Tumors of the pancreas: Difference between revisions
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[[File:MBq cystic-carcinoma-pancreas.jpg|300px|thumb|Pancreatic head carcinoma after contrast application of CT]] | [[File:MBq cystic-carcinoma-pancreas.jpg|300px|thumb|Pancreatic head carcinoma after contrast application of CT]] | ||
* | * according to the location we recognize - carcinoma of the head, body and cauda pancreas | ||
* | * occurrence | ||
** | ** is increasingly common (currently about 2 times more than in the interwar period) | ||
** | ** make up over 10% of GIT malignancies, over 3% of all malignancies | ||
* | * causes - a number of predisposing factors are known - [[obesity]] , alcohol, [[smoking]] , DM , biliopancreatic reflux, [[chronic pancreatitis]] | ||
* | *localization - 65-70% is in the head, 15% in the body, 5% in the cauda area | ||
* | *histology - 90% are adenocarcinomas of the ductal epithelium, acinar cell carcinoma has a very poor prognosis | ||
=== | === stages of the tumor process === | ||
* | * stage I - T1 or 2, N0, M0 | ||
* | * stage II - T3 (infiltration into the stomach, blood vessels), N0, M0 | ||
* | * stage III - any T, N1, M0 | ||
* | * stage IV - any T, N, but M1 | ||
=== | |||
* | === Clinical picture === | ||
** | * initially presents as: | ||
** | **"discomfort" syndrome - anorexia, fullness, weight loss and indigestion | ||
* | **these symptoms should lead to the suspicion of pancreatic malignancy | ||
* | *pain - in the abdomen and banded in the back | ||
=== | *in head tumor - obstructive jaundice - typical painless onset | ||
=== Diagnosis === | |||
* rozhodující jsou zobrazovací metody | * rozhodující jsou zobrazovací metody | ||
* kontrastní rtg – typické rozšíření duodenálního okénka „C“ | * kontrastní rtg – typické rozšíření duodenálního okénka „C“ | ||
Revision as of 18:55, 7 April 2022
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- benign tumors occur very rarely
- malignant tumors – we distinguish ampular tumors and then pancreatic cancer
Regional pancreatic lymph nodes
- upper group - overhead and body
- lower group - under the head and body
- anterior group - pancreatoduodenal, pyloric and proximal mesenteric nodes
- posterior group - posterior pancreatoduodenal, pericholedochal, mesenteric
- lienal group - nodules in the hilus of the spleen
Ampullar (periampullar) tumors
- most often it is a well-differentiated adenocarcinoma with papillary exophytic manifestations
- used to be a rare rarity, today it is the fifth most common cause of cancer death
- affects people over 50 years of age
- prognostically favorable is that it soon manifests as obstructive jaundice - therefore it is indicated up to 4 times more *often for resection than pancreatic head cancer
- metastases occur later
Carcinoma
For more information see Pancreatic carcinoma.
- according to the location we recognize - carcinoma of the head, body and cauda pancreas
- occurrence
- is increasingly common (currently about 2 times more than in the interwar period)
- make up over 10% of GIT malignancies, over 3% of all malignancies
- causes - a number of predisposing factors are known - obesity , alcohol, smoking , DM , biliopancreatic reflux, chronic pancreatitis
- localization - 65-70% is in the head, 15% in the body, 5% in the cauda area
- histology - 90% are adenocarcinomas of the ductal epithelium, acinar cell carcinoma has a very poor prognosis
stages of the tumor process
- stage I - T1 or 2, N0, M0
- stage II - T3 (infiltration into the stomach, blood vessels), N0, M0
- stage III - any T, N1, M0
- stage IV - any T, N, but M1
Clinical picture
- initially presents as:
- "discomfort" syndrome - anorexia, fullness, weight loss and indigestion
- these symptoms should lead to the suspicion of pancreatic malignancy
- pain - in the abdomen and banded in the back
- in head tumor - obstructive jaundice - typical painless onset
Diagnosis
- rozhodující jsou zobrazovací metody
- kontrastní rtg – typické rozšíření duodenálního okénka „C“
- USG – identifikuje tumorovou masu, umožní FNAB
- ERCP– zobrazovací funkce a odběr pankreatické šťávy k cytologii
- CT
- arteriografie – důležitá pro stanovení operability tumoru (infiltrace porty nebo mezenterik – téměř to vylučuje radikální výkon)
- onkomarkery – CEA, CA 19-9, CA 50
- dif.dg. – benigní tumory, pankreatické pseudocysty, chronická pankreatitida
Terapie
- optimálně je chirurgická
- Whipplova operace – při postižení hlavy – kefalická parciální duodenopankreatektomie
- postižení kaudy – levostranná resekce pankreatu
- totální duodenopankreatektomie, spojení trubice gastrojejunoanastomózou
- paliace
- při útlaku žlučových cest – bilidigestivní anastomózy (viz výše)
- při hrozícím útlaku duodena – gastrojejunoanastomóza
- pooperační opatření – kontrola glykémie, příp. terapie iatrogenního DM – tento diabetes je velmi těžce ovlivnitelný pro absenci glukagonu! – velké tendence k hypoglykémiím!!!
- substituce pankreatických enzymů
- adjuvance – perkutánní konvenční RT, na CHT je ca málo senzitivní, používá se jen paliativně
Prognóza
- velmi nepříznivá, operační letalita je 5–15 %
- u včas diagnostikovatelného karcinomu je 5-leté přežití stále jen 3 %
