Pancreas cancer

Pancreas cancer. Occupies the frequency of occurrence of one of the first places among malignant tumors. The risk of the disease is already after 30 years with a peak after 70 years. Isolate the cancer of the head, body and tail of the pancreas. In the main there is a development of cancerous cancer (adenocarcinoma). In the gland head, the tumor is localized in 75% of cases. Rapid compression or sprouting of the common bile duct leads to mechanical jaundice. For the tumor of the head of the gland is characterized by the triad Courvoisier (an enlarged painless gallbladder with jaundice). In this case, there is also an expansion of the bile ducts, an increase in the liver. When the tumor grows into the duodenum or stomach, bleeding or stenosis may develop.

The first symptom of the disease is pain in the epigastric region and hypochondria sometimes with irradiation in the back, with an increase in intensity at night. In addition, a progressive decrease in body weight without a clear cause is characteristic. With the appearance of jaundice, nausea, vomiting, diarrhea increase, the symptoms of cholangitis, etc.,

The cancer of the body of the gland rapidly sprouts into the superior mesenteric veins and arteries, the portal vein. Jaundice occurs rarely. Sometimes (10-20%) due to destruction (-cells develops diabetes mellitus.

The pancreatic tail tumor often sprouts the portal vein and splenic vessels, which leads to the development of portal hypertension with splenomegaly and other characteristic symptoms. When the tumor is localized in the tail and body of the gland, the pain syndrome is especially expressed in connection with the tumor germination of the numerous nervous plexuses surrounding the gland. Metastasizes pancreatic cancer early, more often in regional lymph nodes and liver. It is also possible metastasis in the lungs, bones, peritoneum, pleura, adrenal glands, etc.

Early diagnosis is extremely difficult, especially with pancreatic cancer of the body and tail. Almost 70% of patients diagnosed late. The results of treatment of such patients in this regard are very poor.

In the diagnosis of the disease, a crucial role belongs to modern methods of instrumental research: ultrasound and computer X-ray tomography, endoscopic, retrograde pancreatography, angiography, relaxation duodenography.

In a number of cases, despite the application of the listed diagnostic procedures, significant difficulties arise in differential diagnosis with some forms of chronic pancreatitis. In this situation, the final diagnosis is made based on the cytological and histological examination of the biopsy material obtained with diagnostic puncture (under ultrasound and X-ray tomography control) or during surgery.

Treatment of pancreatic cancer is surgical. In cancer of the head, a radical operation (pancreatoduodenal resection) is possible only in 10-25% of patients. To eliminate jaundice, palliative surgery is used (cholecystojunoanastomosis, etc.). Radiation therapy is ineffective. Among the antitumor drugs are effective 5-fluorouracil (15 mg / kg IV every other day, 3-5 doses), ftorafur (1.2-2 g orally daily for 3-4 weeks), 5-fluorouracil in combination with metomycin C And adriamycin. After the treatment, temporary remissions were noted in 20-40% of patients.