Tumors of the pancreas: Difference between revisions
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* '''benign tumors''' occur very rarely
* '''benign tumors''' occur very rarely
** [[lipoma]], cystadenomas, dermoid cysts, [[teratomas]] , apudomas
** [[lipoma]], cystadenomas, dermoid cysts, [[teratomas]] , apudomas
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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]]


* dle lokalizace rozeznáváme – karcinom hlavy, těla a kaudy pankreatu
* according to the location we recognize - carcinoma of the head, body and cauda pancreas
* výskyt
* occurrence
** je stále častější (v současnosti asi 2× více než v meziválečném období)
** is increasingly common (currently about 2 times more than in the interwar period)
** tvoří přes 10 % malignit GITu, přes 3 % všech malignit
** make up over 10% of GIT malignancies, over 3% of all malignancies
* příčiny – je známa řada predispozičních faktorů – [[obezita]], alkohol, [[kouření]], [[Diabetes mellitus|DM]], biliopankreatický reflux, [[chronická pankreatitida]]
* causes - a number of predisposing factors are known - [[obesity]] , alcohol, [[smoking]] , DM , biliopancreatic reflux, [[chronic pancreatitis]]
* lokalizace – 65–70 % je v hlavě, 15 % v těle, 5 % v oblasti kaudy
*localization - 65-70% is in the head, 15% in the body, 5% in the cauda area
* histologie – 90 % jde o adenokarcinom z duktálního epitelu, velmi špatnou prognózu má karcinom z acinárních buněk
*histology - 90% are adenocarcinomas of the ductal epithelium, acinar cell carcinoma has a very poor prognosis


=== Stádia nádorového procesu ===
=== stages of the tumor process ===
* stádium I – T1 nebo 2, N0, M0
* stage I - T1 or 2, N0, M0
* stádium II – T3 (infiltrace do žaludku, cév…), N0, M0
* stage II - T3 (infiltration into the stomach, blood vessels), N0, M0
* stádium III – jakékoli T, N1, M0
* stage III - any T, N1, M0
* stádium IV – jakékoli T, N, ale M1
* stage IV - any T, N, but M1
=== Klinický obraz ===
 
* zpočátku
=== Clinical picture ===
** syndrom „dyskomfortu“ – nechuť k jídlu, pocit plnosti, úbytek hmotnosti a trávicí obtíže
* initially presents as:
** tyto příznaky by měly vést k podezření na malignitu pankreatu
**"discomfort" syndrome - anorexia, fullness, weight loss and indigestion
* bolesti – v nadbřišku a pásovitě vystřelují do zad
**these symptoms should lead to the suspicion of pancreatic malignancy
* u tumoru hlavy – obstrukční [[ikterus]] – typický bezbolestný nástup
*pain - in the abdomen and banded in the back
=== Diagnóza ===
*in head tumor - obstructive jaundice - typical painless onset
* rozhodující jsou zobrazovací metody
=== Diagnosis ===
* kontrastní rtg – typické rozšíření duodenálního okénka „C“
Imaging methods are crucial in diagnosis:
* USG – identifikuje tumorovou masu, umožní [[FNAB]]
*contrast X-ray - typical enlargement of the duodenal window "C"
* [[Endoskopická retrográdní cholangiopankreatikografie|ERCP]]– zobrazovací funkce a odběr pankreatické šťávy k cytologii
*USG - identifies the tumor mass, enables [[FNAB]]
* [[CT]]
*[[ERCP]] - imaging functions and pancreatic juice collection for cytology
* arteriografie – důležitá pro stanovení operability tumoru (infiltrace porty nebo mezenterik – téměř to vylučuje radikální výkon)
*[[CT]]
* [[tumorové markery|onkomarkery]] – CEA, CA 19-9, CA 50
*arteriography - important for determining tumor operability (infiltration of ports or mesenterics - almost this precludes radical performance)
* dif.dg. – benigní tumory, pankreatické pseudocysty, [[chronická pankreatitida]]
*[[oncomarkers]] - CEA, CA 19-9, CA 50
=== Terapie ===
*differential diagnosis(dif.dg) - benign tumors, pancreatic pseudocysts, [[chronic pancreatitis]]
* optimálně je chirurgická
=== Therapy ===
* Whipplova operace – při postižení hlavy – kefalická parciální duodenopankreatektomie
Therapy is optimally surgical:
* postižení kaudy – levostranná resekce pankreatu
*Whipple surgery - in case of head injury - cephalic partial duodenopancreatectomy
* totální duodenopankreatektomie, spojení trubice gastrojejunoanastomózou
*cauda involvement - left resection of the pancreas
* paliace
*total duodenopancreatectomy, tube connection gastrojejunoanastomosis
** při útlaku žlučových cest – bilidigestivní anastomózy (viz výše)
* palliative:
** při hrozícím útlaku duodena – gastrojejunoanastomóza
**in bile duct oppression - biliary anastomoses (see above)
* pooperační opatření – kontrola [[glykémie]], příp. terapie iatrogenního [[diabetes mellitus|DM]] – '''tento diabetes je velmi těžce ovlivnitelný pro absenci glukagonu! – velké tendence k hypoglykémiím!!!'''
**at imminent duodenal oppression - gastrojejunoanastomosis
** substituce pankreatických [[enzym]]ů
*postoperative measures - glycemic control , or iatrogenic DM therapy - '''this diabetes is very difficult to control due to the absence of glucagon! - great tendency to hypoglycemia !!!'''
* adjuvance – perkutánní konvenční RT, na CHT je ca málo senzitivní, používá se jen paliativně
*pancreatic enzyme substitution
=== Prognóza ===
*adjuvant - percutaneous conventional RT, it is not very sensitive to CHT, it is used only palliatively
* velmi nepříznivá, operační letalita je 5–15 %
 
* u včas diagnostikovatelného karcinomu je 5-leté přežití stále jen 3 %  
=== Prognosis ===
* very unfavorable, operational lethality is 5-15%
* in early diagnosable cancer, 5-year survival is still only 3%




<noinclude>
<noinclude>


== Odkazy ==
== Links ==
=== Zdroj ===
=== Source ===
* {{Citace|typ = web|příjmení1 = Beneš|jméno1 = Jiří|název = Studijní materiály|rok =  
* {{Cite|type = web|surname1 = Beneš|name1 = Jiří|source_name = Studijní materiály|rok =  
|citováno = 6.5.2010
|cited = 6.5.2010
|url = http://jirben.wz.cz}}
|url = http://jirben.wz.cz}}
</noinclude>
</noinclude>


[[Kategorie:Chirurgie]]
[[Category:Surgery]]
[[Kategorie:Onkologie]]
[[Category:Oncology]]

Latest revision as of 20:44, 5 January 2024

  • benign tumors occur very rarely
    • lipoma, cystadenomas, dermoid cysts, teratomas , apudomas
    • cystadenomas tend to malignate, they are removed
  • malignant tumors – we distinguish ampular tumors and then pancreatic cancer

Regional pancreatic lymph nodes[edit | edit source]

  • 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[edit | edit source]

  • 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[edit | edit source]

Searchtool right.svg For more information see Pancreatic carcinoma.
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[edit | edit source]

  • 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[edit | edit source]

  • 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[edit | edit source]

Imaging methods are crucial in diagnosis:

  • contrast X-ray - typical enlargement of the duodenal window "C"
  • USG - identifies the tumor mass, enables FNAB
  • ERCP - imaging functions and pancreatic juice collection for cytology
  • CT
  • arteriography - important for determining tumor operability (infiltration of ports or mesenterics - almost this precludes radical performance)
  • oncomarkers - CEA, CA 19-9, CA 50
  • differential diagnosis(dif.dg) - benign tumors, pancreatic pseudocysts, chronic pancreatitis

Therapy[edit | edit source]

Therapy is optimally surgical:

  • Whipple surgery - in case of head injury - cephalic partial duodenopancreatectomy
  • cauda involvement - left resection of the pancreas
  • total duodenopancreatectomy, tube connection gastrojejunoanastomosis
  • palliative:
    • in bile duct oppression - biliary anastomoses (see above)
    • at imminent duodenal oppression - gastrojejunoanastomosis
  • postoperative measures - glycemic control , or iatrogenic DM therapy - this diabetes is very difficult to control due to the absence of glucagon! - great tendency to hypoglycemia !!!
  • pancreatic enzyme substitution
  • adjuvant - percutaneous conventional RT, it is not very sensitive to CHT, it is used only palliatively

Prognosis[edit | edit source]

  • very unfavorable, operational lethality is 5-15%
  • in early diagnosable cancer, 5-year survival is still only 3%



Links[edit | edit source]

Source[edit | edit source]

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