26.09.2020

Pancreatic cancer

Cancer of the pancreas is a relatively infrequent disease, but the number of patients with this pathology is increasing. A malignant tumor originates from the epithelium of the organ.
The pancreas (from the Latin páncreas – pancreas) is located in the abdominal cavity, located between the stomach and spine.

It produces a number of hormones and enzymes, promoting digestion, and has two structural elements:

  1. The endocrine part of the cluster of pancreatic cells (islets of Langerhans) that produce hormones somatostatin, vasoactive intestinal peptide (VIP), insulin, polypeptide, glucagon.
  2. Exocrine cells that produce enzymes (enzymes) involved in the breakdown of fats during digestion.

Conventionally, the body is divided into its component parts – head, body and tail. Head on one side adjacent to the duodenum, there are supplying the intestinal tract blood vessels. The tail is near the spleen. The body along the entire length adjacent to the splenic vessels. The anatomical proximity of the pancreas and blood vessels, and its posterior location difficult to diagnose and surgery for diseases of the body.

All the tumors originate primarily from the exocrine structure. The complete failure of the pancreas is observed in 20 – 25 % of cases, malignancy body on 10% of the tail – about 5 %. The main part of the cases occurs in head glands – up to 60 %.

Tumors originate from the pancreas, biliary tract, duodenum, ducts of the pancreas and gallbladder into the duodenum.

The causes of tumor development

On the development of cancer of the pancreas is affected by environment and lifestyle.

The risk factors of tumor:

  1. Pre-cancerous condition form the diseases of the pancreas: cystic lesions, adenoma, chronic pancreatitis, hereditary relapsing pancreatitis.
  2. The likelihood of pathology gets higher with age after 55 years.
  3. On the development of cancer is affected by Smoking. Cancer when tobacco dependence is 2 – 3 times more likely than non-smokers.
  4. Long duration of diabetes.
  5. A regular presence in the diet of foods rich in fats. Risk factor – overweight.
  6. Genetic predisposition. Tumor of pancreas in a close relative increases the probability of its occurrence three times.
  7. Effect of some chemical carcinogens: benzidine, β-naphthylamine and asbestos.

Also causes the formation of a pathology called the lack of vitamin D3, sedentary lifestyle, alcohol abuse.

Symptoms of pancreatic cancer

When tumors of the pancreas are no specific clinical signs, the manifestation of which clearly would have signaled that in the cells of the tissue develops cancer. The tumor is detected late when the process is run. Common signs of disease, but they are similar to other diseases. There are also no markers (special characters), which could help to determine the presence of malignancy in the body at an early stage.

The growth of cancer cells causing poisoning in the body, the squeezing (compression) and arteries. Accordingly, all clinical signs of disease are the result of these processes:

  • the tumor presses nerve trunks – the person feels pain;
  • the neoplasm overlaps the pancreatic duct, splenic vein, bile duct, duodenum – increases the pressure in the bile ducts, jaundice occurs of a mechanical nature (non-infectious), feces lose color, itchy skin, urine becomes dark, the liver and gall bladder increase in size;
  • cancerous cells grow the duodenum – there is a violation of the advance contents of the intestines (obstruction), symptoms which is a sense of fullness in the epigastric region (under the sternum, between costal arches), vomiting stagnant, belching with rotten eggs smell, dry skin;
  • the toxins the tumor causes a General weakness, loss of appetite, weight reduction, caused by the disorder of digestion in intestine.

The increased pressure of the bile ducts and disrupts the cardiovascular and nervous systems, liver upsets the metabolism. Decreases heart rate, headache, a person lethargic and irritable. It is extremely heavy painful condition. A long, intense jaundice disrupts the functioning of the liver and kidneys. The accumulation of bile acids reduces blood clotting, there is a risk of bleeding.

Common signs

Signs of pancreatic cancer join the development of the pathological process and the growth of the tumor. The main symptoms of the disease, which draws attention to the cases, are yellowness of the skin, pain, weight loss, lack of appetite, fever (temporary increase in temperature).

The first symptom of overgrowth of malignant cells in the pancreas, regardless of their place of concentration is pain. This symptom appears in about 75 – 80 % of patients. Source – crush nerve trunks or penetration of the tumor through tissue. A rare cause may be a blockage of the ducts, or peritonitis (inflammatory) infection in the case of simultaneously occurring acute pancreatitis.

The location of the pain is due to tumor localization:

  • in the right upper quadrant or upper part of the anterior abdominal wall with the development process in the head of the pancreas;
  • diffuse pain in the upper abdominal cavity in diffuse (diffuse) of the tumor, but it is localized or radiates to the back or under the right shoulder blade;
  • girdle pain attacks when blockage of the bile duct.

A few weeks later the pain is joined by a yellowness of the skin. This characteristic is specific for neoplastic processes in the head of the pancreas, occurs in 75% of patients. Is formed due to stagnation of bile in the biliary system caused by penetration of malignant cells in the bile duct. Because the symptom is not caused by infection, this is called mechanical jaundice.

The yellowness increases gradually. First bright yellow skin have a red tint, as it is accumulated bilirubin. Then the bilirubin is oxidized and the skin becomes yellow with a greenish tint.
Further attached to jaundice itching: bile acids irritate the skin receptors. The condition of the sick worse – the itching does not allow to sleep, irritates the skin there are traces of multiple scratching.

The person loses weight, half of the cases of appetite. Meat and fatty food is disgusting. Increasing lethargy, fatigue, weakness. Sometimes there is a feeling of nausea and vomiting.
The sequence of the described symptoms sometimes change. Itching may be jaundice. Sometimes the first sign of pathology is the loss of body weight.

Features of clinical manifestations depending on the location of the tumor

Malignancy of the pancreatic head does not cause pain or expressed it poorly. Impaired secretion of pancreatic juice into the intestine, the patient loses his appetite and loses weight. This sign speaks of the neglect of the cancer process. Interferes with the normal work of the stomach manifested by nausea, vomiting, feeling of heaviness in the stomach, there are violations of the chair is constipation, diarrhea.

The development of obstruction in the initial section of the small intestine is manifested by regurgitation, provoke vomiting. Then joins a number of other symptoms:

  • overlaps bile duct, forming the yellowness of the skin is the first manifestation of the disease;
  • upset release of bile in the initial section of the small intestine increases the liver, gallbladder, discolor the stool; worried about the night itching, dark urine; long excessive amount of bile in the blood, impaired liver function manifested by vomiting blood, black semi-liquid stool, nasal bleeding;
  • if the tumor penetrates into the initial section of the small bowel, narrowing the lumen, wall ulcerate, joined by signs of bleeding rectum – vomiting of a dark color granular consistency, to vomit yesterday’s food, black stools, splashing on an empty stomach.

The progression of the process develops the accumulation of free fluid in the abdomen, bleeding in the intestinal tract, thrombosis of the legs, infarction of the spleen and lungs.
Malignancy in the body of the pancreas develops weight loss to the extreme exhaustion. Jaundice of this kind of tumors is not typical, occurs only when the penetration of the cancerous tissue in the head of pancreas, or metastasis in the liver.

The pain felt during germination of cancer cells of tissue, it begins under the rib cage, increases, it gives to the spine or bottled opoaryuse. A person does not eat, vomits, vomits, formed constipation.

The penetration growths in the portal vein develops pressure in it: expanded veins of esophagus and stomach are bleeding, increased liver, spleen. Possible portal vein thrombosis.
Malignant tumors of the tail of the pancreas signs characteristic of cancer in the body of the pancreas. But the pain is felt under the left rib, in the area under the rib cage, radiates to the spine.

The initial symptom of pancreatic cancer is diabetes. Should alert the appearance of this pathology in adulthood (in 50 – 60 years) if she’s not in her family history.

Classification of malignant tumors

Malignant tumors of the pancreas varied. Differ in appearance, anatomical early development, the origins: of cells, producing hormones, the glandular tissue of the bile ducts.

Based on the structure of the tumor cells pancreatic cancer has the following form:

  • intraductal adenocarcinoma is the dominant structural form of pathology – glandular epidermoid carcinoma, undifferentiated (anaplastic) carcinoma, mucinous carcinoma necistoty, prestavitelyami carcinoma, mixed ductal endocrine carcinoma;
  • cinemacity cancer;
  • giant cell tumor;
  • mucinous cistadenokarcinoma;
  • intraductal papillary-mucinous carcinoma;
  • pancreatoblastoma;
  • serous cistadenokarcinoma;
  • solid pseudopapillary carcinoma;
  • mixed carcinoma.

Type of glandular tumors (adenocarcinomas) are the most common. Originates in the head of the body that comes from the bile ducts. The most frequent structural (histological) forms of cancer of the pancreas and the peculiarities of their manifestations can be seen in Table 1.

Table 1

Type of tumor Features of the course
Ductal adenocarcinoma Absolutely dominates, constituting 95% of the tumors among the exocrine tumors. It is characterized by a particular aggressive course according to a specific algorithm:

  • penetrates the surrounding tissue and destroys them;
  • microscopic cancer cells form glandular structures that develops the growth of connective tissue;
  • metastases spread via the blood, lymph, penetration by perineural (via nerve fibers).
Osteoclastoma giant cell tumor A rare tumor. Ill people aged 60 -70 years. Can be combined with mucinous cystadenoma or cistadenokarcinoma and with ductal adenocarcinoma. Looks like tumor nodules with a diameter of 7 cm, has a clear outline. Microscopically the cells are represented undifferentiated cancer, atypical cells, when it is impossible to determine which fabric was the source of the tumor.
Serous cistadenokarcinoma Cells produce serous fluid. In tumor cells accumulate a large amount of granules of glycogen – polysaccharide formed by glucose residues. The tumor can grow large, more than 10 cm is characterized by growth into the adjacent tissues and formation of metastases.
Mucinous cistadenokarcinoma Often seen in women located in the tail and body of the organ. Malignant cells produce a mucous secretion (mucin) and dense connective tissue stroma.
Intraductal papillary-mucinous invasive cancer Cystic tumor with high malignant potential. Affects the pancreatic duct or its branches.
Is characterized by segmental or diffuse expansion of the ductal system of the pancreas in which there is a proliferation of cells that produce mucin. On the surface of the epithelium formed buds, which can be microscopic, or to form large nodular masses.
Acierno cell carcinoma The tumor is found cancer enzymes – amylase, lipase, trypsin, proteins, the cytokeratins. Among the tumor cells occur endocrine cells, and pancreatic hormones.
Pancreatoblastoma The tumor almost never occurs in adults, common in children up to 15 years. The surgical removal of cancer, the prognosis is more favourable.

Tumors in the pancreas is most often detected at a late stage. So often in medical practice uses the following classification:

  1. Resectable pancreatic tumor. The tumor has affected gland only or has spread, but not touched the vital veins and arteries. No secondary foci in distant organs. At this stage the percentage of detection of disease low – 10 to 15 % of cases.
  2. Locally common tumor of the pancreas. The malignancy has spread to adjacent tissues and organs, but is limited. To remove the mass no longer, as it has grown into blood vessels passing close by in neighbouring authorities. Secondary foci of tumor (metastases) no. Locally common tumor detected in 35 – 40 % of cases.
  3. Metastatic tumor of the pancreas. Malignant cells have extended beyond the area of the authority. There are metastases. Such prevalence is found in half of the cases.

Quite often in the pancreas metastasize diligence bodies – secondary tumors. The primary focus is “maturing” in the kidneys, colon, lungs.

Diagnosis of the disease

A survey of pancreatic cancer includes the following tools:

  1. CT. Gives clear pictures of the prostate. Helps to solve the question of the possibility to carry out the operation, as it determines the location of the tumor in relation to neighboring tissues and organs, the closeness of the snug fit it to the blood vessels. The method makes it possible to see the roughness and vagueness of the contours of the body, the volume of the gland, its heterogeneity, remoteness of metastases. A CT scan in 90% of cases detects indirect signs of malignancy of the pancreas – the expansion of the bile ducts of the liver in obstructive jaundice.
  2. Ultrasonography (us). Reveals the increase of the volume of the organ, dilated bile ducts, blurred contours.
  3. Laparoscopy. Confirms the formation of obstructive jaundice: distended, tense gall bladder, greenish-yellow, the lower part of the liver, the concentration of free fluid in the peritoneum.
  4. Fibrogastroduodenoscopy (EGD). Defines the symptoms of crushing the tumor of the initial part of the small intestine and stomach. If the malignant cells have sprouted these bodies, it is possible to see them and take the biomaterial for biopsy.
  5. Fluoroscopy (graphy). Shows the deformation of the duodenum and stomach due to compression or germination of malignancy.

Also used other tools and tests.

The treatment of pancreatic cancer

To treat cancer of the pancreas is very difficult. Already at the time of primary diagnosis in the treatment of most patients can be used only with palliative methods, which aim at creating possibilities for the patient a better quality of life. Especially dangerous cancer processes in the body and tail of the pancreas as the tumor covers bile channels, so there is no manifestations of jaundice. Accordingly, the treatment begins later.

The most important is the surgical treatment of the disease. But a large number of patients to do surgery is not possible due to the neglect of the cancer or the severity of the General condition. Surgical treatment of pancreatic cancer only occurs in 5 – 15% of patients. The possibility of surgery depends on the location of the tumor and the extent of the process.

The operation itself is technically complex:

  1. Unlike other organs of the abdominal cavity iron does not have a shell. It makes it difficult to attach to the intestine during the operation.
  2. Close to the body fits multiple blood vessels.

Surgical intervention greatly weakens the patient.

Metastases spread through the blood, of pancreatic cancer are of a cascading nature – some lesions are a source of other, more remote. Colonies of cancerous cells originally come by the portal vein to the liver, then the lungs and further down the arterial line with other authorities.

Conducted radiation and chemical therapy. This is often done before surgery to reduce tumor size. Cancer cells of the pancreas are resistant to chemicals and to radiation, as they are poorly supplied with blood vessels surrounded by dense connective tissue. The active ingredient of chemicals comes to them with difficulty. Increase the dosage of the medication and the intensity of the exposure modes barely acceptable – increases the risk of side effects. In addition, the pancreatic tumor is able to form resistance to chemotherapeutic agents.

Therapeutic assistance is directed to the elimination of jaundice, obstruction of the small intestine, the duodenum and the common bile duct, the decrease in severity of pain, the treatment of diabetes and other side effects.

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