Cancer of the biliary tract and the major duodenal papilla
Cancer of the biliary tract and papillary cancer of the gallbladder usually occurs over the age of 50 years, more frequently in women. According to morphological structure is different adenocarcinoma differentiation-Rovkov with infiltrative growth type, rarely (less than 15%) - ploskokpetochny cancer. The tumor gradually affects the entire bladder, spreads to the liver, cystic and common bile duct, adjacent organs (stomach, duodenum, colon). Metastasis of gallbladder cancer found in the liver, regional lymph nodes, peritoneum, ovaries, pleura. The disease is diagnosed late (70-90% inoperable to the diagnosis of the time). Early gallbladder cancer - accidental find at cholecystectomy for cholelithiasis or cholecystitis. A careful analysis of the clinical symptoms, complete with examination, facilitates early diagnosis of this disease.
The earliest symptom - pain in the right upper quadrant, epigastric area radiating to the back. Characteristically night increased pain. Compared with the previous period in patients with cholecystitis, cholelithiasis possible to identify changes in the nature of pain (constant intensity). There have nausea, vomiting, weight loss. When it is a blockage of the bile ducts, develop hydrops and empyema of the gall bladder, jaundice, increased proximal duct sections and cholangitis secondary cirrhosis. Bilirubin reaches high numbers, increased levels of alkaline phosphatase, transaminases. On palpation the liver is determined by increased dense, sometimes palpable enlarged gallbladder. In the absence of blockade of the common bile duct during intravenous cholegraphy discover the so-called disabled gall bladder. Clarify diagnosis by ultrasound and computed X-ray tomography.
Radical surgery, which rarely manages to produce includes, besides cholecystectomy, resection of the right lobe of the liver, sometimes pankreatoduodenektomiyu.
Cancer of the extrahepatic bile duct is more common in the age of 60-70 years. In half of the cases affected the common bile duct. The tumor is adenocarcinoma of varying differentiation with infiltrative growth type. There is a growing tumor on the stretch of the ducts involves the hepatic vein and artery, portal vein, pancreas, duodenum. Metastases are formed in the regional lymph nodes and liver. Clinical symptoms and diagnosis methods are the same as for cancer of the gallbladder. It is very informative percutaneous transhepatic cholangiography, which helps to identify the location of the tumor level. The diagnosis is confirmed during surgery, but a biopsy is often difficult. Radical surgery Can rarely, mainly in cancer distapnogo of the common bile duct. At the same time produce pankreatoduodenektomiyu.
papillary carcinoma primary tumor is represented (40%) or other tumors germinating in this zone (bile duct, duodenum, pancreas). To distinguish these tumors is difficult, given the similarity of the histological structure. Clinical symptoms of cancer of the major duodenal papilla emerge early, when the tumor size is still small. There has been a rapid tumor ulceration. Among the clinical symptoms that distinguish this disease - transient jaundice, loss of blood in the feces, anemia. Other symptoms characteristic of jaundice (cholangitis, etc.). The main diagnostic methods are duodenoscopy with biopsy, relaxation duodenography. surgery relatively favorable prospects, given the possibility of early detection of cancer of the papilla and slow development. After pankreatoduodenektomii 30-40% of patients live 5 years with no signs of disease.
Palliative value in inoperable cancer of the gallbladder, biliary tract and papillary have different biliodigestive anastomoses or external drainage of the biliary tract to eliminate jaundice. Chemotherapy can cause temporary remission (20- 30%). Use of 5-fluorouracil, ftorafur, mitomycin C, adriamycin, sometimes a combination of these drugs.
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