Pancreatic cancer: signs and manifestations, how long they live, how to treat. Palliative treatment of pancreatic cancer. Radiation therapy for pancreatic cancer

The pancreas is important body, which is responsible for food digestion and metabolism. Without it, the human body cannot function normally. However, there are some diseases that require immediate removal of the gland, since this is the only way to save a person’s life. And in what situations the pancreas is removed and how the patient’s life changes after this, you will now find out.

Functions of the organ

The pancreas is responsible for the synthesis of enzymes necessary for the normal functioning of digestive processes. They ensure the breakdown of proteins, fats and carbohydrates, and also contribute to the formation food bolus, which then enters the intestines. If there is a malfunction in the functioning of the pancreas, all these processes are disrupted and serious problems with health.

But in addition to digestive enzymes, the pancreas produces hormones, the main of which is insulin, which controls blood glucose levels. Its deficiency causes the development diabetes mellitus, which, unfortunately, cannot be treated and requires the patient to constantly take medications, which also negatively affects the overall functioning of the body. And the patient cannot do without them, because sudden jump blood sugar levels can lead to sudden death.

There are a large number of factors that can lead to disruption of the pancreas. But most often the culprit of problems with these organs is the person himself, who eats unhealthy foods and alcoholic drinks. As a result, pancreatitis develops, characterized by inflammation of the pancreatic parenchyma and disruption of its functionality.

Since this organ is so important to the human body, is the pancreas removed? People with pancreatitis are mainly treated with medication. But this disease provokes more serious pathologies, such as the formation of malignant tumors on the surface of the gland, cysts, stones in the ducts, or the development of necrosis. In all these cases, the only correct method of treatment is surgery. However, doctors are in no hurry to resort to it, since the pancreas is an important organ in the human body and it is almost impossible to predict the consequences that may arise after its removal.

Even if partial resection of the gland is planned during the operation, this does not provide a 100% guarantee that inflammation will not recur. If we are talking about pancreatic cancer, then in this case the chances of a complete cure after surgery are only 20%, especially if the disease has affected nearby organs.

Indications for removal

The pancreas can be removed if the following diseases develop:

• acute pancreatitis complicated by necrosis;
• oncology;
• cysts;
• deposition of stones in the gland ducts;
• pancreatic necrosis;
• abscess;
• hemorrhages inside the cyst.

There are many indications for pancreatic removal, but most often the operation is performed for oncology and necrosis

Removal method

For partial or complete resection of the pancreas, a method such as pancreatectomy is used. If it is necessary to completely remove an organ, the operation is performed laparotomically, that is, access to the affected gland is gained through an incision in abdominal cavity. After all the measures have been taken, the incision site is stitched or secured with staples.

Sometimes during such an operation, drainage tubes are installed in the abdominal cavity, which allow the fluid that accumulates in the area of ​​the surgeon to be removed. In some cases, doctors also place drainage tubes in the intestines. As a rule, this is done only when the need for probed nutrition arises.

If the gland is not completely removed (only part of it), then in this case pancreatectomy can be carried out using the laparoscopic method - access to the organ is gained through punctures in the abdominal cavity by introducing into the abdominal cavity a special device equipped with a camera, which allows you to monitor all the actions taking place on a computer monitor. This operation is less traumatic and requires a shorter rehabilitation period. But, unfortunately, not in all cases it is possible to use this method surgical intervention.

During the operation, not only the pancreas can be removed, but also other organs located near it, for example:

• gallbladder;
• spleen;
• upper part of the stomach.

During and after surgery, there is a high probability of serious complications. IN in this case it speaks not only about the possibility of developing inflammation or infection, but also about the further work of the whole organism. Indeed, quite recently, operations during which the gland was completely removed were not carried out in medical practice, since it was believed that without this organ people could not live even one year.

The final stage of pancreatectomy

However, today the situation has completely changed, and the prognosis after such operations is favorable, but only if all the doctor’s instructions are followed. How will the body recover? rehabilitation period and how long a person can live after this depends on several factors:

• patient's weight (people with overweight bodies have a harder time recovering from surgery and live less);
• age of the patient;
• nutrition;
• presence in a person bad habits;
• state of the cardiovascular system;
• the patient has other health problems.

Is it possible for a person to live without a pancreas? Of course! But it should be understood that the more negative factors affect the body, the greater the likelihood that complications will arise after surgery, which may lead to a reduction in life expectancy. After removal of the pancreas, you can live long and happily only if you lead a healthy lifestyle and follow all the doctor’s recommendations.

Rehabilitation period

After removal of the pancreas, a person’s life changes dramatically. Even if only the tail of the organ or another part of it was removed, and the operation itself went without complications, the patient will need a lot of time and effort to fully recover.

If the patient follows all the doctor’s recommendations, the rehabilitation period in 90% of cases proceeds without serious complications

If the pancreas has been removed, the patient will have to comply strict diet, receive special drugs and use insulin injections to keep blood sugar levels under control.

Many patients complain for a long time that they have pain in the operated area, and the pain is severe. And to minimize them, doctors, as a rule, prescribe complementary therapy painkillers. Full recovery of the body after pancreatic surgery takes about 10–12 months.

Possible consequences in the postoperative period

The consequences of removing the pancreas can vary. Any surgical intervention has a high risk of developing inflammatory or infectious processes in the tissues of the body in postoperative period. And to avoid them, the doctor prescribes a course of antibiotics before and after the operation. If the patient takes them strictly according to the prescribed regimen, the risks of such complications are reduced several times.

After removal of the gland, diabetes mellitus develops, because after the operation there is an acute lack of insulin in the body, which is why the person is forced to constantly take insulin injections. If you skip them or use them incorrectly, this is also fraught various consequences, among which there is hypo- and hyperglycemic coma.

In addition, even the removal of a small part of the pancreas disrupts its exocrine functions responsible for digestion. Therefore, the patient will also have to constantly take enzyme preparations (they are prescribed on an individual basis).

Drugs used as replacement therapy after removal of the pancreas

Nutrition after surgery

After surgery to remove the pancreas, all patients, without exception, are prescribed a strict diet. You will have to stick to it constantly. Remove from the diet once and for all:

• fried and fatty foods;
• smoked meats;
• pickles;
• flour;
• spices;
• canned food;
• semi-finished products;
• sausages;
• spicy dishes and sauces;
• carbonated and alcoholic drinks;
• chocolate;
• cocoa;
• legumes

It is also not recommended to eat vegetables and fruits raw, as they contain a lot of fiber, which is difficult to digest. All dishes should be steamed or baked in the oven, but only without adding oil.

The patient's daily diet must include meat and fish. low-fat varieties. However, they cannot be consumed together with the skin. He also needs to eat dairy and fermented milk products every day (their fat content should not be more than 2.5%).

You also need to eat food according to certain rules:

• for the first 3–4 months after surgery, it needs to be crushed to a puree-like consistency;
• you need to eat small portions at least 5 times a day;
• 30–40 minutes before meals you need to inject insulin (only if short-acting insulin is used), and while eating you need to take an enzyme preparation;
• food must be warm, hot and cold dishes are prohibited;
• The last meal should be taken 2-3 hours before bedtime.

The diet must be followed not only during the rehabilitation period, but throughout life

If you strictly follow the diet and apply it in a timely manner medicines prescribed by a doctor, you can live a long and happy life even after complete removal of the pancreas. If you neglect the doctor’s recommendations, this can lead to serious consequences and significantly reduce your life expectancy.

Update: November 2018

Pancreatic cancer is an oncological disease that usually develops either against the background of decreased immunity, or in cases where a person suffers from chronic diseases of this organ (,). The disease does not show any symptoms for a long time, and its late manifestations can masquerade as the underlying disease or be “vague,” which makes diagnosis much more difficult. Pancreatic cancer tends to progress rapidly, growing in area, giving rise to metastases to the lymph nodes, liver, bones and lungs. All this determines the name of the disease - “silent killer”.

Oncologists recommend that every healthy person undergo a retroperitoneal examination once a year. And if you find 2 or more of the risk factors listed below, it is recommended to add an abdominal MRI and a blood test for the CA-19-9 marker to your annual examination.

About the pancreas

This is a glandular organ 16-22 cm long. It has the shape of a pear lying on its side, but inside it consists of lobules, the cells of which produce a large number of digestive enzymes. Each lobule has its own small excretory duct, which connects into one large - Wirsung - duct, which opens into the duodenum. Inside the lobules there are islands of cells (islets of Langerhans) that do not communicate with the excretory ducts. They release their secretion - the hormones insulin, glucagon and somatostatin - directly into the blood.

The gland is located at the level of the first lumbar vertebrae. The peritoneum covers it in front, and it turns out that the organ is not located in the abdominal cavity itself, but in the retroperitoneal space, next to the kidneys and adrenal glands. The organ is partially covered in front by the stomach and a fatty “apron” called the “lesser omentum”, its end abuts the spleen. This makes the gland not as accessible for research as, for example, the liver. However, in experienced hands, ultrasound is a good method of screening diagnosis (that is, primary, initial, if suspected, requiring clarification using other methods).

The pancreas weighs about 100 grams. Conventionally, it is divided into head, neck, body and tail. The latter contains the most islets of Langerhans, which are the endocrine part of the organ.

The pancreas is covered by a capsule of connective tissue. The same “material” separates the lobules from each other. Violation of the integrity of this tissue is dangerous. If the enzymes produced by exocrine cells do not enter the duct, but into an unprotected place, they are able to digest any own cells: they break down complex proteins, fats, and carbohydrates to their elementary components.

Statistics

According to the USA, being relatively rare (developing in 2-3 cases out of a hundred malignant tumors), pancreatic cancer ranks fourth among the causes of death from cancer. This disease is more likely than all other oncological pathologies to lead to death. This is explained by the fact that in the early stages the disease does not manifest itself at all, but later the symptoms can make one think of completely different diseases. Men get sick 1.5 times more often. The risk of getting the disease increases after age 30, increases after age 50, and peaks after age 70 (60% or more cases in people over 70).

Most often, cancer develops in the head of the pancreas (3/4 of cases), the body and tail of the organ are least likely to be affected. About 95% of cancers arise from mutations in exocrine cells. Then adenocarcinoma occurs. The latter often has a scirrhous structure, when the tumor contains more connective tissue than epithelial “filling”.

Pancreatic cancer likes to metastasize to regional lymph nodes, liver, bones and lungs. The tumor can also grow, compromising the integrity of the walls of the duodenum, stomach, and large intestine.

Why does the disease develop?

When the cells of each organ divide, cells with an incorrect DNA structure periodically appear, which ensures their structure is disrupted. But the immune system comes into play and “sees” that the cell is abnormal by the antigen proteins that appear on the surface of its membrane. T-lymphocyte cells, producing daily work, must “check” the antigens of all cells that are not fenced off by a special barrier with the data about the norm that they have in their memory. When the test data is not as expected, the cell is destroyed. If this mechanism is disrupted, mutated cells also begin to divide and, accumulating, give rise to cancerous tumor. Before reaching a certain critical number, they turn on a mechanism that hides them from the immune system. Then, when this volume is reached, the defense forces recognize the tumor, but they are not able to cope with it on their own. Their struggle causes the appearance of early symptoms.

No specific cause of pancreatic cancer has been found. Only risk factors are described that, especially when they “meet” together, can cause this disease. They are as follows:

• Chronic pancreatitis. Gland cells in a state of constant inflammation are a good substrate for the development of mutations in them. The risk of developing cancer is reduced by maintaining the disease in remission, which is possible by following a diet.
• Hereditary pancreatitis is an inflammation of the pancreas that occurs as a result of being “dictated” by a defective gene.
• Diabetes. Insulin deficiency (especially relative, in type 2 disease) and a constantly elevated blood glucose level as a result increases the risk of pancreatic cancer.
• Smoking. This risk factor is reversible: if a person quits smoking, freeing his blood vessels from tar and nicotine, and his pancreas from ischemia, the risk of this disease is reduced.
• Obesity also increases your risk of cancer. This occurs due to a change in the balance of sex hormones, provoked by an increased accumulation of adipocyte (fat) tissue.
• . The risk of developing pancreatic cancer increases with this pathology.
• Availability . This disease changes the microflora of the gastrointestinal tract, resulting in toxic compounds appearing in the digestive system. With an operated peptic ulcer, the risk of pancreatic cancer increases even more.
• Nutrition. There are studies, but they have not yet been proven, that increase the risk of developing pancreatic cancer:
  1. “processed meat”: ham, sausage, bacon, smoked ham: the risk increases by 20% with every 50 grams of such meat;
  2. an excess of simple carbohydrates, especially those contained in soft carbonated drinks, which, moreover, contain soda;
  3. Grilled meat, especially red meat, contains heterocyclic amines, which increase the risk of cancer by 60%;
  4. large amounts of saturated fatty acids in food.
• Non-specific ulcerative colitis And . Having existed for many years, these pathologies “poison” the pancreas with chemicals produced during inflammation.
• Low physical activity.
• Chronic allergic diseases: , and others.
• Oral diseases. There is an inexplicable but proven fact here that caries, pulpitis, and periodontitis increase the risk of pancreatic cancer.
• Ingestion of various dyes and chemicals used in metallurgy.
• Existing cancer of another location, especially: cancer of the pharynx, cervix, stomach, intestines, lungs, breast, ovaries, kidneys, bladder.
• Age over 60 years.
• Belonging to the African race.
• Mutations in the structure of one’s own DNA, for example, in BRCA2, a gene responsible for suppressing tumor growth. Such mutations can be inherited. Excessive activity of the protein kinase P1 (PKD1) gene may also stimulate the development of pancreatic cancer. Research is currently underway into targeting the latter gene as a way to treat the disease.
• Presence of cancer in close relatives. People whose first-degree relatives were diagnosed with pancreatic cancer before age 60 are especially at risk. And if there are 2 or more such cases, the chances of developing morbidity increase exponentially.
• Being male. This risk factor, like the four penultimate ones, is one of those that a person cannot influence. But by following preventive measures (about them at the end of the article), you can significantly reduce your chances.

Precancerous diseases of the pancreas are:

• chronic pancreatitis;

Classification of the disease by structure

Depending on from which cells the malignant tumor developed (this determines its properties), it can have several types:

• Ductal adenocarcinoma is a cancer that develops from the cells lining the excretory ducts of the gland. The most common type of tumor.
• Glandular squamous cell carcinoma is formed from two types of cells - those that produce enzymes, and those that form excretory ducts.
• Giant cell adenocarcinoma is a collection of cystic, blood-filled cavities.
• Squamous cell carcinoma. Consists of duct cells; is extremely rare.
• Mucinous adenocarcinoma occurs in 1-3% of pancreatic cancers. It is less aggressive than the previous form.
• Mucinous cystadenocarcinoma develops as a result of degeneration of a gland cyst. This form of cancer most often affects women.
• Acinar cancer. Tumor cells here are arranged in clusters, which gives rise to the name of the tumor.
• Undifferentiated cancer. Its most malignant type.

If cancer develops from the endocrine part of the gland, it may be called:

• glucagonoma - if it produces glucagon, a hormone that increases blood sugar levels;
• insulinoma, which synthesizes excess insulin, which reduces blood glucose levels;
• gastrinoma - a tumor that produces gastrin - a hormone that stimulates the stomach.

Classification of the disease by its location

Depending on the location, there are:

1. pancreatic head cancer. This is the most common type of malignant tumor;
2. gland body carcinoma;
3. pancreatic tail cancer.

If you combine the 2 above classifications, then scientists give the following statistics:

• in 61% of cases, ductal carcinoma is localized in the head, in 21% in the tail, in 18% in the body;
• the head of the gland provides “shelter” for more than half of giant cell adenocarcinomas;
• in more than 60% of cases, glandular squamous cell carcinoma is located in the head of the organ, less often its foci are multiple or located only in the tail;
• localized in the head and more than 78% of mucinous adenocarcinomas;
• the localization structure of acinar cell carcinoma is as follows: 56% is located in the head, 36% in the body, 8% in the tail;
• But mucinous cystadenocarcinomas are located in the head in only 1/5 of cases, more than 60% affect the body, and in 20% of cases they are localized in the tail.

Thus, we can conclude that the head of the pancreas is the place where a malignant tumor is most often found.

Symptoms of the disease

Developed cancer of the head of the pancreas initially has no external manifestations. Then the first symptoms of the disease appear. They are as follows:

1. Abdominal pain:
   • in the area “under the stomach”;
   • and at the same time in the hypochondrium;
   • gives to the back;
   • pain intensity increases at night;
   • it hurts more if you lean forward;
   • It becomes easier if you press your legs to your stomach.
2. Periodic redness and soreness of one or the other vein. Blood clots can form in them, causing part of the limb to become bluish.
3. Losing body weight without dieting.
4. The early stages of cancer are also characterized by general weakness, loss of ability to work, and heaviness in the stomach after eating.

Further signs of cancer associated with tumor enlargement are:

• . It begins gradually, a person does not notice it for a long time, maybe, perhaps, pay attention to the yellowing of the eyes. Over time, when the formation where the excretory duct of the pancreas opens and the main bile duct coming from the liver is compressed, jaundice increases sharply. The skin becomes not just yellow, but acquires a greenish-brown tint.
• Severe itching of the skin of the whole body. It is caused by stagnation of bile inside its ducts, when at the same time bile deposition develops in the skin.
• The feces become light and the urine becomes dark.
• Appetite is completely lost.
• Intolerance to meat and fats develops.
• Digestive disorders such as:
  • nausea;
  • vomit;
  • diarrhea. The stool is loose, foul-smelling, greasy; it changes due to deterioration in fat absorption due to the fact that the gland ceases to secrete the normal amount of enzymes.
• Body weight decreases even more, the person looks exhausted.

Symptoms of pancreatic cancer located in the body or tail will have slightly different manifestations. This is due to the fact that this localization is far from the biliary tract, and it is their compression that causes jaundice - the main symptom that forces a person to seek treatment. medical care. In addition, it is in the body and tail that there are a large number of islets consisting of cells of the endocrine part of the gland. Therefore, signs of body or tail cancer may include:

• Symptoms of diabetes:
  • thirst;
  • large amounts of urine excreted;
  • night urge to urinate.
• Symptoms similar to chronic pancreatitis:
  • pain in the upper abdomen;
  • fatty stool, more liquid, difficult to wash off the toilet;
  • may have diarrhea;
  • nausea;
  • decreased appetite;
  • weight loss
• If glucagonoma develops, it will manifest itself:
  • weight loss;
  • the appearance of a jam in the corners of the mouth;
  • changing the color of the tongue to bright red; its surface becomes smooth, and it itself seems to swell, becoming larger and “fleshy”;
  • the skin becomes pale;
  • a skin rash appears, often localized on the extremities;
  • Dermatitis periodically appears, which is called necrolytic migratory erythema. This is the appearance of one or several spots, which then turn into blisters, then into ulcers that become crusty. When the crust falls off, a dark spot remains. Several different elements are found in one place at once. The process lasts 1-2 weeks, then passes, and after that it can be repeated again. Dermatitis is usually located on the lower abdomen, groin, perineum, and around the anus. Treatment with ointments does not affect it, since it is based not on allergies or microbial inflammation, but on a disorder in the metabolism of proteins and amino acids in the skin.
• Symptoms of gastrinoma may also develop:
  • constant diarrhea;
  • the stool is greasy, shiny, smelly, and difficult to wash off the toilet;
  • pain “in the pit of the stomach” after eating, which decreases when taking drugs such as “,” Rabeprazole, “Ranitidine,” prescribed as for gastric ulcers;
  • with the development of complications of stomach ulcers that occur due to excessive production of gastrin, there may be: vomiting of brown contents, brown loose stools, a feeling that the stomach does not work (“stands”) after eating.
• Diarrhea.
• Edema.
• Menstrual dysfunction.
• Decreased libido.
• Slow wound healing.
• The appearance of acne and pustules on the face.
• Trophic ulcers often appear on the legs.
• Allergy-like spots periodically appear on the skin.
• “Hot flashes” occur in fits and starts with a feeling of heat in the head and body, redness of the face. A hot flush may develop after drinking hot drinks, alcohol, generous intake food or stress. The skin may become paler than before or, conversely, turn red, or even turn purple.
• Due to the loss of sodium, magnesium, potassium with diarrhea, cramps in the limbs and face may appear without loss of consciousness.
• You may feel heaviness and a feeling of fullness in the left hypochondrium. This is a sign of an enlarged spleen.
• Diffuse acute pain in the abdomen, severe weakness, pale skin. These are signs of internal bleeding from dilated (due to increased pressure in the portal vein system that supplies blood to the liver) veins of the esophagus and stomach.

Thus, weight loss, pain in the upper abdomen, and fatty stools are characteristic symptoms for cancer of any location. They are also present in chronic pancreatitis. If you do not have pancreatitis, you need to be examined not only for its presence, but also for cancer. If chronic inflammation of the pancreas already occurs, it is necessary to be examined for cancer not only routinely, annually, but also when some new, previously absent, symptom appears.

Here we looked at the symptoms of stages 1 and 2. There are 4 of them in total. Last stage, in addition to severe girdle pain, diarrhea and almost complete indigestibility of foods, there will be - due to distant metastases– manifest symptoms from those organs where the daughter cells of the tumor have entered. Let's look at the symptoms of this stage after we find out how and where pancreatic cancer can metastasize.

Where does pancreatic cancer metastasize?

A malignant pancreatic tumor “scatters” its cells in three ways:

• Through lymph. It happens in 4 stages:
  1. First, the lymph nodes located around the head of the pancreas are affected;
  2. tumor cells penetrate into the lymph nodes located behind the place where the stomach passes into the duodenum, as well as where the hepatoduodenal ligament passes (in the sheet of connective tissue there is a common bile duct and arteries, which then go to the stomach, along the latter these lymph nodes are located );
  3. the lymph nodes located in the upper section mesenteries (connective tissue, inside which there are vessels that nourish and hold the small intestine);
  4. the last screening of lymph occurs in the lymph nodes located in the abdominal space, on the sides of the aorta.
• Through the circulatory system. This is how the daughter cells of the tumor enter the internal organs: liver, lungs, brain, kidneys and bones.
• Pancreatic cancer also sheds its cells through the peritoneum. Thus, metastases can appear on the peritoneum itself, in the pelvic organs, and in the intestines.

Also, a cancerous tumor can grow into organs adjacent to the pancreas: the stomach, bile ducts - if the cancer is localized in the head of the gland, large vessels - if the mutated cells are located in the body of the gland, the spleen if the tumor spreads from the tail. This phenomenon is not called metastasis, but tumor penetration.

Pancreatic cancer development process

There are 4 stages of pancreatic cancer:

If stage 4 occurs with liver metastases, the following are noted:

• yellowing of the skin and whites of the eyes;
• urine becomes darker and feces become lighter;
• bleeding of gums and mucous membranes increases, spontaneously occurring bruises can be detected;
• enlargement of the abdomen due to the accumulation of fluid in it;
• bad breath.

At the same time, an ultrasound, CT or MRI of the liver reveals metastasis in it, which is possible - due to the similarity of symptoms and the presence of a tumor - and will be mistaken for the primary tumor. It is possible to understand which cancer is primary and which is metastasis only with the help of a biopsy of the tumor.

If metastases develop to the lungs, the following are noted:

• shortness of breath: first after physical activity, then at rest;
• if the metastasis has destroyed the vessel, there may be hemoptysis.

Metastases in the bone are manifested by local pain in the bones, which intensifies when palpating or tapping the skin of this localization.

If the daughter tumor has been introduced into the kidneys, changes appear in the urine (blood and protein often appear in it, which makes it cloudy).

Metastatic brain damage can have one or more different manifestations:

• inappropriate behavior;
• personality change;
• facial asymmetry;
• change in muscle tone of the limbs (usually on one side);
• disturbance (weakening, strengthening or change) of taste, smell or vision;
• unsteadiness of gait;
• shiver;
• choking when swallowing;
• nasal voice;
• inability to perform simple steps or complex but memorized work;
• incomprehensibility of speech for others;
• impaired understanding of speech by the patient himself, and so on.

Diagnosis confirmation

The following tests help in making a diagnosis:

• determination of tumor marker CA-242 and carbohydrate antigen CA-19-9 in the blood;
• pancreatic amylase in blood and urine;
• pancreatic elastase-1 in feces;
• blood alkaline phosphatase;
• level of insulin, C-peptide, gastrin or glucagon in the blood.

The above tests will only help to suspect pancreatic cancer. Other laboratory tests, such as urine, stool, blood glucose, and liver tests, will help determine how much homeostasis is disrupted.

The diagnosis is made on the basis of instrumental studies:

1. Ultrasound of the abdominal cavity. This is a screening study that only allows you to determine the location that needs to be examined in more detail;
2. CT is an effective X-ray-based technique for detailed examination of the pancreas;
3. MRI is a method similar computed tomography, but based on magnetic radiation. It will provide better information about the tissues of the pancreas, kidneys, liver, and lymph nodes located in the abdominal cavity than CT;
4. Sometimes a tumor in the head of the pancreas, the extent of its damage to the papilla of Vater of the duodenum, its relationship with the bile ducts can only be seen on ERCP - endoscopic retrograde cholangiopancreatography. This is a research method when an endoscope is inserted into the duodenum, through which an X-ray contrast agent is injected into the papilla of Vater, where both the pancreatic duct and bile ducts open. The result is examined using x-rays.
5. Positron emission tomography. Also an accurate modern research method. It requires preliminary injection into a vein of a contrast agent, which is not an iodine preparation, but isotope-labeled sugar. According to its accumulation in various organs and an inspection is carried out.
6. Endoscopic retrograde cholangiography. It is performed if the previous research method was unavailable. Here, under ultrasound guidance, a puncture of the liver is made, and contrast is injected into the bile ducts. Then it flows down the bile ducts and enters the duodenum.
7. Laparoscopy. Like the previous method, this invasive technique, requiring injections. Here under local anesthesia in the front abdominal wall a hole is made through which gas is pumped into the stomach, separating the organs and moving the abdominal wall away from them (so that the device that is inserted into this hole subsequently does not cause injury to the intestines or other structures). The internal organs are examined through a percutaneously inserted endoscope, and if the tumor is visualized, a biopsy can be performed immediately.
8. Biopsy - pinching off pieces of a tumor to further research under a microscope - this is the method that allows you to make a diagnosis. No one has the right to say “pancreatic cancer” without a biopsy. Therefore, doctors - either during laparoscopy or during endoscopic examination, or already during the operation, the material is necessarily selected for histological examination.

To identify metastases, computed tomography of the lymph nodes of the abdominal cavity, spine, liver, lungs, kidneys, MRI or CT of the brain are performed.

The above studies allow you to make a diagnosis, determine the histological type of the tumor, and also find out the stage of cancer according to the TNM system, where T is the size of the tumor, N is damage to the lymph nodes, M is the presence or absence of metastases to distant organs. The index “X” means no information about the size of the tumor or metastases, “0” means absence, “1” regarding N and M indicates the presence of regional or distant metastases, regarding the T indicator indicates the size.

How is the treatment performed?

Treatment of pancreatic cancer is based on the stage of the disease, that is, how large the tumor is, where it has managed to grow, and what it has damaged. Ideally, the cancerous tumor and nearby lymph nodes should be removed, then this localization should be irradiated with gamma rays. But this is only possible at the “cancer in situ” and stage 1 stages. At other stages, combinations of different methods outlined below can be used.

Surgery

The following types of operations are performed here:

a) Whipple operation: removal of the head of the pancreas along with the tumor, part of the duodenum, stomach, gall bladder, and all nearby lymph nodes. This operation is performed only in the initial stages; it cannot be decided for a long time and cannot be postponed, as time will be lost.

b) Complete resection of the pancreas. It is used when cancer has developed in the body of an organ and has not spread beyond its boundaries.

c) Distal resection of the gland. It is used when cancer has developed in the body and tail of the organ; They are removed and the head is left.

d) Segmental resection. Here, only the central part of the gland is removed, and the other two are sewn together using an intestinal loop.

e) Palliative operations. They are carried out for unresectable tumors and aim to make a person’s life easier. It could be:

• removal of part of the tumor in order to eliminate pressure on other organs and nerve endings, reducing the tumor load;
• removal of metastases;
• eliminating obstruction of the biliary tract or intestines, thickening the stomach wall or eliminating organ perforation.

f) Endoscopic stent. If the bile duct is blocked by an inoperable tumor, a tube can be inserted into the latter, through which the bile will either enter the small intestine or exit out into a sterile plastic receiver.

g) Gastric bypass surgery. It is used when a tumor interferes with the passage of food from the stomach to the intestines. In this case, it is possible to hem these 2 digestive organ, bypassing the tumor.

Operations can be performed with a scalpel, or with a Gamma Knife, when simultaneous removal of cancerous tissue and irradiation of adjacent tissue are performed (if the cancer was not completely removed, its cells will die under the influence of gamma rays).

The intervention can be performed through micro-incisions, especially in the case of an inoperable tumor (so as not to cause dissemination cancer cells). The DaVinci programmable robot can do this. He can also use a gamma knife without the risk of radiation.

After surgery, radiation or chemoradiotherapy is performed.

Chemotherapy

Here, various types of drugs are used that block the proliferation of cancer cells, both the youngest and most immature. At the same time, there is an impact on the growing normal cells, which is the reason for the huge number of side effects of this treatment: nausea, hair loss, severe weakness and pallor, neuroses, mild incidence of infectious pathologies.

Chemotherapy can be given as:

1. monochemotherapy – one drug, courses. Effective in 15-30% of cases;
2. polychemotherapy – a combination of drugs with different mechanisms of action. The tumor partially regresses. The effectiveness of the method is 40%.

To improve the tolerability of such treatment, drink plenty of fluids, avoid alcohol, and include fermented milk products in the diet. The person is prescribed anti-nausea medications - “Cerucal” or “Osetron”, and is advised to visit a psychologist.

Targeted therapy

This is a new branch of chemotherapy that uses drugs that act exclusively on cancer cells, without affecting living structures. Such treatment is easier to tolerate by patients, but has a much higher cost. An example of targeted therapy for pancreatic cancer is Erlotinib, which blocks the signal transmission pathway to the tumor cell nucleus about its readiness to divide.

Radiation therapy

This is what irradiation of a tumor is called:

• before surgery - to reduce the volume of cancer;
• during and after surgery - to prevent recurrence;
• in case of inoperability - to reduce the activity of cancer and inhibit its growth.

Radiation therapy can be carried out in three ways:

1. bremsstrahlung;
2. in the form of remote gamma therapy;
3. fast electrons.

New treatments

US scientists are working on a new method - introducing into the body a vaccine consisting of a weakened culture of the bacterium Listeria monocytogenes and radioactive particles. The experiments clearly show that the bacterium infects only cancer cells and mainly affects metastases, leaving healthy tissue intact. If she becomes a carrier of radio particles, she will carry them into the cancerous tissue, and it will die.

Drugs are also being developed that target the immune system to fight cancer. Such a drug, for example, is the drug Ipilimumab from the group of monoclonal antibodies.

Treatment depending on the stage of cancer

Forecast

The general prognosis for pancreatic cancer is unfavorable: the tumor grows quickly and metastasizes, without making itself felt for a long time.

The question of how long people live with pancreatic cancer does not have a clear answer. It all depends on several factors:

• histological type of cancer;
• the stage at which the tumor was discovered;
• initial state of the body
• what treatment is done.

Depending on this, you can obtain the following statistics:

• If the tumor has spread beyond the gland, only 20% of people live for 5 or more years, and this is only if active treatment is used.
• If surgery was not used, they live for about 6 months.
• Chemotherapy prolongs life by only 6-9 months.
• Radiation therapy alone, without surgery, allows you to live for 12-13 months.
• If a radical operation was performed, they live 1.5-2 years. 5-year survival is observed in 8-45% of patients.
• If the operation is palliative, from 6 to 12 months. For example, after an anastomosis (connection) is made between the bile ducts and the digestive tube, a person lives after that for about six months.
• With a combination of palliative surgery and radiation therapy, they live an average of 16 months.
• At stage 4, only 4-5% survive over a year, and only 2% survive to 5 years or longer. The more intense the pain and poisoning by cancer toxins, the shorter the life.

By histological type:

The causes of death in pancreatic cancer are liver, cardiac, or those that arise from metastasis together with cachexia (exhaustion) due to cancer intoxication.

Prevention of pancreatic cancer

To truly avoid this terrible disease, scientists advise the following:

• Quit smoking. The changes caused by smoking are reversible for all organs.
• Eat foods with a low glycemic index (a measure of sweetness that affects the functioning of the pancreas). Preference not to be given simple carbohydrates, and legumes, non-starchy vegetables and fruits.
• Do not consume large amounts of protein, periodically resorting to protein-free fasting days.
• Increase the content of cabbage in your diet: Brussels sprouts, cauliflower, broccoli and others.
• Among the spices, I prefer turmeric (found in curry seasoning). It contains curcumin, which interferes with the production of interleukin-8, a mediator that affects the development of pancreatic cancer.
• Include more foods with ellagic acid in your diet: pomegranates, raspberries, strawberries, strawberries, some other red berries and fruits.
• Avoid products with nitrates.
• Consume your daily intake of vitamins C and E – natural antioxidants.
• If you like nuts and legumes, make sure they are fresh. Last year’s nuts, and even more so “suspiciously” looking nuts, may be contaminated with aflatoxin.
• The diet must contain green vegetables rich in chlorophyllin.
• You need to eat fish and fortified milk products, which contain vitamin D, which blocks the spread of cancer cells.
• Eat as little fat as possible, especially from animals: no more than 20% of total calories. Red meat, yolk, and offal are dangerous for the pancreas.
• Eat enough foods with B vitamins, vitamin A and carotenoids.

Pancreatic cancer is a difficult disease to diagnose and difficult to treat. At the Yusupov Hospital, oncologists carry out comprehensive diagnostics for timely verification of the diagnosis of pancreatic cancer and use modern, most effective methods of treating the pathology.

A little anatomy

The pancreas has a head, body and tail. The head of the organ is adjacent to the duodenum, and the bile duct passes next to it. A neoplasm of the pancreas may manifest itself as obstruction of adjacent organs.

The body of the gland is localized behind the stomach and is closely adjacent to it, so a tumor of the gland can grow into the walls of the stomach.

The tail of the pancreas is located between the spleen and the left border of the aorta. Due to this location, tumor cancer cells can affect the splenic vessels.

A malignant tumor can affect one or more parts of the pancreas, or spread to the entire organ.

According to statistics, in 75% of cases the tumor develops in the head area.

The peak incidence occurs over the age of 70 years.

Pancreatic cancer: symptoms, manifestations

• The first symptoms of pancreatic cancer are epigastric pain. The pain usually worsens at night. The connection between the appearance of pain in the early stages of the disease and food intake is not clear. Pancreatic cancer of the head is manifested by pain in the area near the navel and in the right hypochondrium. When the tumor is localized in the tail or body of the organ, pain in the back and lower back appears. The pain syndrome is variable. As a rule, the pain intensifies with any body movement. They are often confused with symptoms of sciatica;
• signs of pancreatic cancer at an early stage can be expressed in lack of appetite, weight loss, general weakness, aversion to fatty and meat foods, tobacco and alcohol;
• indigestion in the form of frequent diarrhea, caused by a decrease in the flow of enzymes and bile into the intestines;
• obstructive jaundice caused by compression of the bile duct. In this case, the skin and urine acquire a dark yellow tint. The stool becomes lighter. Quite often itching appears on the skin;
• due to the close location of the pancreas to the walls of the stomach, the tumor can grow into its walls or the walls of the duodenum. This process is accompanied by internal bleeding. Symptoms manifest themselves in the form of attacks of vomiting with a black mushy mass or charcoal-colored stool;
• When the tumor puts pressure on the duodenum, the patient experiences heaviness in the stomach. Moreover, even after a small snack, the patient feels that his stomach is full. As the malignant neoplasm develops, attacks of vomiting may appear several hours after eating, nausea, and rotten belching;
• when the splenic vein is compressed, the patient develops leukopenia, thrombocytopenia and anemia. The spleen itself increases in size;
• in the case when the insulin-producing islets of the pancreas are affected, the patient experiences symptoms of diabetes mellitus - itching of the mucous membranes and skin appears, a feeling of thirst and dry mouth persists;
• accumulation of fluid in the abdominal cavity. Is late sign pancreatic cancer, indicating that the tumor has begun to metastasize and the portal vein is affected.

The first symptoms of pancreatic cancer are nonspecific, appearing depending on the location of the tumor, the stage of development of the disease and the presence of metastases. If you experience any ailments, be it loss of appetite, yellowing of the skin and itching, lower back pain, etc., you should definitely undergo a proper medical examination. Moreover, even if the examination revealed gastritis, the diagnosis cannot be considered final until the pancreas is examined.

When you contact the Yusupov Hospital, you can be sure of receiving professional medical care. All diagnostic procedures are carried out on the most modern equipment. Doctors have extensive experience in dealing with oncological diseases and master all classical and innovative treatment methods.

Your stay in the hospital will be comfortable, the rooms are equipped with everything necessary.

Diagnosis of pancreatic cancer

• when you first contact a doctor, one of the optimal, safe and informative methods diagnostics will happen ultrasonography abdominal cavity. During an ultrasound, a neoplasm can be detected, provided that its diameter is at least 2 centimeters. The quality of the equipment and the qualifications of the doctor are of no small importance;
• CT scan. Based on the results of the study, it is possible to assess the size of the tumor, its exact location and the presence of metastases in other organs. Computed tomography involves irradiating the patient, so this method is used only if indicated;
• magnetic resonance imaging: the method is quite informative, and less harmful than computed tomography. The only contraindication to this type of examination is the presence of any kind of metal implants.

There are a number of methods that can, to a greater extent, not establish the presence of a tumor, but rather determine its exact location and the extent of damage to the organ. Among them:

• X-ray examination of the duodenum and stomach, which allows identifying deformations of organs due to tumor growth in them;
• positron emission tomography: makes it possible to identify the extent of tumor growth and its metastases. A radionuclide is introduced into the patient's body, which settles in the tumor cells. Next, using special equipment, a series of photographs are taken, from which the distribution of radionuclides in the body is determined. The method allows you to determine the choice of subsequent treatment: chemotherapy, radiation therapy, or the need for surgical intervention;
• fibrogastroduodenoscopy allows you to determine the condition of the mucous membrane when a tumor grows into the walls of the stomach;
• oral cholangiopancreatography: allows you to examine the condition of the main pancreatic and bile duct. The study is carried out by introducing an endoscope through the duodenum;
• angiography: makes it possible to detect displacement or narrowing of blood vessels at the site of tumor damage;
• biopsy: a sample of tumor tissue is taken from the patient to examine it for the presence of cancer cells.

Pancreatic cancer: causes

U healthy person Cell division occurs continuously in every organ. In this process, disruptions occur from time to time, in scientific language - mutations. Cells with incorrect DNA are formed. The immune system recognizes and kills such “broken” cells. When the immune system fails, it stops identifying and killing cells with incorrect DNA. The latter, in turn, continue to divide and oncology develops. Pathological cells turn on the “protection function”, and the immune system does not recognize them as “foreign”.

In modern medicine, there is no exact opinion on why pancreatic cancer develops; there are only a number of factors that can provoke the development of pathology:

1. Chronic pancreatitis. There is no more favorable soil for the development of a malignant tumor in the pancreas than the constant inflammatory process in the cells of the organ, characteristic of chronic pancreatitis. The risk of developing the disease is reduced to a minimum with adequate treatment of pancreatitis, adherence to diets and strict adherence to all doctor’s recommendations;
2. Hereditary pancreatitis. The disease develops as in the first case. In this case, the cause of pancreatitis is a hereditary factor;
3. Crohn's disease and ulcerative colitis. With a long chronic course of these diseases, the pancreas is constantly poisoned by toxins. At the same time, an inflammatory process occurs in it, which can lead to the development of a tumor;
4. Overweight. Extra pounds can cause a lot of harm to our body. They entail the development of a large number of diseases. When adipose tissue accumulates, this leads to disturbances in the normal level of sex hormones, which in turn affects the functioning of the pancreas and can cause the development of oncology;
5. Stomach ulcer. In this case it is violated normal microflora stomach, toxins accumulate in the organs gastrointestinal tract. All these processes can become a “push” for the formation of malignant cells in the pancreas;
6. Tobacco smoking. When a person gives up a bad habit, the risk of developing cancer is significantly reduced, and the pancreas gets rid of ischemia;
7. Wrong mode and diet. The risk of developing the disease increases when a person eats fatty foods, sausages, sausages, ham, etc. By adjusting their diet, everyone can reduce the risk of developing cancer;
8. Age factor. According to statistics, people over 60 years of age are most susceptible to pancreatic cancer;
9. Harmful production factors, in particular poisoning with various chemical dyes and toxic substances;
10. Genetic factor. It is known that the likelihood of developing pancreatic cancer increases in people who have relatives with this type of cancer;
11. Diseases developing in oral cavity, for example, stomatitis, caries, gingivitis, etc.;
12. Chronic allergic pathologies. Among them are eczema and atopic dermatitis;
13. Already diagnosed cancer of other organs;
14. Sedentary lifestyle.

Pancreatic cancer: classification

Pancreatic cancer exhibits symptoms depending on the location of the tumor and its characteristics.

Pancreatic cancer is classified as follows:

• acinar cancer – pathological cells in this case they look like a bunch of grapes;
• Ductal adenocarcinoma is the most common type of malignancy. The tumor develops in the cells of the pancreatic ducts;
• mucinous cystadenocarcinoma. In most cases, signs of pancreatic cancer occur in women with this type of tumor. In men, mucinous cystadenocarcinoma is much less common. Pathology is formed due to the degeneration of a cyst into a malignant neoplasm;
• squamous cell carcinoma - a tumor develops in the cells of the duct. This form of cancer is very rare;
• giant cell adenocarcinoma - represented by a large number cystic formations, the cavities of which are filled with blood;
• glandular squamous cell carcinoma - simultaneously originates from two types of cells - forming excretory ducts and producing enzymes;
• undifferentiated pancreatic cancer is the most dangerous form of cancer. The tumor is characterized by rapid growth and extremely quickly leads to death.

When cancer cells form from the endocrine component of the pancreas, the oncology classification is as follows:

• glucagonoma – a large amount of the hormone glucagon is produced, leading to an increase in blood glucose levels;
• Insulinoma – excessive production of insulin occurs in the body, leading to a decrease in blood glucose levels;
• gastrinoma - the hormone gastrin is produced in excess quantities, the task of which is to stimulate the activity of the stomach.

According to the classical scheme, pancreatic cancer is usually divided into:

• pancreatic head cancer;
• tail gland cancer;
• pancreatic body carcinoma.

Pancreatic head cancer: symptoms, stages

Symptoms of pancreatic cancer in the early stages do not appear when the tumor is localized in the head of the organ. As the tumor grows, it begins to make itself felt in the following way. Appears:

• pain due to pancreatic cancer in the abdomen. They can occur in the hypochondrium, “in the pit of the stomach,” or radiate to the back. As a rule, pain bothers the patient more at night. The pain subsides when the person leans forward a little or assumes a fetal position in a lying position;
• redness of the veins of the extremities. Sometimes blood clots can form;
• after eating there may be a feeling of heaviness in the pit of the stomach;
• weakness, drowsiness, apathy are noted;
• weight loss, especially with improper diet nutrition. The patient must constantly adhere to a special diet.

As the tumor develops, pancreatic cancer has the following signs and symptoms:

• itching in the skin. It is caused by stagnation of bile accumulated in the skin;
• jaundice. At first, the patient may not even be aware of it. Yellowness can only appear on the eye sclera. Then the skin acquires a yellowish tint. As the pathology progresses, the skin becomes greenish-brown in color;
• total loss appetite. Intolerance to fatty and meat foods is especially noted;
• urine becomes dark in color, feces, on the contrary, become discolored;
• observed constant violations at work digestive system. Frequent attacks of nausea and vomiting appear;
• the feces become greasy, that is, shiny. In this case, the stool is liquid with a sharp unpleasant odor.

The first signs of pancreatic cancer, symptoms when the tumor is localized in the body and tail of the organ

Signs of pancreatic cancer at an early stage include:

• in signs identical to those of diabetes mellitus: dry mouth, constant feeling thirst, large amounts of urine excreted, frequent urge to urinate at night;
• in pallor of the skin, redness of the tongue, loss of body weight. As glucagonoma progresses, the patient develops dermatitis and eczema;
• pain in the abdominal area, loose stools, a feeling of heaviness in the pit of the stomach even after consuming a small amount of food.

As the tumor grows, patients may experience:

• the appearance of trophic ulcers on lower limbs;
• the appearance of red spots on the skin, reminiscent of an allergic reaction;
• hot flashes to the face or hands;
• slow healing of wounds;
• reduction or complete absence sexual desire;
• violations menstrual cycle among women.

The first signs of pancreatic cancer of any localization appear painful sensations in the abdominal area, weight loss and gastrointestinal disorders.

Metastases in pancreatic cancer

Pathological (cancerous) pancreatic tumor cells can spread throughout the body in three ways: through the blood, lymph and peritoneum.

Through the circulatory system, tumor cells enter the lungs, liver, kidneys, brain, bone tissue, that is, almost all systems of the body.

Through the lymphatic route, cancer cells first affect the lymph nodes located around the gland. The cells then spread to the lymph nodes located behind the organ, then to the nodes located in the mesentery. At the last stage of the spread of cancer cells, they affect the lymph nodes localized in the retroperitoneal space.

Along the peritoneum, malignant tumor cells affect the peritoneum itself and spread to the intestinal walls and pelvic organs.

Pancreatic cancer: stages

There are several stages of pathology development, each of which has its own characteristics.

Stage 0

At this stage, the “wrong” cells are just beginning to grow deeper into the organ. Pathology at stage 0 can be detected using computed tomography or ultrasound examination. With timely diagnosis and treatment, the chances of a full recovery are 99%.

Stage 1

IA – the tumor does not extend beyond the pancreas and its diameter does not exceed 2 centimeters. In this case, with pancreatic cancer, the underlying symptoms do not appear. Symptoms are typical only if the neoplasm is located at the site where the duct exits into the duodenum. With this arrangement, the patient may experience attacks of nausea and diarrhea if the diet is not followed.

IB – the neoplasm is located within the pancreas and its size does not exceed 2 centimeters. If the tumor is localized in the tail or body of the organ, the patient will exhibit signs characteristic of gastrinoma, insulinoma and glucoganoma. When the tumor is localized on the head of the organ, the patient experiences pain due to pancreatic cancer, attacks of nausea, stomach upset and jaundice.

Stage 2

IIA - the neoplasm extends beyond the organ and affects the duodenum and bile ducts.

IIB – cancer cells at this stage spread to regional lymph nodes. In this case, the tumor can be very small. The symptoms in this case are mild and can manifest themselves in the form of decreased appetite, weight loss, diarrhea, and pain in the upper abdomen.

Stage 3

The tumor formation extends far beyond the pancreas. Cancer cells attack large blood vessels, intestines, stomach, spleen. In some cases, abnormal cells are found in regional lymph nodes.

Stage 4

Malignant tumor cells even affect distant organs: the brain, ovaries, etc.

Stage 4 pancreatic cancer has its own specific symptoms:

• pain intensifies and becomes encircling in the upper abdomen;
• the skin simultaneously becomes pale and yellowish;
• severe weight loss due to food refusal;
• an increase in the size of the liver, accompanied by a feeling of heaviness in the area where it is located;
• accumulation of fluid in the abdominal cavity;
• the appearance of soft formations in the form of nodules under the skin;
• enlargement of the spleen, accompanied by severe pain under the right hypochondrium.

With liver metastases at stage 4 of pancreatic cancer, the following symptoms are observed:

• the skin and whites of the eyes acquire a stable yellow tint;
• urine becomes dark, and feces, on the contrary, become discolored;
• the mucous membranes of the oral cavity begin to bleed;
• fluid begins to accumulate in the abdomen;
• a strong unpleasant odor constantly emanates from the mouth.

In cases where cancer cells are found in both the pancreas and liver, it is almost impossible to determine which type of cancer is primary. Carrying out histological analysis of tissue fragments from both organs will allow us to establish the root cause.

When a tumor metastasizes to the brain at stage 4, the patient experiences the following symptoms:

• speech becomes slurred;
• work skills are lost;
• behavior may be inappropriate;
• hearing, vision and smell impairments are observed;
• the face may acquire an asymmetrical appearance;
• the muscles of the limbs lose their normal tone. As a rule, this phenomenon is observed only on one side;
• the patient loses the ability to perform familiar and simple actions.

When a pancreatic tumor metastasizes to the lungs, the patient experiences shortness of breath even at rest, as well as a dry cough and spitting up blood (if a blood vessel ruptures).

When a malignant tumor metastasizes into bone tissue, the patient suffers from bone pain.

Pancreatic cancer treatment

The choice of treatment tactics primarily depends on the stage of development of the disease and the nature of the tumor itself. If oncology was diagnosed at stage 0 or 1, then, as a rule, therapy consists of surgical removal of the tumor and further irradiation of the organ with gamma rays.

If pancreatic cancer is detected at later stages, comprehensive treatment is carried out.

Oncologists at Yusupov Hospital long years practice treatment of this type of pathology and save the lives of thousands of patients. Treatment programs are selected for each client of the clinic individually.

Let's take a closer look at the features of each type of treatment:

• Surgery:
• Whipple surgery is performed in the early stages of cancer. This involves removing the tumor along with the head of the pancreas, as well as parts of the stomach, duodenum and gall bladder;
• complete removal of the organ. This treatment tactic is effective provided that the tumor does not extend beyond the pancreas;
• distal resection: involves removal of the tail and body of the organ along with the tumor, when the tumor is located in these parts of the organ. In this case, the head of the pancreas is left;
• segmental resection: surgery involves removing the cancerous tumor along with the central part of the pancreas. In this case, the head and tail of the organ are sutured using an intestinal loop;
• endoscopic stent: manipulation is carried out in cases where the tumor is inoperable and blocks the bile duct. A special tube is inserted into it, through which the bile is discharged either into the small intestine or into a plastic container brought out;
• Gastric bypass: performed when a tumor puts pressure on the stomach, preventing food from passing into the intestines. In this situation, the surgeon sutures the intestines and stomach, bypassing the tumor.

If the disease has reached its peak of development and the tumor cannot be treated, the patient is prescribed palliative treatment to improve his quality of life:

carry out partial removal tumors to reduce its pressure on nearby organs;
remove metastases;
eliminate obstruction of the intestines and bile ducts;
eliminate perforations of the pancreas, intestinal walls and stomach.

The surgical operation is performed using a classic medical scalpel, or a gamma knife is used. Using the latter, you can not only eliminate the tumor itself, but also destroy cancer cells at the site of its removal. It is important to maintain proper nutrition after pancreatic cancer surgery.

1. Chemotherapy for pancreatic cancer. It is carried out using special drugs, the action of which is aimed at inhibiting the division and growth of malignant tumor cells. Chemotherapy for stage 4 pancreatic cancer, as well as at earlier stages, as an independent method of treatment is ineffective. It is prescribed in combination with other types of treatment.

1. Radiation therapy. Similar treatment carry out:

before the surgical operation to stop the growth of the tumor and reduce its size;

immediately at the time of or after surgery to avoid the development of relapses;

in cases where the tumor is inoperable. In such situations, radiation therapy is used as palliative treatment to prolong the patient's life and improve its quality.

1. Targeted therapy. It is considered a new development in the fight against cancer. The method is based on taking special drugs that have a detrimental effect only on cancer cells, while normal tissues of the body are not affected. This treatment is noted high efficiency and considerable cost.

Pancreatic cancer: how long can you live, prognosis

Pancreatic cancer can be cured, but only if the disease is diagnosed in the early stages. To prevent the development of a sad scenario, you should be attentive and responsible towards your health and regularly undergo preventive examinations with a doctor.

The prognosis depends on the nature of the tumor and how quickly pancreatic cancer develops.

The most important thing is not to waste time and see a doctor on time. Unfortunately, in practice, patients come to the clinic when the disease has already progressed. Such a late request for medical help is caused by vague and weak symptoms of pancreatic cancer in the early stages of its development.

Specialists at the Yusupov Hospital use the latest technologies for diagnosing and treating pancreatic cancer. Oncologists practice using the latest and effective drugs and methods.

Prevention of pancreatic cancer

Pancreatic cancer is a fairly aggressive form of malignant tumor and is widespread. No geographical differences in the frequency of its occurrence have been noted, but it is known that residents of industrialized countries get sick somewhat more often.

Among all malignant tumors, pancreatic cancer accounts for no more than 3%, but In terms of mortality, this type of tumor occupies a confident fourth place, which makes it very dangerous. In addition, every year the number of cases in different countries continues to grow steadily.

It is believed that the disease is equally common in men and women, however, some sources indicate that there are slightly more men among patients. This may be due to the greater prevalence of bad habits (in particular, smoking) among males.

Like many other tumors, pancreatic cancer primarily affects the elderly population and occurs in patients over 60 years of age. By this age, natural mechanisms of antitumor defense decrease, various spontaneous mutations accumulate, and cell division processes are disrupted. It is also worth noting that most older people already have pathological changes in the gland (pancreatitis, cysts), which also contribute to the growth of cancer.

Very often, the presence of a tumor is not accompanied by any specific symptoms, and patients make complaints even in advanced cases of the disease. This is partly due to not always good treatment results and an unfavorable prognosis.

Pancreatic head cancer accounts for more than half of the cases of all tumors of this location. Up to a third of patients have total pancreatic damage. The manifestations of the tumor are determined by the part in which it is located, but symptoms appear earlier when the head of the pancreas is affected.

Causes of cancer

The causes of pancreatic cancer are varied, and contributing factors are quite common in the population.

The main risk factors for pancreatic tumors are:

• Smoking;
• Nutritional features;
• The presence of diseases of the gland itself - pancreatitis, cysts, diabetes;
• Diseases of the biliary tract;
• Hereditary factors and acquired gene mutations.

Smoking causes the development of many types of malignant tumors, including pancreatic cancer. Carcinogenic substances, entering the lungs with inhaled smoke, are carried through the blood throughout the body, realizing their negative effects in various organs. In the pancreas of smokers, hyperplasia of the ductal epithelium can be detected, which can become a source of malignant transformation in the future. Perhaps with the more frequent spread of this addiction among men there is also a slightly higher incidence of incidence among them.

Peculiarities nutrition to a large extent contribute to damage to the pancreatic parenchyma. Abuse of fatty and fried foods, alcohol provokes excessive secretion of digestive enzymes, dilation of the ducts, stagnation of secretions in them with inflammation and damage to the glandular tissue.

Chronic diseases pancreas, accompanied by inflammation, atrophy of the islets, proliferation of connective tissue with compression of the lobules (chronic pancreatitis, diabetes mellitus, cysts after acute inflammation or necrosis, etc.) are conditions that significantly increase the risk of cancer. Meanwhile, chronic pancreatitis is found in most elderly people, and can also be a substrate for type 2 diabetes mellitus, in which the risk of carcinoma doubles.

pancreatitis and others chronic diseases Gastrointestinal tract may be precancerous conditions

Diseases of the biliary tract, for example, the presence of stones in the gall bladder, cirrhosis of the liver prevents the normal emptying of the pancreatic ducts, which leads to stagnation of secretions, damage to epithelial cells, secondary inflammation and sclerosis, and this can become a background to the development of cancer.

The role of hereditary factors and genetic disorders continues to be researched. There are known familial cases of the disease, and more than 90% of patients have a mutation in the p53 and K-ras genes. Study genetic abnormalities for pancreatic cancer, the population has not yet been carried out, however, very soon such an opportunity may appear, which will facilitate early diagnosis of the disease, especially with an unfavorable family history.

Since carcinoma usually occurs in already changed tissue, processes such as adenoma (benign glandular tumor), chronic pancreatitis and pancreatic cysts can be considered precancerous.

As you can see, a big role in the genesis of cancer is played by external adverse influences, to which most of us do not attach importance, while such simple rules as balanced diet, a healthy lifestyle, and eliminating bad habits greatly help maintain a healthy pancreas even in old age.

Features of the classification of pancreatic tumors

The pancreas is very important not only for proper operation digestive system. As is known, it also carries out endocrine function, producing hormones, in particular insulin, glucagon, etc.

The bulk of the organ is formed by glandular tissue that produces digestive enzymes, and the endocrine function is performed by specialized cells grouped into the so-called islets of Langerhans.

Since the main part of the pancreas is represented by exocrine parenchyma, it most often becomes a source of cancerous tumors.

The classification of malignant neoplasms of the pancreas is based on their histological structure, localization, degree of damage to the organ, lymph nodes, etc. Based on all of these signs, the stage of the disease is established.

Depending on the histological structure There are different types of neoplasia:

1. Adenocarcinoma;
2. Cystadenocarcinoma;
3. Squamous cell carcinoma;
4. Acinar cell carcinoma.

These varieties are characteristic of the exocrine part of the gland, and the most common form is adenocarcinoma varying degrees of differentiation, occurring in more than 90% of cases.

A tumor of the endocrine region is diagnosed much less frequently, and its type is determined by the type of endocrine cells it originates from (insulinoma, glucagonoma, etc.). These neoplasms, as a rule, are not malignant, but due to hormonal activity and the ability to grow to significant sizes, they can lead to significant adverse consequences.

Traditionally, the TNM system is used to classify cancer. however, it is only used for tumors of the exocrine part of the gland. Based on data characterizing the tumor (T), lymph node involvement (N) and the presence or absence of metastases (M), stages of the disease:

• IA – characterizes a tumor up to 2 cm located within the gland, the lymph nodes are not affected, and there are no distant metastases;
• IB – the neoplasm exceeds 2 cm, but is still localized in the gland, without going beyond its boundaries; metastases to lymph nodes and distant organs are not typical;

• IIA – neoplasia extends beyond the pancreas, but is large arterial trunks(celiac, superior mesenteric artery) remain intact; metastasis at this stage is not detected;
• IIB – tumor up to 2 cm or more, can extend beyond the boundaries of the organ without growing into the vessels, but metastases are detected in nearby lymph nodes;

• III – the tumor invades the celiac trunk, the superior mesenteric artery, regional lymphogenous metastases are possible, but there are no distant ones;
• Stage IV is the most severe degree of tumor damage, accompanied by the detection of distant metastases, regardless of the size of the tumor itself, the presence or absence of changes in the lymph nodes.

Like any other malignant tumor, pancreatic cancer tends to spread throughout the body in the form of metastases. The main route is lymphogenous (with lymph flow), and the lymph nodes in the region of the head of the organ, celiac, mesenteric, and retroperitoneal are most often affected.

The hematogenous pathway is realized through the circulatory system, while metastases can be found in the lungs, bones and other organs and characterize an advanced process. Hepatic metastases are detected in approximately half of patients and can even be mistaken for liver cancer, although they are not.

Since the pancreas is covered on three sides by the peritoneum, when the tumor reaches its surface, cancer cells spread throughout the serous covering of the abdominal cavity - carcinomatosis, which underlies the implantation path of dissemination.

Manifestations of a pancreatic tumor

There are no specific symptoms of pancreatic cancer, and often the signs of a tumor are caused by damage to neighboring abdominal organs when they are invaded by a neoplasm.

Early symptoms such as changes in taste preferences, loss of appetite or weakness do not always force the patient to immediately consult a doctor, since they can be characteristic of many other diseases.

Often the tumor grows for quite a long time and does not cause any concern to the patient himself, but upon detailed questioning it still turns out that not all is well with the gastrointestinal tract. The fact is that most often cancer affects older people who have certain diseases of the digestive system, therefore symptoms of disorders in the functioning of the abdominal organs are not rare, they are common and can remain in the early stages without proper attention.

Jaundice is an alarming symptom characteristic of various gastrointestinal diseases

The manifestations of pancreatic cancer depend not only on the stage of the lesion, but also on the location of the tumor in the organ. Most often found:

1. Stomach ache;
2. Jaundice;
3. Nausea and vomiting;
4. Weakness, loss of appetite;
5. Weight loss.

A feature of lesions of the gland parenchyma is the tendency of patients to thrombosis various localizations, which is associated with the entry into the bloodstream of excess proteolytic enzymes, disrupting the coordinated functioning of the coagulation and anticoagulation systems.

All manifestations of cancer can be grouped into three phenomena:

• Obstruction – associated with the germination of the bile ducts, intestines, and pancreatic duct itself, which is fraught with jaundice, increased pressure in the biliary tract, and impaired passage of food masses through the duodenum;
• Ontoxication – associated with the progression of the tumor and its release various products metabolism, as well as disruption of digestion processes in the small intestine due to a lack of pancreatic enzymes (loss of appetite, weakness, fever, etc.);
• The phenomenon of compression is caused by compression of the nerve trunks by the tumor node, accompanied by pain.

Since the common bile duct and the pancreatic duct open together into the duodenum, gland head cancer, squeezing and growing into nearby tissues, accompanied by difficulty in the outflow of bile with signs of jaundice. In addition, it is possible to palpate an enlarged gallbladder (Courvoisier's sign), indicating damage to the head of the pancreas.

Pancreatic body cancer is characterized predominantly by a pain syndrome, when the pain is localized in the epigastrium, lumbar region, left hypochondrium and intensifies when the patient takes a supine position.

Pancreatic tail cancer It is diagnosed relatively rarely, and symptoms appear only in advanced stages. As a rule, this is severe pain, and when the tumor grows into the splenic vein, its thrombosis is possible, increasing pressure in the portal system, which is fraught with enlargement of the spleen and varicose veins of the esophagus.

The first pronounced symptoms of cancer are pain, and after a few weeks jaundice may develop.

Pain is the most frequent and most characteristic feature regardless of the location of neoplasia growth. Greater intensity accompanies a tumor of the body, and is also possible when the tumor grows into the nerve plexuses and blood vessels. Patients describe the pain in different ways: dull constant or acute and intense, localized in the epigastrium, right or left hypochondrium, radiating to the interscapular region, encircling. Often the pain intensifies with errors in diet (fried, spicy, fatty foods, alcohol), as well as at night and in the evening, then patients take a forced position - sitting, leaning forward slightly.

Pain in pancreatic cancer is similar to that in acute or exacerbation of chronic pancreatitis, osteochondrosis or herniated intervertebral discs, so cases of delayed diagnosis of cancer are possible.

tumor germination and metastasis into the duodenum

A very significant manifestation of pancreatic cancer is considered jaundice, diagnosed in 80% of patients with cancer of the head of the organ. The reasons for it are tumor invasion of the common bile duct or enlarged compression due to metastasis lymph nodes. Violation of the passage of bile into the duodenum leads to an enlargement of the gallbladder, absorption of the bile pigment bilirubin through its wall back into the blood, and the skin and mucous membranes acquire a yellow tint. The accumulation of bile acids in the skin causes intense itching and promotes scratching, and patients are prone to irritability, anxiety, and sleep disturbances.

No less important symptoms of pancreatic neoplasia are decline weight and dyspeptic disorders : vomiting, nausea, diarrhea, loss of appetite, etc. Disruption of digestive processes is associated with a lack of enzymes normally produced by the exocrine apparatus of the pancreas, as well as with difficulty in the outflow of bile. In addition, the character of the stool changes - steatorrhea, when the stool contains significant amount undigested fat.

Similar symptoms of dyspepsia can occur with stomach cancer, especially when the tumor spreads to the pancreas. The opposite situation is also possible: pancreatic cancer grows into the wall of the stomach, leading to disruption of the passage of contents, narrowing antrum etc. Such cases require careful diagnosis and clarification of the primary source of tumor growth, since this will determine both treatment tactics and prognosis in the future.

As a result of damage to the islets of Langerhans, symptoms of diabetes due to a lack of insulin may be added to the described signs of the tumor.

As tumors progress, they grow larger general symptoms intoxication, fever appears, digestive disorders worsen and weight decreases sharply. In such cases, a severe degree of damage to the pancreas is diagnosed.

Rare forms of neoplasms of the endocrine part of the gland are manifested by symptoms characteristic of disturbances in the level of a particular hormone. Thus, insulinomas are accompanied by hypoglycemia, anxiety, sweating, and fainting. Gastrinomas are characterized by the formation of ulcers in the stomach due to increased production of gastrin. Glucagonomas are manifested by diarrhea, thirst and increased diuresis.

How to detect a tumor?

Detecting pancreatic cancer is not an easy task. In the early stages, its detection is very difficult due to scanty symptoms and few and nonspecific complaints. Often, patients themselves put off visiting a doctor. Suffering for a long time chronic pancreatitis, inflammatory processes in the stomach or intestines, patients attribute symptoms of indigestion or pain to an existing pathology.

Diagnosis of the disease begins with a visit to a doctor who will examine, palpate the abdomen, and find out in detail the nature of the complaints and symptoms. After this, laboratory and instrumental examinations will be prescribed.

General and biochemical blood tests are mandatory if pancreatic cancer is suspected, and they can be detected changes such as:

• Anemia, leukocytosis, increased ESR;
• Decrease in quantity total protein and albumin, an increase in bilirubin, liver enzymes (AST, ALT), alkaline phosphatase, amylase, etc.

Occupies a special place definition tumor markers, in particular, CA-19-9, however, this indicator increases significantly only in the case of massive tumor lesions, while in the early phase of the tumor it may not change at all.

Among instrumental methods detection of pancreatic cancer has a high diagnostic value Ultrasound, CT with contrast, MRI, biopsy with morphological verification of the diagnosis.

Currently, endoscopic examination is preferred to conventional ultrasound examination, when the sensor is located in the lumen of the stomach or duodenum. Such a close distance to the pancreas makes it possible to suspect even a small tumor.

Among the radiological methods used CT, and retrograde pancreatocholangiography, which allows using a contrast agent to visualize the excretory duct of the gland, which in case of tumors will be narrowed or not passable in certain areas.

To identify lesions of the stomach or intestines, it is possible to introduce a radiopaque contrast agent followed by radiography, fibrogastroduodenoscopy.

In some cases, doctors come to the aid radionuclide study (scintigraphy), and surgical techniques up to laparoscopy.

Even when using the entire arsenal of modern research methods, the diagnosis of pancreatic adenocarcinoma is very complex, and scientists are constantly searching for simple and available ways, which can become screening.

Interestingly, a real breakthrough in this direction was made by 15-year-old student D. Andraka from the USA, whose close family friend suffered from pancreatic cancer. Andraka invented a simple paper-based cancer test, similar to one used to diagnose diabetes. Using special paper impregnated with antibodies to mesothelin secreted by tumor cells, the presence of a neoplasm can be assumed with a probability of more than 90%.

Treatment

Treatment of pancreatic cancer is very difficult task for oncologists. This is due to the fact that most patients, being of advanced age, suffer from various other diseases that make it difficult to perform surgery or use other methods. In addition, the tumor is usually detected in advanced stages, when its invasion of large vessels and other organs makes it impossible to completely remove the tumor.

Postoperative mortality is, according to various sources, up to 30-40%, which is associated with a high risk of complications. The operation, which is traumatic in its scope, the need to remove fragments of the intestine, bile duct and bladder, as well as the production of various enzymes by the affected gland, predisposes to poor regeneration, failure of the sutures, the possibility of bleeding, necrosis of the gland parenchyma, etc.

The main and most effective method remains surgical removal of the tumor. however, even in this case, under the most favorable circumstances, patients live for about a year. With a combination of surgery, chemotherapy and radiation therapy, life expectancy can increase to one and a half years.

The main types of surgical interventions are radical and palliative. Radical treatment involves removal of the affected part of the gland along with the tumor, a fragment of the duodenum and jejunum, the antrum of the stomach, the gallbladder and the distal portion of the common bile duct. Naturally, lymph nodes and tissue must also be removed. In the case of cancer of the body and tail of the gland, the scope of intervention also includes the spleen. It is clear that with such an operation it is difficult to count on wellness And full recovery, but still it prolongs life.

Option of surgery for pancreatic head cancer. The organs to be removed along with part of the gland and tumor are highlighted in grey.

IN in rare cases In case of total cancer, the entire pancreas is removed, however, the subsequent development of severe diabetes mellitus, which is difficult to correct with insulin, significantly worsens the prognosis. The five-year survival rate of operated patients with advanced forms of cancer does not exceed 10%.

Treatment methods such as chemotherapy and radiation are more often used in combination with surgery, and their isolation is carried out only in cases of contraindications to surgery.

When chemotherapy is administered with several drugs simultaneously, some regression of the tumor can be achieved, but relapse is still inevitable.

Radiation exposure is carried out both before surgery and during or after it, and patient survival is about a year. Noted high probability radiation reactions in elderly patients.

A diet for pancreatic cancer involves eating easily digestible foods that do not require the production of large amounts of enzymes. It is necessary to exclude from the diet fatty, fried, spicy foods, smoked meats, canned food, as well as any alcohol, strong tea and coffee. If diabetes develops, you will have to give up carbohydrates ( confectionery, baked goods, sweet fruits, etc.).

Many patients who have been diagnosed with pancreatic cancer are inclined to self-medicate with the help of folk remedies, however, with such severe forms of malignant tumors they are unlikely to be effective, so you should prefer traditional medicine, which, if not cure, will at least prolong life and will ease suffering.

Pancreatic cancer is an insidious tumor, for a long time hiding under the “mask” of pancreatitis or completely asymptomatic. It is impossible to prevent cancer, but it can be prevented with preventive measures Everyone can do it, and this requires proper nutrition, a healthy lifestyle and regular visits to the doctor if there are any signs of damage to the pancreas.

Video: pancreatic cancer in the program “Live Healthy!”

Video: pancreatic cancer in the program “About the Most Important Thing”

The author selectively answers adequate questions from readers within his competence and only within the OnkoLib.ru resource. Unfortunately, face-to-face consultations and assistance in organizing treatment are not provided at the moment.

Pancreatic cancer is a serious disease that belongs to a polymorphic group of malignant neoplasms, the formation of which occurs directly in the area of ​​the acini and ducts of the head of the pancreas. On initial stage this disease does not manifest itself in any way, but upon reaching certain stages of development, when the tumor metastasizes to neighboring organs, irreversible pathological processes occur in the body, accompanied by a pronounced clinical picture.

Cancer of the head of the pancreas in 30% of cases is diagnosed completely by accident during a preventive medical examination. In other cases, it is detected already at the 3rd or 4th stage of development, when patients turn to doctors due to the presence of pronounced symptoms of the disease. Unfortunately, doctors can no longer help such patients. The only thing that remains in their power is to reduce the severity of symptoms and prolong the patient’s life for some time. People aged 50–60 years are at risk. It is during these years of life that people are most often diagnosed with cancer. This is due to various reasons, including the aging processes occurring in the body. Moreover, in 70% of cases, cancer is detected in men. Scientists compare this to having bad habits.

A few words about pathology

This disease is one of the most aggressive and has poor prognosis. Despite the fact that until today a huge amount of research has been devoted to it in various fields (surgery, gastroenterology, oncology), unfortunately, in most cases, pancreatic cancer is diagnosed already at the stage when radical surgery becomes impossible.

Malignant tumors quickly progress and metastasize to neighboring organs and tissues, which causes their degeneration and dysfunction. And this leads to disruption of the functioning of the entire body. As long-term practice shows, people live with this diagnosis for no more than 5 years. The prognosis for cancer is favorable only if the disease was diagnosed in the early stages of development, when it is possible to resect the affected part of the pancreas. In this case, a person has every chance to get rid of the disease and live to a ripe old age.

Types of pancreatic head cancer

Cancer of the head of the pancreas is detected in 70% of patients with this disease. This disease has several classifications, including international ones. Among them is the TNM classification, in which each letter has its own meaning:

• T – tumor size;
• N – presence of metastases in lymph nodes;
• M – presence of metastases in distant organs.

However, this classification is rarely used today. Most often, cancer is classified according to the following indications:

• the type of tissue affected - in the overwhelming majority, malignant tumors are formed from the epithelium of the gland ducts, much less often from parenchymal tissues;
• according to tumor growth – diffuse, exophytic, nodular;
• according to histological characteristics - papillary cancer, mucous tumor, scirrhus;
• by type - anaplastic or squamous cell.

Metastasis of cancer can occur lymphogenously and hematogenously, as well as by contact. In the first two cases, the tumor metastasizes to distant organs - liver, kidneys, bones, etc.; in the latter - into nearby organs - stomach, duodenum, spleen, etc.

Reasons for development

Cancer was first diagnosed many centuries ago. Since then, scientists have been actively searching for the causes of its occurrence and developing a medicine that would help stop the growth of the tumor and prevent its metastasis. But, unfortunately, so far neither causes nor cures have been discovered.

It is generally accepted that cancer is a disease that is formed under the long-term influence of negative factors on the body, several at once. Most often it occurs in people who have smoked for several years and abuse alcoholic beverages, as well as in those who do not monitor their diet and constantly subject the pancreas to excessive stress.

Abuse of alcoholic beverages and consumption of “junk” food are the main factors provoking the development of oncology of the digestive system.

Scientists suggest that the development of pancreatic cancer can also be various diseases(in 90% of cases they are diagnosed in parallel with this disease):

• diseases of the biliary tract;
• cholecystitis;
• pancreatic cyst;
• pancreatitis (both in acute and chronic forms);
• stomach ulcer;
• gastritis.

Previous operations on the pancreas, during which partial resection of the organ was performed, as well as prolonged and inappropriate use of certain medications can also provoke the development of oncology. Scientists also suggest that cancer is formed under the influence of chemicals, so it is often detected in people whose work activities involve regular contact with harmful substances and their vapors.

An important factor in this matter is heredity. If someone in the family has previously been diagnosed with cancer of the head of the pancreas, the risk of its occurrence in descendants increases several times.

Symptoms

As mentioned above, in the initial stage of cancer there are no symptoms. The patient does not experience any sensation of pressure, pain, or digestive disorders. The first clinic appears only at the moment when the cancer is at the 3rd stage of its development. As a rule, during this period metastasis has already occurred and it cannot be helped in such a situation.

And speaking about what symptoms of pancreatic cancer appear first, it should be noted that the main sign of its development is pain, which can be either localized, that is, appear in one place (usually in the left hypochondrium), or encircling, radiating to the lower back, stomach, sternum, etc.

Pain in the left hypochondrium or upper abdomen is the first sign of impaired pancreatic function and the development of oncology

The occurrence of pain is caused by the fact that the tumor grows progressively and, increasing in size, begins to compress the nerve endings. As for the nature of the pain, it is mostly aching. However, when exposed to certain factors, such as eating fatty foods, alcohol, stress, etc., it becomes acute.

Since the pancreas is the main organ of digestion, when it is damaged, digestive disorders, which appear as:

• nausea;
• disgust for fatty foods and alcohol;
• diarrhea or constipation;
• changes in the nature of feces (they contain undigested pieces of food, an oily sheen appears, which is caused by disruption of the gland);
• heaviness in the stomach after eating.

The development of pancreatic head cancer is also accompanied by:

• sudden weight loss;
• deterioration of memory and concentration;
• constant weakness;
• decreased performance.

A sharp decrease in body weight is the second main feature pancreatic cancer with metastases to the liver or other internal organs. Already after 1–2 months, the patient develops cachexia (exhaustion), which is associated with impaired absorption process nutrients organisms as a result of deficiency of pancreatic enzymes.

In case of cancer of the head of the gland of 3–4 degrees, the above-described clinical picture is supplemented by the following signs:

• discoloration of feces and emitting a sharp putrid odor from it;
• darkening of urine;
• obstructive jaundice (characterized by yellowing of the skin and sclera of the eyes);
• an increase in the volume of the liver and pancreas (noted during palpation).

Symptoms of obstructive jaundice

In cases where cancer grows into other organs, there is a high risk of internal gastric or intestinal bleeding, impaired functionality of the heart muscle (possible myocardial infarction and stroke), and the development of iron deficiency anemia.

Diagnostics

At the patient’s initial appointment, the doctor examines him, studies the medical history and interviews the patient, focusing special attention on the symptoms that bother him. However, it is very difficult to make a correct diagnosis based on such data. After all, the clinical manifestations of cancer are quite similar to the symptoms characteristic of other pancreatic diseases.

To make a diagnosis, various laboratory and instrumental studies are prescribed. The first step is to take a clinical blood test. During development in the body pathological processes is revealed increased content leukocytosis and thrombocytosis in the blood. Biochemical tests are also done to determine the level direct bilirubin, AsT and AlT.

For any deviations from the norm, the doctor prescribes a more detailed examination, which includes:

• duodenal intubation with cytological examination of duodenal juice;
• caprogram (during its implementation, the level of urobilin and stercobilin in the feces is reduced to zero, and steatorrhea and creatorrhoea increases several times);
• ultrasonography (examines not only the pancreas, but also the gallbladder);
• MRI of the pancreas;
• MSCT of all abdominal organs;
• endoscopic retrograde cholangiopancreatography.

Only a complete and detailed examination can confirm or refute the diagnosis of pancreatic head cancer.

Carrying out these research methods allows us to identify not only the presence of a malignant tumor, but also the exact location of its localization, as well as assess the functioning of the gland, the patency of the pancreatic and bile ducts, and detect the presence of metastases in other organs.

Most often, endoscopic ultrasound is used to make a diagnosis, which determines the type of tumor, the degree of its growth, and the deformation of blood vessels and regional lymph nodes. In some cases, a biopsy or diagnostic laparoscopy is performed to make a diagnosis.

Treatment

Treatment for pancreatic head cancer is carried out in the following ways:

• surgical;
• chemotherapy;
• radiological;
• combined (several methods are used simultaneously).

The most effective treatment for cancer is surgery. It is used only in the early stages of the disease. It is carried out using the method of pancreatoduodenal resection. Less commonly used as therapy are operations that allow preserving the functions of the gastrointestinal tract - removal of the pancreas while preserving the pyloric zone, duodenum, biliary tract and spleen. When performing pancreaticoduodenal surgery, resection is carried out not only of the affected part of the pancreas, but also of the vessels surrounding it, as well as regional lymph nodes.

Surgery is the most effective treatment for pancreatic head cancer

In the case of grade 3-4 carcinoma, the above methods are not applied. In such situations, a palliative operation is used, with the help of which jaundice is eliminated, the process of moving food masses through the intestines is restored and relief painful sensations. In some cases, doctors are able to restore the functionality of the gland when performing this procedure. To achieve these results, bypass anastomoses or percutaneous transhepatic stenting are used during surgery.

After surgical treatment of pancreatic head cancer, radiation therapy is performed. It is prescribed for a period of 2–3 weeks. The following indications are available:

• ulcer of the gastrointestinal tract of any origin;
• leukopenia;
• tumor metastasis into blood vessels;
• cachexia;
• persistent obstructive jaundice.

Radiation therapy, effective in 40% of cases, has contraindications and is often accompanied by complications

Radiological treatment is used for:

• inoperable tumor after surgery to eliminate obstruction of the bile ducts;
• locally advanced form of cancer;
• recurrence of cancer.

Treatment of pancreatic cancer with chemotherapy cannot be used as a monotherapy. It is carried out only for the purpose of preparation for surgical treatment or after it to consolidate the results.

Prognosis and prevention

Pancreatic head cancer is a dangerous disease that has a poor prognosis. And it is impossible to say exactly how long you can live with this disease, since each case is individual.

According to scientific research, for stage 2 pancreatic head cancer, 5-year survival after surgical treatment is 50%; with stage 3–4 cancer, patients live no more than 6 months. This is due to the fact that at such stages of the development of the disease surgical interventions are carried out extremely rarely - only in 10%–15% of cases. In other situations, only palliative therapy is used, the action of which is aimed at eliminating the symptoms of the disease. And generally speaking, the results of any treatment methods for stage 2, 3 and 4 cancer are unsatisfactory.

Positive dynamics are achieved only if cancer is detected at the initial stages of its development. But, unfortunately, as statistics show, treatment of the disease at stage 1 is extremely rare (only in 2% of patients), since it is detected extremely rarely.

As for preventive measures, they include:

• timely treatment of gastrointestinal pathologies;
• balanced and rational nutrition;
• rejection of bad habits;
• moderate exercise.

Remember, cancer of the head of the pancreas progresses very quickly and affects all nearby organs and tissues. Therefore, to avoid fatal outcome, treatment of the disease must be done from the first days of its occurrence. And in order to detect cancer on time, it is necessary to carry out preventive medical examinations every 6–12 months.