Pancreatic cancer
Contents:
Description:
The pancreatic cancer belongs to localizations of cancer from which incidence and mortality around the world steadily grows.
Elderly people, after 60 years get sick generally. Men and women are ill equally often. In structure of mortality from malignant new growths in the specific weight of a pancreatic cancer makes about 5%.
Symptoms of the Pancreatic cancer:
The clinical picture depends on localization of a tumor. The general symptoms of a pancreatic cancer are: appetite loss, nausea, weight loss, the general weakness, dull aches in an upper half of a stomach, disorder of function of intestines, fervescence, Trusso's symptom (the migrating thrombophlebitis).
Often first clinical sign of a pancreatic cancer ("alarm signal") is the mechanical jaundice proceeding without fervescence and painful attacks. Mechanical jaundice at a pancreatic cancer is caused by the fact that the cancer node, increasing in sizes, moves apart "horseshoe" of a duodenum in the beginning and squeezes its gleam, then sprouts its wall, extends to bile-excreting canals, causing disturbance of their passability. Icteric coloring of integuments is replaced gradually olive, further by dark green color; kcal, dark urine, a skin itch are characteristic yellowness of scleras of eyes and visible mucous, colourless (akholichny). Body temperature becomes subfebrile. In this period there is noticeable a weight loss of the patient. Bile pressure in all canals located above a prelum increases. It is followed by uniform expansion of bilious channels and leads to increase in a liver and gall bladder.
At pancreas head cancer Courvoisier's symptom – detection is characteristic at a palpation of volume painless education in the right upper quadrant of a stomach (the stretched gall bladder).
If prior to the beginning of a disease the gall bladder was not changed, then under the influence of bile supertension it increases so that there are available palpations. The increased gall bladder at the icteric patient indicates lack of communication of jaundice with cholelithiasis. But in the presence at the patient of symptoms of mechanical jaundice the doubtful or negative symptom of Courvoisier does not exclude pancreas head cancer.
At cancer of a body and tail of a pancreas the constant aching pain in epigastriums with irradiation in a waist is characteristic; intensity of pain changes at change of position of a body. The growing tumor reaches a stomach and a cross colon, sprouts their walls, breaking passability of these bodies.
At a pancreatic cancer cancer intoxication accrues, all functions of gland, activity of other bodies of the alimentary system are broken; profuse bleedings in the hollow bodies affected with the burgeoning tumor are possible.
Reasons of the Pancreatic cancer:
Risk factors and precancerous diseases:
Among risk factors it should be noted smoking, alcohol intake, greasy and spicy food, a diabetes mellitus, calculous cholecystitis, cirrhosis, etc.
Allocate the following diseases of a pancreas which are carried to precancerous:
* Chronic pancreatitis, in particular indurative pancreatitis
* Pancreas adenoma
* Pancreas cysts (post-pancreatic, posttravmatiky).
The most frequent localization of a pancreatic cancer is the head – in 50-60% of cases, total damage of a pancreas is observed in 20-35% of cases, the body is surprised approximately in 10%, a tail – in 5-8%.
Macroscopically the pancreatic cancer looks as a dense hilly node of the different sizes, without clear boundary with surrounding normal fabric; on a section a tumor of white or light yellow color, with certain sites of disintegration, a dense consistence.
Cancer therapy of a pancreas:
Cancer therapy of a pancreas – one of the most difficult sections of oncology. Difficulties of treatment, first of all, are connected with the fact that patients with cancer of a pancreas are persons of advanced and senile age with a mass of associated diseases and widespread tumoral process with defeat of adjacent bodies.
The surgical method of treatment at the present stage is the leading method of cancer therapy of a pancreas. Distinguish radical and palliative operations. Carry pankreatoduodenalny resections in different modifications to radical pancreatic cancer operations, a resection of a body and tail of gland, a total pancreatoduodenectomy.
Palliative operations are carried out for the purpose of improvement of quality of life of patients and are directed to elimination of a pain syndrome, mechanical jaundice, impassability of a duodenum. Distinguish the following options of palliative operations: imposing of a biliodigestivny anastomosis between a gall bladder or the general bilious channel and a small bowel or a stomach; "an anemic zhelcheotvedeniye".
Operability at a pancreatic cancer makes from 10 to 25%. The postoperative lethality reaching 25-40% depends on a tumor stage. Changes in gland stump, insolvency of a pankreatoyeyunalny anastomosis, a liver failure are the main reasons for a postoperative lethality.
Average life expectancy of patients with the established diagnosis of a pancreatic cancer makes:
* without operation – about 6 months;
* after radical operation – 1,5-2 years (depending on a tumor stage);
* after palliative operation – 6-12 months.
X-ray surgical treatment ("anemic zhelcheotvedeniye") - the option of a palliative method of treatment directed to a decompression of bilious channels at patients with mechanical jaundice.
Various X-ray biliary interventions are carried out:
* Transdermal rekanalization of a gepatikokholedokh.
* Outside and naruzhnovnutrenny drainage of bilious channels - transdermal transhepatic installation of a drainage – a tube from synthetic material, a catheter to the bilious canal under RTVK. It is applied independently or as a stage of preparation for surgery or endobiliary prosthetics.
* Transdermal gepatikokholangiostomiya.
* Endobiliary prosthetics (internal drainage) - transdermal transhepatic installation of an endoprosthesis from synthetic material or a nitinol endoprosthesis in the space of a stricture of a bilious channel for RTVK. Intraoperative implantation is possible.
Average life expectancy when performing endobiliary prosthetics as an alternative of palliative operation makes 6-12mes.
At cancer therapy of a pancreas the following types of radiation therapy are used:
* Remote gamma therapy.
* Radiation by a bremsstrahlung.
* Radiation by bystry electrons.
Preoperative, intraoperative and postoperative courses of radiation are conducted. Average life expectancy of the patients receiving radiation therapy concerning a pancreatic cancer makes 12-13mes, and in a combination with palliative operations – about 16 months. Inside - and the extra hospital lethality is connected with cancer intoxication and a cachexia, local and general beam reactions.
The chemotherapy is applied independently in cases of impossibility of performing other treatment at widespread process or in combination with other methods of treatment. Efficiency of monochemotherapy makes 15-30%, polychemotherapy - 40%, at the same time are possible to achieve only partial regression of a tumor.
