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Pancreatic neoplasms (imaging studies (ERCP (endoscopic retrograde…
Pancreatic neoplasms
imaging studies
Ultrasound
- the first study
- sensitivity approx. 70%
- patient and operator-dependent examination
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- Octreoscan - in the diagnosis of neuroendocrine tumors whose characteristic feature is the overexpression of somatostatin receptors.
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clinical picture
- asymptomatic
- accidentally detected in abdominal ultrasound
Pain in the abdomen, poorly localized, constant pain, often radiating to the spine.
Constant, severe pain may reflect the severity of the disease and irresectability
- In the case of tumors of the pancretic head will almost invariably develop: jaundice, itching
- body or tail: abdominal pain, anorexia and weight loss.
A characteristic feature is partial relief of pain by sitting forward.
- a significant weight loss (over 10%)
lack of appetite and reduced calorie intake
reduced secretion of pancreatic enzymes and, consequently, digestive disorders
gastric emptying delay: mechanical ileus
- impared coordination of motor activity of the stomach.
Therapy
- The only chance - radical surgery.
- more than 85% are unresectable at diagnosis.
- Currently attempt to take radical resection also in patients with superior mesenteric vein infiltration, and even the portal vein (T3).
- Even if all the studies assessing the severity of pancreatic cancer - including laparoscopy - indicate resekcyjność tumor during surgery turns out to be unresectable cancer in 10-20% of patients.
surgery
- In the past, the perioperative mortality rate after radical surgical treatment reached 10-20%, now in specialized centers is 2-5%.
- Cancers located in the head of the pancreas require pancreatoduodenectomy, the most common method of Whipple's done.
- The tumors in the body or tail may be treated by distal pancreatectomy.
risk factors
- Congenital CP (risk of about 50% at 70 years of age)
- Familial pancreatic cancer (about 10% of patients with PADC has a positive family history)
- Non-0 blood group (1.3x)
laboratory tests
- None of the laboratory test is not specific
- Amylase and / or lipase N, +/-
- Increased biochemical parameters of liver function, with a disproportionate increase in alkaline phosphatase.
- anemia / thrombocytopenia <= hypersplenism (accompanying the splenic vein thrombosis)
- Markers of the cancer:
CA19-9 and CEA> N - 75-85%
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Aetiology
- Smoking, alcohol, diabetes and chronic pancreatitis.
- 95% - ductal epithelium (adenocarcinoma)
- 5% - NET: Insulinoma, Glucagonoma, VIP-oma, Gastrinoma, Somatostatinoma