masses whose pathological properties are difficult to determine, especially those with mucinous cysts, they should be treated according to the principles of treatment of pancreatic cystadenocarcinoma, and the tumor and part of the pancreatic tissue in its location are removed. For pancreatic cystadenocarcinoma, the internal drainage or external drainage of cysts must not be easily performed. It will not only achieve the purpose of surgical treatment, but will increase the chance of cyst infection, which will delay the timing of radical surgery.

(3) Pancreatic cystadenocarcinoma is not sensitive to chemotherapy and radiotherapy.