Signs and methods of treatment of pancreatic cancer

Pancreatic cancer - a malignant disease that is difficult to diagnose in the first stages, usually develops from atypical cells of the parenchyma and ducts of the organ.

Despite the success of surgical surgery and chemotherapy, this type of oncology is one of the most difficult tasks for doctors.

This is due to the anatomical and physiological characteristics of the gland, its localization, the ability of cells to quickly transform and the difficulty of diagnosis.

A little about the pancreas and the ailment

The pancreas( pancreas) is a unique parenchymal organ that carries out both external and internal secretions.

It is located behind the stomach, as if wrapping it, at the level of L 1-2( 1-2 lumbar vertebrae).Part of the organ lies in the left hypochondrium. In women, the length of the pancreas is 13-18 cm, in men 20-25 cm.

Anatomically the head is distinguished - the widest part, the body and the tail. A lot of lobules of the organ are connected with the help of the finest connective tissue partitions, and above there is a dense elastic capsule with nerve endings, which irritate painful sensations.

Exogenous or external secretion is associated with the release of 0.7 to 1 liter of pancreatic juice containing enzymes( enzymes).

Getting into the digestive tract, they decompose all the basic nutrients - proteins, fats, simple and complex carbohydrates.

Endogenous or internal secretion is caused by the secretion of vital hormones - insulin, glucagon, gastrin, directly into the blood.

When the function of the islets of Langerhans, the cells of which produce insulin, develops diabetes mellitus.

Pancreatic cancer refers to polyethological diseases, that is, several predisposing factors take part in its occurrence:

• pancreatic diseases( chronic pancreatitis, cysts and benign tumors);
• age. Despite the fact that this kind of oncology occurs at a young age, after 70 years the incidence rate sharply increases;
• genetic predisposition. The risk increases if the next of kin are ill with malignant tumors or if there are congenital lesions of the p53 and K-ras genes;
• floor. Before the disease, both men and women are equally vulnerable, but the manifestation of cancer in the stronger sex, especially after 60 years, is twice as likely;
• smoking. In smokers, pancreatic cancer is 2 times more common;
• alcohol abuse. According to statistics, the number of men who are predisposed to this and the above factor is greater, therefore, perhaps the frequency of manifestation of the disease is affected not by gender( according to some researchers), but by exposure to negative habits;
• violation of diet. The abundance of fatty and spicy food, the predominance of protein foods( meat).A similar diet is manifested in 80% of patients with pancreatic cancer;
• diabetes, especially type 2( acquired);
• cirrhosis and liver tumors, diseases of the hepatobiliary system;
• professional nuances, for example, work with pesticides, herbicides, asbestos, heavy radiation and heavy metal salts;
• diseases of the digestive tract, which led to surgical intervention;
• is an oncogenic virus that damages the genetic apparatus of cells.

These causes lead to a mutation in the genes that regulate cell division. They begin atypically, that is, in an unusual way, to share, losing their function, which leads to the appearance of a tumor.

"Quiet killer"

The first signs of pancreatic cancer are often absent or masked under the symptoms of other diseases, greatly complicating timely diagnosis. Patients do not experience any painful or unpleasant sensations.

Prolonged absence of symptoms leads to the fact that the cancer is detected when the diameter of the tumor reaches already 3-4 cm, the structure of the organ changes, the affected tissue grows into nearby organs, local and distant metastases appear.

The retroperitoneal location of the gland also makes it difficult to diagnose, because the tumor becomes invisible for most instrumental diagnostic tools.

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The first symptoms of the tumor appear even with a significant organ damage:

• abdominal pains both in the epigastric region( "under the spoon") and in the left hypochondrium. Often "give" to the lumbar region and grow in the morning. Indirectly, these symptoms are a manifestation of the progression of the disease, i.e., similar sensations increase with the spread of the tumor over a large area and the continuation of intensive growth. Patients become easier if they accept the "embryo pose" or stand on all fours. This is due to a decrease in intra-abdominal pressure on the nerve endings of the basal membrane of the pancreas;
• weight loss. There are several reasons for this. First, pancreatic cancer squeezes the normal healthy tissue of the organ, which affects the secretory function, resulting in disruption of nutrient cleavage. Secondly, patients have a symptom such as anorexia - loss of appetite, leading to weight loss;
• the main symptoms of diabetes are polyuria( an increased amount of urine) and a constant thirst;
• thrombophlebitis of lower extremities. They appear without a special preceding cause, usually conducive to this disease, namely - the absence of varicose veins, injuries and other;
• general malaise and weakness.

Then the following signs of the disease are attached:

• mechanical jaundice. Pancreatic cancer squeezes the gallbladder and its ducts, resulting in the following symptoms: jaundice of the skin and sclera, acholic( colorless) stool and urine of dark color;
• an increase in the size of the abdomen associated with the occurrence of ascites - accumulation in the abdominal cavity of excess fluid.

The onset of signs of cancer affects not only the size of the tumor, but its localization. So, when the tail of the organ is affected, the pancreatic cancer proceeds almost imperceptibly for a person, and the symptoms themselves will be absent for a very long time.

The form of the disease, that is, the type of cells from which the tumor has grown, affects the symptoms of cancer.

So, if a patient has insulinoma( a tumor from the islets of Langerhans, associated with hyperproduction of insulin), then the main symptoms are palpitations, sweating, tinnitus, a constant feeling of hunger, weakness until unconsciousness and coma.

The clinical picture of the disease is associated with a deficiency of glucose, rapidly degraded by the excess amount of insulin secreted by the tumor.

The effectiveness of pancreatic cancer treatment is less than 20%, inoperable cases( 3-4 stages of cancer) with a newly diagnosed disease are significantly more than half.

The lifespan of such patients varies from six months to a year, and a five-year threshold with this disease is less than 1% of men and women.

Most often, cancer develops in the head of the pancreas( up to 75%), less often the localization of the tumor - tail and body.

Pancreatic Cancer Stages

Early diagnosis of pancreatic cancer is a priority task facing modern oncology.

It is necessary to diagnose this disease as soon as possible, because both the tumor treatment tactics and the overall prognosis depend on it.

But most often detected pancreatic cancer at an early stage is an accidental finding in the diagnosis of another disease.

Pancreatic cancer is divided into 4 stages. So, in the first stage the tumor is limited by the gland itself, there is no metastasis to either the lymph nodes or to other organs, the symptoms are absent.

Depending on the diameter of the tumor, IA and IB of the disease stage are distinguished. In the IA stage, it is less than 2 cm, with IB stage - more.

If the tumor is located next to the duct of the duodenum, such dyspeptic symptoms as nausea, vomiting, diarrhea, especially after nutritional errors, may occur.

In the second stage of cancer, the tumor can germinate into the tissue of the parenchymal organ, but does not affect the celiac trunk and artery, regional lymph nodes can be affected.

Germination of pancreatic cancer usually in the duodenum or bile duct.

The second stage of the tumor is also divided into A and B, the IIA stage of the disease does not affect the near-pancreatic lymph nodes, in the IIB stage of the cancer they are involved in the pathological process.

At stage 3, the cancer grows into large blood vessels and nerves - the celiac trunk and near-pancreatic lymph nodes, at stage 4 of the disease, tumor metastases arise in distant organs( cancer cells affect the peritoneum, pelvic organs and intestines).

In the last two stages of the disease, the patient feels very badly, the unbearable pains start to worry, symptoms of cancer intoxication appear - sudden weight loss, fever, weakness.

Modern diagnosis of pancreatic cancer allows it to be identified at the 0 stage of the disease, when there are no symptoms, a very small number of cells have been changed, the tumor is localized within the basal membrane.

With the timely initiation of therapy, the percentage of patients recovering from stage 0 cancer is 99%.

Oncomarkers - what is it?

One of the reliable means of early diagnosis is the analysis on oncomarkers - the kind of specific antigens produced by the tumor itself.

Each malignant formation( cancer) is capable of releasing only "its" substances and their derivatives.

Medicine knows about 300 of them, but the practical value is not more than 20. According to these antigens, you can accurately determine the type of tumor and its location.

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Which tumor markers are specific for pancreatic cancer?

1. cancer markers СА-242 - the most modern kind of antigen, produced by cells of the intestinal mucosa and gland ducts. In the blood, the cancer marker is found with pancreatic cancer, thick and small intestine. Sometimes the cause of the antigen is pancreatitis, peptic ulcer disease( more often up to the reference value), so the CA-242 tumor marker is never examined in isolation, but only in combination with other specific proteins. If there is a lack or insignificant value in the blood( up to 20 IU / ml), this indicates the absence of this type of tumor;
2. oncomarkers CA 19-9( cancer antigen of the digestive tract, in particular the pancreas).If the number of oncomarker is less than 500 IU / ml, this indicates a benign tumor leading to obstruction of the biliary tract or exacerbation of the inflammatory disease( cholangitis, pancreatitis, enterocolitis).The oncomarker is not used as a means of primary diagnosis, but is examined when it is necessary to find the tumor localization or to analyze the effectiveness of the treatment;
3. tumor markers CA-72-4( carcinoembryonic antigen).The reference value( maximum permissible norm) of this oncomarker is up to 5 IU / ml. With pancreatic cancer, the amount of antigen increases in 82% of cases. Sometimes there is an increase in the cancer marker for diseases such as benign tumor, pregnancy, exacerbation of pancreatitis. High levels of occurrence of one of the tumor antigens CA 72-4 or CA 19-9 indirectly indicate the presence of metastases in the lymph nodes;
4. oncoprotein AFP( alpha-fetoprotein).Normally synthesized by an embryo, in adults it signals more often about a liver tumor( hepatocellular carcinoma), but it also occurs in pancreatic cancer. This type of tumor markers is studied together with the above antigens.

The main reasons for the study of different types of oncomarkers:

• diagnosis of cancer at an early stage;
• need to check the symptoms of cancer, for example, abdominal pain, weight loss;
• differential diagnosis between benign and malignant tumors;
• diagnosis of cancer metastases in other organs before manifestation( manifestation);
• with the established diagnosis it is possible to judge the dynamics of tumor growth and the effectiveness of the therapy. The growth of cancer markers indicates the need to change tactics and treatment regimens;
• the choice of the type of treatment of the disease, for example, when the CA-125 blood cancer marker increases above 1000 IU / ml, there are suspicions of a 3-4 stage cancer, when the tumor is considered inoperable;
• after surgery and cancer chemotherapy can be judged on the tumor recurrence or absence. But with a positive result on oncomarkers it is important to confirm the diagnosis with a biopsy or some other method of instrumental diagnosis.

In the blood of a healthy person, the reasons for the presence of oncomarkers in a small amount are inflammatory processes and cysts.

It is also possible to obtain incorrect results with impaired hepato-biliary function( liver and bile ducts) of the system and kidneys.

How to prepare for the study?

If it is not right to prepare for this blood diagnosis, it can lead to a false-positive or false-negative result.

The physician should inform the doctor, since each type of oncomarker requires some preparation.

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However, there are several general rules:

• tests for oncomarkers are given on an empty stomach( "on an empty stomach"), ie, the last meal should be no later than 8 to 12 hours before a visit to the laboratory. The reasons for this in the proteins contained in food, which, entering the bloodstream, can lead to false positive results;
• the optimal time for blood testing - the morning hours( no later than 11).
• for half an hour before a blood sample you can not smoke( due to stimulation of gastric secretion), drink strong tea or coffee. With thirst, it is better to limit yourself to simple water;
• , three days before blood donation, you must stop using alcoholic beverages, fatty foods. Intensive physical activity causes the breakdown of proteins, which also affects the results of the blood test, so they are excluded;
• should stop taking medication, after consulting with a doctor;
• one week before the blood test should refrain from having sexual intercourse;
• does not take blood from women during menstruation.

Usually 5 ml of blood on oncomarkers is taken from the ulnar( cubital) vein in the patient's sitting or lying down position. Diagnosis is carried out by means of an enzyme immunoassay( ELISA), and the results can be obtained the next day.