Pancreatic cancer

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I. The etiology and prevalence

  • Morbidity.

Fifth place in mortality. Value for sick men and women of 1:1. The tumor rarely occurs in people under 45 years, the incidence is maximal in the age 65 79 years.

  • Etiology.
    • The cause of pancreatic cancer is still not known, but several factors to some extent, affect the incidence.
      • Smoking, according to some studies, increases the risk of pancreatic cancer at least 1.5 times. The risk increases with the number Patchko-years. 10-15 years after quitting the excess risk disappears. Carcinogenic effect of tobacco smoke is associated with nitrosamines.
      • Power. Consumption of large amounts of fat and meat is associated with increased risk, and fresh fruits and vegetables - with a reduction.
      • Resection of the stomach. 15-20 years after surgery the incidence is 2-5 times higher than expected. The pathogenesis of gastric cancer and pancreatic cancer after resection of the stomach associated with a decrease in acidity, bacteria that produce nitrate reductase, and formation of nitroso compounds.
      • Cholecystectomy. Cholecystokinin - a major factor for the growth of L exocrine pancreatic cells (have value as epidermal growth factor and insulin-like growth factors). Persistent reflux duodenogastral increases holenistokinina and causes cancer of the pancreas in the experiment. Its level increases as cholecystectomy, and, according to some clinical studies, it increases the risk of pancreatic cancer.
      • Diabetes may be an early manifestation of cancer or predispose to it.
      • Chronic pancreatitis, including hereditary, increases the risk of pancreatic cancer by 15 times.
      • Industrial carcinogens - 2-naphthylamine, benzidine, gasoline - increased the risk by 5 times. Long-term effects of DDT and its two derivatives (ethyl, and DDD) increases the risk 4-7 times.
      • Low socioeconomic status increases the risk of a few.
      • Of coffee. Of the 30 works, only one study of the "case-control" showed significant correlation between coffee consumption and risk of pancreatic cancer, the results of prospective studies were negative.
      • Deep venous thrombosis caused no apparent reason, especially recurrent, increases the risk of mucinous cancers (including pancreatic cancer).
      • Dermatomyositis and polymyositis may have a paraneoplastic nature and arise, including against pancreatic cancer.)
      • Tonsillectomy, for a number of observations reduces the risk of pancreatic cancer and other tumors.
      • Family pancreatic cancer is about 3% of cases.

II. Morbid anatomy

  • The primary tumor.

Distinguish cancer of exocrine and endocrine cells (see Chapter 15. Section VI), occasionally there are non-epithelial tumors (sarcoma, lymphoma). 75 to 90% of cases of ductal adenocarcinoma, of which 57% are head cancer, 9% of the body, 8% of the tail, 6% on the border between them in 20% of the entire affected gland.  

  • Metastasis.

Based on materials from autopsies, for every 4 cases of primary cancer have a metastasis to the pancreas, most often breast cancer, lung cancer, melanoma and lymphoma.  

III. Diagnosis

  • The complaint.

Most patients lead to a doctor or other mc complaint, it can be a pain in the abdomen (80% of cases), anorexia (65%). weight loss, rapid saturation (60%), dry mouth, insomnia (at 55%), jaundice (50%), fatigue (45%), weakness, nausea, constipation, depression (40%), dyspepsia (35%), vomiting (30%), hoarseness, impaired taste, flatulence, belching (25%), dyspnea, nausea, edema (20%), cough, steatorrhea, hiccups, pruritus (15%), dysphagia (5%).

  • The clinical picture.

Includes cachexia (44% of patients), fall in serum albumin below 3.5 g% (35%), palpable abdominal education (35%), ascites (25%), supraclavicular lymph nodes increase (5%). Distant metastases are found in 65% of patients (v45% of the affected liver, 30% - easy, 3% - the bone). Cancer of the body and tail of the pancreas causing jaundice only at the expense of liver metastases, the pain may not be up to a late stage. Rarely is the first manifestation of acute pancreatitis.

  • Prognostic factors.
  • One-year survival in patients with adenocarcinoma of the pancreas is less than 20% survive 5 years, only 3% of patients.  
    • Operable tumors. Five-year survival after removal of the tumor is small and varies according to various estimates, from 3 to 25% (median survival of 12-20 months). When tumors of 2 cm it is 30%, in the absence of residual tumor and necessary to separate the tumor from large vessels - 35%, if not affected lymph nodes - 55%.  
    • Local and distant spread megastazy lower median survival to 2-6 months. Survival depends on the general condition and the presence of four symptoms: shortness of breath, loss of appetite. cachexia and xerostomia, with better general condition and fewer symptoms of patients live longer.
  • The operation.

Resectable pancreatic cancer is diagnosed in only 5-20% of patients

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