Pancreas cancer

Pancreas cancer

It occupies one of the first places among malignant tumors in terms of frequency of occurrence. The risk of the disease is present after 30 years of age with a peak after 70 years of age. Cancer of the head, body and tail of the pancreas is distinguished, mainly ductal cancer (adenocarcinoma) develops.

The tumor is localized in the head of the gland in 75% of cases. Rapid compression or growth of the common bile duct leads to obstructive jaundice. A tumor of the head of the gland is characterized by Courvoisier's triad (an enlarged, painless gallbladder in the presence of jaundice).

In this case, dilation of the bile ducts and enlargement of the liver also occur. When a 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 hypochondrium, sometimes radiating to the back, with increasing intensity at night.

In addition, a progressive decrease in body weight without a clear reason is characteristic. With the appearance of jaundice, nausea, vomiting, diarrhea intensify, and symptoms of cholangitis and others may appear. Cancer of the gland body quickly grows into the superior mesenteric veins and arteries, and the portal vein.

Jaundice occurs rarely. Sometimes (10 - 20%) diabetes mellitus develops due to the destruction of β-cells. A tumor of the tail of the pancreas often invades 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 pronounced due to the tumor growing into numerous nerve plexuses surrounding the gland. Pancreatic cancer metastasizes early, often to regional lymph nodes and the liver. Metastasis to the lungs, bones, peritoneum, pleura, adrenal glands, etc. is also possible.

Early diagnosis is extremely difficult, especially for cancer of the body and tail of the pancreas. Almost 70% of patients are diagnosed late. The results of treatment of such patients are therefore very poor.

In the diagnosis of the disease, a decisive role belongs to modern methods of instrumental research: ultrasound and computed x-ray tomography, endoscopic, retrograde pancreatography, angiography, relaxation duodenography. In some cases, despite the use of the listed diagnostic procedures, significant difficulties arise in the differential diagnosis with some forms of chronic pancreatitis. In such a situation, the final diagnosis is made on the basis of cytological and histological examination of biopsy material obtained during a diagnostic puncture (under ultrasound and X-ray tomographic control) or during surgery.

Treatment of pancreatic cancer is surgical. For head cancer, radical surgery (pancreatoduodenal resection) is possible only in 10-25% of patients. To eliminate jaundice, palliative operations (cholecystojejunostomy, etc.) are used. Radiation therapy is ineffective. Among the effective antitumor drugs are 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 treatment, temporary remissions were observed in 20 - 40% of patients.