"King of Cancer" - diagnosis and treatment of pancreatic cancer
The previous article introduced incidence of pancreatic cancer and its associated symptoms, here we continue to introduce diagnosis and treatment of pancreatic cancer!
diagnostic CT
Computed tomography is most important diagnostic and diagnostic tool.
Ultrasound Echography
It is more accurate than CT in distinguishing between obstructive and non-obstructive jaundice. Compared to CT, its effectiveness decreases with obesity and excess gas in intestines.
ERCPAlthough endoscopic retrograde cholangiopancreatography and fine needle aspiration biopsy are invasive procedures, they have certain advantages. Endoscopic retrograde cholangiopancreatography (ERCP) has a high diagnostic sensitivity (94%) in pancreatic cancer [28]. It can detect tumors and locate blocked ducts. In addition, endoscopic retrograde cholangiopancreatography allows for a cytological study of aspiration of pancreatic secretions. Bile entry can also determine other cancer-causing factors such as K-ras oncogene. According to a group report [29], false-negative rate of ERCP is only 3%. Microscopic retrograde cholangiopancreatography, but fine needle aspiration biopsy with a sensitivity of 86% [30] allows for a histological diagnosis.
Oncomarker CEA
Tumor markers such as CEA and CA19-9 are of low specificity but may help in making a diagnosis when clinical manifestations are unclear.
Without pathological data, diagnosis of pancreatic cancer is impossible. This must be taken prior to surgery. Thanks to advances in diagnostics such as endoscopic ultrasonography and CT-guided biopsy, there is no need to perform exploratory laparoscopy except in very rare cases. Endoscopy (ERCP) also allows cytology (because most cancers originate in the ducts).
Pathology
Must be clearly differentiated from islet cell tumors with a good prognosis. They have a different histological appearance and stain positively for chromogranin.
Staging and prognostic factors Adrenal tumor stagingIt is important to note that TNM classification has no clinical value beyond classification of operable and non-resectable diseases. According to TNM system, operable disease was defined as T1N0M0 and T2N0M0.
Prognostic factors (risk factors for relapse)The two main predictors of adrenal cancer are:
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Only surgery can provide radical treatment for patients with operable disease. This refers to tumors of head that have not spread to adjacent structures such as celiac plexus or superior mesenteric artery. Adjuvant chemoradiotherapy is not standard and is used by many centers. In locally advanced disease, combination chemotherapy and radiation therapy may be helpful.
1. Operable casesDetermining stage and resectability is of great prognostic value. Tools for assessing resectability include CT, MRI, angiography, and laparoscopic "surgical confirmation". Determination of surgical resectability includes careful examination of liver, hilum, portal vein, and superior mesenteric vessels. The head of pancreas and uncinate process are assessed using a wide Kocher test. The SMA was palpated and assessed for its association with tumor. Check hepatic artery and celiac trunk to make sure there are no vascular wraps.
Operable cases show none of following:
Pancreatoduodenal resection (Whipple operation and its variants) is method of choice. Variants of Whipple procedure include pylorus-sparing surgery to reduce postgastrectomy syndrome and extended Whipple procedure commonly used in Japan.
BenefitsThe overall 5-year survival rate for resected tumors less than 2 cm is approximately 18%.
Surgical mortalitySurgical mortality rates range from 5% to 20%. Serious complications accounted for 30%, including sepsis, abscess formation, hemorrhage, and fistula formation.
Complementary TherapyThe Small Gastrointestinal Tumor Study (GITSG) found that patients with pancreatic cancer who received radiotherapy in combination with 5-Fu chemotherapy had a significantly higher survival rate (median survival, 11 to 20 months). The long-term cure rate also improved in radiotherapy group.
2. Locally advanced cases in combination with chemotherapy.
Several studies conducted at same institution evaluated role of preoperative radiotherapy in combination with chemotherapy with fluorouracil (5-Fu) and gemcitabine (gemcitabine). In these studies, 60-80% of lesions were completely removed 1.0-1.5 months after completion of chemotherapy. Median survival is 16 to 25 months.
Intraoperative electron beam therapyIntraoperative electron beam therapy is closely associated with good local control.
3. Metastatic cases ChemotherapyIn cases of spread beyond pancreas to lymph nodes or liver, chemotherapy may provide temporary relief.
BenefitsThe five-year survival rate for patients with stage IV tumors is less than 2%, and median survival time is usually less than 6 months.
"King of Cancer" - diagnosis and treatment of pancreatic cancer
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