This tumor is a master of disguise. It can disguise itself as other diseases and emit various "smoke bombs" that make it difficult for people to see its true self. It is often hidden deep in the human body, and may be too late by the time you notice. It is a highly malignant digestive tract tumor, pancreatic cancer, AKA the "king of cancers".
Pancreatic cancer features high incidence, high recurrence rate, and high mortality; low early diagnosis rate, low surgical resection rate, and low drug effectiveness. Recently, Hu Yong, director of the fourth medical department of Guangzhou Fuda Cancer Hospital, talked about issues related to pancreatic cancer.
Q 1
What is pancreatic cancer?
Pancreatic cancer refers to malignant tumors that originate from the pancreas and are mainly divided into two categories:
o One is the most common pancreatic adenocarcinoma that originates from the pancreatic duct, also known as pancreatic cancer, which accounts for about 90% of all pancreatic cancers;
o The other type is relatively rare, which is a tumor originating from the hormone-secreting cells of the pancreas, such as pancreatic endocrine tumors and insulinomas.
Most pancreatic cancer patients are in the middle or late stages when they seek medical treatment, and the surgical resection rate is less than 20%. The average survival time of pancreatic cancer patients without any treatment is only 3 to 6 months. Therefore, pancreatic cancer is called the "king of cancers."
Q 2
Why is pancreatic cancer difficult to detect early?
First, because the symptoms of pancreatic cancer are very atypical, they can be easily misdiagnosed as common gastritis and enteritis. For example, it may only cause back pain, loss of appetite, left upper abdominal pain, etc., which are no different from common gastritis and enteritis.
Second, the location of the pancreas makes it difficult to detect pancreatic lesions in time with general examinations. Even CT and magnetic resonance imaging can sometimes miss judge.
Q 3
What are the symptoms of pancreatic cancer?
The most common symptoms of pancreatic cancer are pain, jaundice, and weight loss. Depending on where the pancreatic tumor grows, its clinical symptoms vary.
60% to 70% of pancreatic tumors grow in the head of the pancreas. Tumors in this area often manifest as jaundice, yellow staining of the skin and sclera, gray-white stools, and skin itching. This is because the tumor enlarges and compresses the bile duct, preventing bile from flowing smoothly into the small intestine, causing the pressure in the bile duct to increase, and bile to reflux into the blood, causing jaundice, which is yellow staining of the skin and sclera. The patient's skin and urine will become darker, but the color of the stool will be lighter, which is often called obstructive jaundice.
20%~25% of pancreatic tumors occur in the pancreatic body and tail , and the main symptom is pain. This is because the tumor compresses the pancreatic duct of the pancreas, causing obstructive high pressure and pain, or the tumor may invade the peripheral nerve plexus and cause intractable pain. The typical characteristic of pain is night pain , that is, at night, the pain is more obvious and continuous pain. The pain can radiate to the chest and back. The pain can be relieved when the body is bent or sitting with knees bent . At present, the analgesic effect of nerve block surgery satisfies most patients.
In addition, some patients with pancreatic cancer will develop steatorrhea , and some patients will have abnormal fluctuations in blood sugar as the first symptom, so these patients will develop diabetes. The main reason is that patients with pancreatic cancer will cause endocrine disorders, that is, the Abnormal production of insulin and glucagon can cause the patient to lose a dynamic balance in regulating blood sugar, and abnormal blood sugar fluctuations will lead to the occurrence of diabetes.
Q 4
How is pancreatic cancer diagnosed?
In addition to the above clinical symptoms, blood tests for tumor markers and related biochemical indicators (such as CA19-9, CEA, etc.), color ultrasound (to observe the size, shape and structure of the pancreas, etc.), and CT (to understand the morphology of the pancreas and surrounding lymph node metastasis and distant metastasis), MRI (to understand the depth and scope of infiltration of pancreatic tumors, etc.), endoscopic ultrasound (to observe the morphology of pancreatic mucosa, and tissue biopsy can be performed to determine whether there is cancer) and other methods to help with diagnosis. However, the final diagnosis requires a biopsy and pathological examination to confirm the diagnosis.
It is worth noting that CA19-9 needs to be repeatedly reviewed for diagnosis before treatment and follow-up after treatment. By checking CA19-9 after treatment, the effect of treatment can be judged. For example, after surgery, the CA19-9 index drops from a very high level to normal, indicating that the surgery was relatively thorough and the tumor was basically completely eliminated. However, after chemotherapy for advanced tumors, the index increases instead, indicating that the plan is not working and needs to be changed. During the follow-up period, the CA19-9 index gradually increased from the normal state, indicating that the patient may have tumor recurrence or metastasis. Therefore, CA19-9 is of great value for overall observation of patient prognosis and formulation of treatment plans.
Q 5
How should patients with pancreatic cancer eat?
In terms of diet, try not to eat greasy foods and foods high in animal fat, such as fried, smoked, pickled, moldy foods etc.
In daily life, we should try to eat more light and digestible food, including cereals, beans, sweet potatoes and other foods as our daily staple food. Fruits and vegetables are indispensable, and we also need to eat lean meat and fish together to achieve a reasonable diet.
In addition, pancreatic cancer patients need to quit smoking and drinking. Studies have shown that smoking and drinking are both high-risk factors for pancreatic cancer. Drinking after having pancreatic cancer is like adding insult to injury. Drinking may cause gallstone pancreatitis and chronic pancreatitis to recur, which can further aggravate the occurrence of pancreatic cancer. Therefore, pancreatic cancer patients are advised to maintain good living and eating habits.
Q 6
How to prevent pancreatic cancer?
To prevent pancreatic cancer, we must start from the aspects of lifestyle, diet and habits.
First of all, do not eat high-fat, high-protein and high-sugar foods for a long time, because such a diet will increase the burden on the pancreas, leading to corresponding cell proliferation and degeneration and then cancer.
Secondly, you should quit smoking and drinking. Chronic pancreatitis and pancreatic cancer are closely related. Chronic pancreatitis can stimulate the proliferation of pancreatic tissue. The incidence of pancreatic cancer in patients with chronic pancreatitis is higher than that in the general population. In addition, for patients with gallbladder disease, if bile refluxes into the pancreas, it contains more carcinogens and is also related to the formation of pancreatic cancer.
Q 7
How is pancreatic cancer treated?
Pancreatic cancer surgery is a very large operation. It removes many organs, including the stomach, biliary tract, pancreatic head, and duodenum. Not only is it highly invasive, the success rate is not particularly high, but it also has many complications. However, with the advancement of surgical technology, its success rate has also improved in recent years.
In addition to conventional surgery, radiotherapy and chemotherapy, there are other treatments that are also suitable for the treatment of pancreatic cancer. At present, it is widely used, including radioactive seed implantation, cryotherapy and some gamma knives. The nanoknife treatment carried out by Guangzhou Fuda Cancer Hospital is an advanced minimally invasive treatment for pancreatic cancer.
This therapy, also known as irreversible electroporation, is a new type of non-physical ablation therapy based on the principle of irreversible electroporation. It can effectively protect adjacent important structures while selectively ablating tumor tissue. For inoperable advanced pancreatic cancer, Nanoknife is a good choice. At the same time, combined with other therapies such as chemotherapy, targeted therapy, and immunotherapy, it can effectively alleviate the patient's clinical symptoms and prolong the patient's survival.
In June 2015, China approved the use of Nanoknife ablation devices for liver and pancreatic tumor ablation. In July of the same year, Guangzhou Fuda Cancer Hospital was the first to complete domestic Nanoknife ablation. As of March 2024, Fuda has completed 1,007 Nanoknife surgeries and has rich clinical experience.
Q8
How to follow up pancreatic cancer?
It is recommended to follow up every 3 months within 2 to 3 years after surgery, and then every 6 to 12 months. If it is more than 5 years, it is recommended to follow up once a year. The follow-up content includes hematology (including blood routine, liver and kidney function electrolytes, tumor markers), imaging etc.