Pancreas tumor. Symptoms of a benign tumor. Methods for diagnosing the disease

A pathology such as a pancreatic tumor usually progresses every year.

Formations can be benign or malignant. In the first case, the patient has a better chance of overcoming the disease.

The main problem in diagnosing the disease is the lack characteristic symptoms in the early stages. It is difficult for doctors to formulate the reasons for the appearance of a tumor, so patients should pay attention to a number of factors that may contribute to the further development of the process.

The prognosis and life expectancy depend on the degree to which the disease is diagnosed, the nature of the pathology, the age of the patient and concomitant health problems.

What can lead to the development of the disease

Medicine has not yet been able to specify the causes of formations in the pancreas. But there are certain risk factors, the presence of which increases the likelihood of a tumor developing.

These include:

• Heredity. If there were relatives in the family who were diagnosed with pancreatic diseases, then their descendants also have high risk development of the disease.
• Age-related changes. Older people are more susceptible to the disease, especially after 60 years of age.
• Presence of bad habits, mainly smoking. 1/3 of all cancerous pathologies of the gland occur for this reason.
• Gender. It has been established that formations occur more often in males.
• Obesity. The presence of excess weight leads to a malfunction of metabolic processes and disruption of the functionality of various internal organs.
• Errors in nutrition. Excessive consumption of carbohydrates and fatty foods increases the load on the pancreas. One-time problems do not cause complications; the organ recovers on its own. But long-term negative effects lead to depletion of the pancreas and its failure.
• The presence of certain diseases of internal organs: chronic pancreatitis, diabetes, ulcers.
• Chemical poisoning.
• Decreased immunity.

Type of tumors

Considering the localization of the formation, the pathology can be diagnosed as:

• Tumor of the head of the pancreas.
• Formation on the body of an organ.
• A lesion affecting only the tail of the gland.

All formations can be benign or malignant. Prognosis, symptoms and treatment depend on which category the tumor belongs to.

The first form of formations consists of cells similar to the affected organ. They can be either epithelial or not, while the progression of the pathology occurs slowly and there are no metastases.

If the disease is malignant, then glandular, epithelial or ductal tissues take part in the formation. The development of the disease is rapid; within several years the body is significantly affected by metastases.

Benign formations

A benign tumor in its structure can be represented by:

• Insuloma, consisting of glandular tissue.
• Fibroma, in which connective cells are involved in the process.
• Lipoma expelled from the fat layer.
• Leiomyoma formed by muscle structures.
• Hemangioma, damage to blood vessels.
• Neuromoma when nerve fibers are involved.
• Schwannoma, formed from the tissues of the nerve sheath.
• Like a pseudopapillary tumor, the contents of the capsule have a liquid consistency.

Malignant tumors

Such formations according to histological factor can be divided into:

• Adenocarcinoma. Most common cancer, this type accounts for 4/5 of all pathological processes.
• Cystadenocarcinoma.
• Acinar cell carcinoma.
• Mucinous adenocarcinoma and cystadenocarcinoma.
• Squamous form.
• Undifferentiated species.

Rarely, a neuroendocrine tumor may develop when the tumor consists of nerve cells producing hormonal substances. This type of pathology includes:

• Glucagonoma.
• Insulin.
• Gastrinoma.

Tumor stages

At an early stage, it is difficult to recognize the presence of a tumor, since a minor mutation of individual cells does not cause obvious symptoms of the disease.

As the process progresses, the classification of the disease can take place in 4 phases:

• Stage 1. This stage has two development options. In the first case, the formation is localized in the middle of the gland, its size is no more than 2 cm. Symptoms may be absent. If the tumor is located close to the beginning of the duodenum, the patient experiences diarrhea and nausea. In the second case, the formation begins to grow, signs of jaundice, nausea, vomiting, and pain appear.
• Stage 2 has two phases. The first is characterized by the spread of the tumor to neighboring tissues, and the second by the fact that metastases affect nearby The lymph nodes. This stage is remembered by severe pain in the abdominal area, vomiting, diarrhea and often anorexia.
• Stage 3 is characterized by damage to the main vessels.
• Stage 4 is characterized by metastases affecting internal organs that spread throughout the body. The symptoms have the most vivid picture. Moreover, not only the characteristic signs, but also the symptoms of the disease of the organs involved in the process differ.

Symptoms of benign tumors

Signs of a tumor may not appear immediately, but only when the formation reaches a significant size, for example, 5 cm. Early symptoms include:

• Pain in the epigastric zone and hypochondrium, sensations can radiate to the back.
• Discomfort in the abdominal area.
• Hunger pain or after eating.
• Nausea.
• Decreased appetite.
• Increased fatigue.

To more late manifestations diseases include:

• Mechanical jaundice.
• Change in the color of urine, it darkens significantly.
• Vomit.
• Change in stool color to a lighter color.
• Chills.
• Abnormal bowel movements, most often diarrhea.
• Excessive sweating.
• Painful sensations in the liver area.
• Failure of the menstrual cycle.

Signs of malignant tumors

If the size of the formation is small (up to 4 cm), there may be no symptoms, with the exception of general health sick. As cancer cells grow, the manifestation of the disease becomes more pronounced.

When the tumor is located in the area of ​​the head of the organ, the patient may encounter the following problems:

• Presence of itching of the skin.
• Pain in the right hypochondrium, which can radiate to the back.
• Fat stool.
• Mechanical jaundice.
• Increase in the number of enzymes.

When the tail or body of an organ is affected, changes in condition include:

• Development of ascites.
• Pain under the ribs on the left.
• Enlarged spleen.
• Fall in body mass index.

Common signs of cancer pathologies include:

• Abnormal stool.
• Discoloration of stool.
• Vomiting.
• Bloating, flatulence.
• Weakness.
• Darkening of urine.

Diagnostics

Determining the presence of a tumor during examination is quite difficult, since symptoms of the disease appear only in the later stages. If there is a suspicion of cancer, then laboratory and instrumental examinations are prescribed.

The first include:

• General blood analysis. If there are problems, change ESR indicators, platelets and hemoglobin.
• Biochemical screening. The doctor is interested in bilirubin and the amount of liver enzymes, which increase if the pancreas cannot cope with its functions.
• Determination of tumor markers. The values ​​CA-19-9, CA-125, CF-15, CA-494 will be positive. Each of these indicators has its own period of manifestation; the problem remains that in the early stages these data may be missing.

Instrumental methods consist of:

• Ultrasound abdominal cavity.
• CT, MRI. Radiation diagnostics helps the doctor to see even minor formations up to 1 cm and the presence of metastases.
• PET scan. With its help, any formation is identified by assessing the functionality of organs. This examination very informative, in addition to the main problem, it can determine the degree of involvement of other organs in the pathological process.
• Retrograde cholangiopancreatography is an invasive procedure, so its implementation is carried out according to special recommendations. In the presence of minor formations, the method may not be informative, since only tumors larger than 2 cm can be seen during the manipulation process.
• Histological examination, the material for which is taken during laparoscopy. It can be performed if necessary during the operation.

Treatment

Tumor therapy consists of carrying out appropriate manipulations that alleviate the patient’s suffering and eliminate pain. Depending on the nature and extent of the disease, the following treatment may be recommended:

• Surgical intervention.
• Targeted therapy.
• Irradiation.
• Chemotherapy.
• Diet.

Surgical intervention

The main method of eliminating a tumor is surgery. The choice of method for each patient is determined individually. This depends on the size of the formation, location, degree of damage, involvement of nearby organs, and the nature of the tumor.

The following types of manipulations are used:

• Operation Whipple. Indicated in the early stages of the disease. During the manipulation, the head of the organ with the tumor is removed, the area of ​​the duodenum, stomach, gall bladder, and some lymph node tissues are partially excised.
• Complete resection. Indicated when the body of the gland is damaged and extends beyond the organ.
• Distal resection. Suitable for cases where the body and tail are involved. When they are completely excised, the head remains intact.
• Segmental resection. The center of the organ is removed, the remaining parts are stitched together, secured with an intestinal loop.
• Palliative surgery. This type of manipulation is resorted to when the formation is inoperable. In this case, intestinal or biliary obstruction, metastases, part of the tumor that affects neighboring organs.
• Endoscopic stent. Used for inoperable tumor, if it blocks the movement of bile. A tube is inserted into the bile duct to drain the contents of the duct.
• Gastric bypass. Indicated for patients who have an obstacle to the passage of food into the intestines.

Tumor removal can be performed with a gamma knife. Such a device allows during the operation not only to remove the formation, but also to irradiate the adjacent tissues involved in the process.

Targeted therapy

This method is considered an innovative treatment method. The drugs are aimed at eliminating the affected cells.

The main advantage is the lack of influence on healthy structures of the body. The big disadvantage is the high cost.

Irradiation

This method is used before and after surgery, as well as in cases where the tumor cannot be removed due to a number of contraindications. Helps reduce pain, reduce the likelihood of relapse and support the functioning of other organs. Manipulation can be carried out:

• In the form of remote gamma therapy.
• Bremsstrahlung radiation.
• Fast electrons.

Chemotherapy

This method involves taking certain drugs, blocking further development of the process. Chemotherapy has a number of disadvantages, the main one of which is the impact not only on patients, but also on healthy cells, which provokes a decrease in immunity and many side effects.

To improve tolerability and greater effectiveness, the patient must follow an appropriate regimen, monitor nutrition, and give up bad habits.

Diet

The nutrition of a patient who has been diagnosed with a tumor should be complete both before and after surgery. The main direction in changing the diet is to eliminate junk food: fatty, fried, salty, sweet foods, carbonated drinks, confectionery, baked goods.

The patient's menu should be expanded with products with high content carbohydrates. You need to eat often, but the serving size should be small.

Forecast

When wondering how long patients with a pancreatic tumor live, it should be noted that the prognosis in the presence of a malignant tumor is disappointing. Almost all such patients last a maximum of 4-6 months. Sometimes life expectancy can reach 5-10 years.

This is explained by late diagnosis due to lack of symptomatic signs on early stage. The age of the patient is very important; most patients are elderly. If a malignant formation is detected in the initial phase by chance during an ultrasound scan, then the chances of full recovery increase significantly.

Although pancreatic cancer is more often diagnosed in older people, you should be careful about your health. Treatment of an organ tumor is lengthy and does not always end successfully, due to the absence of signs of the disease at an early stage.

To avoid the development of pathology, you should active image life, monitor nutrition, weight and exercise.

Update: November 2018

Pancreatic cancer is an oncological disease that usually develops either against the background of decreased immunity, or in cases where a person suffers chronic diseases this body ( , ). The disease does not show any symptoms for a long time, and its late manifestations can masquerade as the underlying disease or be “vague,” which makes diagnosis much more difficult. Pancreatic cancer tends to progress rapidly, growing in area, giving rise to metastases to the lymph nodes, liver, bones and lungs. All this determines the name of the disease - “silent killer”.

Oncologists recommend to everyone healthy person Once a year, go through the retroperitoneum. And if you find 2 or more of the risk factors listed below, it is recommended to add an abdominal MRI and a blood test for the CA-19-9 marker to your annual examination.

About the pancreas

This is a glandular organ 16-22 cm long. It has the shape of a pear lying on its side, but inside it consists of lobules, the cells of which produce a large number of digestive enzymes. Each lobule has its own small excretory duct, which connects into one large - Wirsung - duct, which opens into the duodenum. Inside the lobules there are islands of cells (islets of Langerhans) that do not communicate with the excretory ducts. They release their secretion - the hormones insulin, glucagon and somatostatin - directly into the blood.

The gland is located at the level of the first lumbar vertebrae. The peritoneum covers it in front, and it turns out that the organ is not located in the abdominal cavity itself, but in the retroperitoneal space, next to the kidneys and adrenal glands. The organ is partially covered in front by the stomach and a fatty “apron” called the “lesser omentum”, its end abuts the spleen. This makes the gland not as accessible for research as, for example, the liver. However, in experienced hands, ultrasound is a good method of screening diagnosis (that is, primary, initial, if suspected, requiring clarification using other methods).

The pancreas weighs about 100 grams. Conventionally, it is divided into head, neck, body and tail. The latter contains the most islets of Langerhans, which are the endocrine part of the organ.

The pancreas is covered by a capsule of connective tissue. The same “material” separates the lobules from each other. Violation of the integrity of this tissue is dangerous. If the enzymes produced by exocrine cells do not enter the duct, but into an unprotected place, they are able to digest any own cells: they break down complex proteins, fats, and carbohydrates to their elementary components.

Statistics

According to the USA, being relatively rare (developing in 2-3 cases out of a hundred malignant tumors), pancreatic cancer ranks fourth among the causes of death from cancer. This disease more often than all other oncopathologies leads to fatal outcome. This is explained by the fact that in the early stages the disease does not manifest itself at all, but later the symptoms can make you think about it completely. various diseases. Men get sick 1.5 times more often. The risk of getting the disease increases after age 30, increases after age 50, and peaks after age 70 (60% or more cases in people over 70).

Most often, cancer develops in the head of the pancreas (3/4 of cases), the body and tail of the organ are least likely to be affected. About 95% of cancers arise from mutations in exocrine cells. Then adenocarcinoma occurs. The latter often has a scirrhous structure, when the tumor contains more connective tissue than epithelial “filling”.

Pancreatic cancer likes to metastasize to regional lymph nodes, liver, bones and lungs. The tumor can also grow, compromising the integrity of the walls of the duodenum, stomach, and large intestine.

Why does the disease develop?

When the cells of each organ divide, cells with an incorrect DNA structure periodically appear, which ensures their structure is disrupted. But the immune system comes into play and “sees” that the cell is abnormal by the antigen proteins that appear on the surface of its membrane. T-lymphocyte cells, performing their daily work, must “check” the antigens of all cells that are not fenced off by a special barrier with the data about the norm that they have in their memory. When the test data is not as expected, the cell is destroyed. If this mechanism is disrupted, mutated cells also begin to divide and, accumulating, give rise to cancerous tumor. Before reaching a certain critical number, they turn on a mechanism that hides them from the immune system. Then, when this volume is reached, the defense forces recognize the tumor, but they are not able to cope with it on their own. Their struggle causes the appearance of early symptoms.

No specific cause of pancreatic cancer has been found. Only risk factors are described that, especially when they “meet” together, can cause this disease. They are as follows:

• Chronic pancreatitis. Gland cells in a state of constant inflammation are a good substrate for the development of mutations in them. The risk of developing cancer is reduced by maintaining the disease in remission, which is possible by following a diet.
• Hereditary pancreatitis is an inflammation of the pancreas that occurs as a result of being “dictated” by a defective gene.
• Diabetes. Insulin deficiency (especially relative, in type 2 disease) and a constantly elevated blood glucose level as a result increases the risk of pancreatic cancer.
• Smoking. This risk factor is reversible: if a person quits smoking, freeing his blood vessels from tar and nicotine, and his pancreas from ischemia, the risk of this disease is reduced.
• Obesity also increases your risk of cancer. This occurs due to a change in the balance of sex hormones, provoked by an increased accumulation of adipocyte (fat) tissue.
• . The risk of developing pancreatic cancer increases with this pathology.
• Availability . This disease changes the microflora of the gastrointestinal tract, resulting in digestive system toxic compounds arise. During the operated peptic ulcer the risk of pancreatic cancer increases even more.
• Nutrition. There are studies, but they have not yet been proven, that increase the risk of developing pancreatic cancer:
  1. "processed meat": ham, sausage, bacon, smoked ham: the risk increases by 20% with every 50 grams of such meat;
  2. an excess of simple carbohydrates, especially those contained in soft carbonated drinks, which, moreover, contain soda;
  3. Grilled meat, especially red meat, contains heterocyclic amines, which increase the risk of cancer by 60%;
  4. a large number of saturated fatty acids in food.
• Non-specific ulcerative colitis And . Having existed for many years, these pathologies “poison” the pancreas with chemicals produced during inflammation.
• Low physical activity.
• Chronic allergic diseases:, and others.
• Oral diseases. There is an inexplicable but proven fact here that caries, pulpitis, and periodontitis increase the risk of pancreatic cancer.
• Ingestion of various dyes and chemical substances, used in metallurgy.
• Existing cancer of another location, especially: cancer of the pharynx, cervix, stomach, intestines, lungs, breast, ovaries, kidneys, bladder.
• Age over 60 years.
• Belonging to the African race.
• Mutations in the structure of one’s own DNA, for example, in BRCA2, a gene responsible for suppressing tumor growth. Such mutations can be inherited. Excessive activity The protein kinase P1 (PKD1) gene may also stimulate the development of pancreatic cancer. Research is currently underway into targeting the latter gene as a way to treat the disease.
• Presence of cancer in close relatives. People whose first-degree relatives were diagnosed with pancreatic cancer before age 60 are especially at risk. And if there are 2 or more such cases, the chances of developing morbidity increase exponentially.
• To belong to male. This risk factor, like the four penultimate ones, is one of those that a person cannot influence. But by following preventive measures (about them at the end of the article), you can significantly reduce your chances.

Precancerous diseases of the pancreas are:

• chronic pancreatitis;

Classification of the disease by structure

Depending on from which cells the malignant tumor developed (this determines its properties), it can have several types:

• Ductal adenocarcinoma is a cancer that develops from the cells lining the excretory ducts of the gland. The most common type of tumor.
• Glandular squamous cell carcinoma is formed from two types of cells - those that produce enzymes and those that form excretory ducts.
• Giant cell adenocarcinoma is a collection of cystic, blood-filled cavities.
• Squamous cell carcinoma. Consists of duct cells; is extremely rare.
• Mucinous adenocarcinoma occurs in 1-3% of pancreatic cancers. It is less aggressive than the previous form.
• Mucinous cystadenocarcinoma develops as a result of degeneration of a gland cyst. This form of cancer most often affects women.
• Acinar cancer. Tumor cells here are arranged in clusters, which gives rise to the name of the tumor.
• Undifferentiated cancer. Its most malignant type.

If cancer develops from the endocrine part of the gland, it may be called:

• glucagonoma - if it produces glucagon, a hormone that increases blood sugar levels;
• insulinoma, which synthesizes excess insulin, which reduces blood glucose levels;
• gastrinoma - a tumor that produces gastrin - a hormone that stimulates the stomach.

Classification of the disease by its location

Depending on the location, there are:

1. pancreatic head cancer. This is the most common species malignant tumor;
2. gland body carcinoma;
3. pancreatic tail cancer.

If you combine the 2 above classifications, then scientists give the following statistics:

• in 61% of cases, ductal carcinoma is localized in the head, in 21% in the tail, in 18% in the body;
• the head of the gland provides “shelter” for more than half of giant cell adenocarcinomas;
• in more than 60% of cases, glandular squamous cell carcinoma is located in the head of the organ, less often its foci are multiple or located only in the tail;
• localized in the head and more than 78% of mucinous adenocarcinomas;
• the localization structure of acinar cell carcinoma is as follows: 56% is located in the head, 36% in the body, 8% in the tail;
• But mucinous cystadenocarcinomas are located in the head in only 1/5 of cases, more than 60% affect the body, and in 20% of cases they are localized in the tail.

Thus, we can conclude that the head of the pancreas is the place where a malignant tumor is most often found.

Symptoms of the disease

Developed cancer of the head of the pancreas initially has no external manifestations. Then the first symptoms of the disease appear. They are as follows:

1. Abdominal pain:
   • in the area “under the stomach”;
   • and at the same time in the hypochondrium;
   • gives to the back;
   • pain intensity increases at night;
   • it hurts more if you lean forward;
   • It becomes easier if you press your legs to your stomach.
2. Periodic redness and soreness of one or the other vein. Blood clots can form in them, causing part of the limb to become bluish.
3. Losing body weight without dieting.
4. Early stages of cancer are also characterized general weakness, loss of ability to work, heaviness in the stomach after eating.

Further signs of cancer associated with tumor enlargement are:

• . It begins gradually, a person does not notice it for a long time, maybe, perhaps, pay attention to the yellowing of the eyes. Over time, when squeezing the formation into which the excretory duct of both the pancreas and the main bile duct, coming from the liver, jaundice increases sharply. The skin becomes not just yellow, but acquires a greenish-brown tint.
• Severe itching of the skin of the whole body. It is caused by stagnation of bile inside its ducts, when at the same time bile deposition develops in the skin.
• The feces become light and the urine becomes dark.
• Appetite is completely lost.
• Intolerance to meat and fats develops.
• Digestive disorders such as:
  • nausea;
  • vomit;
  • diarrhea. The stool is loose, foul-smelling, greasy; it changes due to deterioration in fat absorption due to the fact that the gland ceases to secrete normal amount enzymes.
• Body weight decreases even more, the person looks exhausted.

Symptoms of pancreatic cancer located in the body or tail will have slightly different manifestations. This is due to the fact that this localization is far from the biliary tract, and it is their compression that causes jaundice - the main symptom that forces a person to seek treatment. medical care. In addition, it is in the body and tail that a large number of islets are located, consisting of cells of the endocrine part of the gland. Therefore, signs of body or tail cancer may include:

• Symptoms of diabetes:
  • thirst;
  • large amounts of urine excreted;
  • night urge to urinate.
• Symptoms similar to chronic pancreatitis:
  • pain in the upper abdomen;
  • greasy stool, more liquid, difficult to wash out of the toilet;
  • may have diarrhea;
  • nausea;
  • decreased appetite;
  • weight loss
• If glucagonoma develops, it will manifest itself:
  • weight loss;
  • the appearance of a jam in the corners of the mouth;
  • changing the color of the tongue to bright red; its surface becomes smooth, and it itself seems to swell, becoming larger and “fleshy”;
  • the skin becomes pale;
  • a skin rash appears, often localized on the extremities;
  • Dermatitis periodically appears, which is called necrolytic migratory erythema. This is the appearance of one or several spots, which then turn into blisters, then into ulcers that become crusty. When the crust falls off, it remains dark spot. In one place several are found at once different elements. The process lasts 1-2 weeks, then passes, and after that it can be repeated again. Dermatitis is usually located on the lower abdomen, groin, perineum, and around the anus. Treatment with ointments does not affect it, since it is based not on allergies or microbial inflammation, but on a disorder in the metabolism of proteins and amino acids in the skin.
• Symptoms of gastrinoma may also develop:
  • constant diarrhea;
  • the stool is greasy, shiny, smelly, and difficult to wash off the toilet;
  • pain “in the pit of the stomach” after eating, which decreases when taking drugs such as “,” Rabeprazole, “Ranitidine,” prescribed as for gastric ulcers;
  • with the development of complications of stomach ulcers that occur due to excessive production of gastrin, there may be: vomiting of brown contents, brown loose stool, a feeling that the stomach does not work (“stands”) after eating.
• Diarrhea.
• Edema.
• Menstrual dysfunction.
• Decreased libido.
• Slow wound healing.
• The appearance of acne and pustules on the face.
• Trophic ulcers often appear on the legs.
• Allergy-like spots periodically appear on the skin.
• “Hot flashes” occur in fits and starts with a feeling of heat in the head and body, redness of the face. A hot flush may develop after drinking hot drinks, alcohol, generous intake food or stress. The skin may become paler than before or, conversely, turn red, or even turn purple.
• Due to the loss of sodium, magnesium, potassium with diarrhea, cramps in the limbs and face may appear without loss of consciousness.
• You may feel heaviness and a feeling of fullness in the left hypochondrium. This is a sign of an enlarged spleen.
• Spilled sharp pain in a stomach, severe weakness, pale skin. These are the signs internal bleeding from dilated (due to increased pressure in the portal vein system, which supplies blood to the liver) veins of the esophagus and stomach.

Thus, weight loss, pain in the upper abdomen, fatty stools - characteristic symptoms for cancer of any location. They are also present at chronic pancreatitis. If you do not have pancreatitis, you need to be examined not only for its presence, but also for cancer. If chronic inflammation pancreas already occurs, it is necessary to be examined for cancer not only routinely, annually, but also when some new, previously absent, symptom appears.

Here we looked at the symptoms of stages 1 and 2. There are 4 of them in total. The last stage, in addition to severe girdle pain, diarrhea and almost complete indigestibility of foods, will - due to distant metastases - be manifested by symptoms from those organs where the daughter cells of the tumor have entered. Let's look at the symptoms of this stage after we find out how and where pancreatic cancer can metastasize.

Where does pancreatic cancer metastasize?

Malignant tumor The pancreas “scatters” its cells in three ways:

• Through lymph. It happens in 4 stages:
  1. First, the lymph nodes located around the head of the pancreas are affected;
  2. tumor cells penetrate into the lymph nodes located behind the place where the stomach passes into the duodenum, as well as where the hepatoduodenal ligament passes (in the sheet of connective tissue there is a common bile duct and arteries, which then go to the stomach, along the latter these lymph nodes are located );
  3. the lymph nodes located in the upper section mesenteries (connective tissue, inside which there are vessels that nourish and hold the small intestine);
  4. the last screening of lymph occurs in the lymph nodes located in the abdominal space, on the sides of the aorta.
• Through the circulatory system. This is how the daughter cells of the tumor enter the internal organs: liver, lungs, brain, kidneys and bones.
• Pancreatic cancer also sheds its cells through the peritoneum. Thus, metastases can appear on the peritoneum itself, in the pelvic organs, and in the intestines.

Also, a cancerous tumor can grow into organs adjacent to the pancreas: the stomach, bile ducts - if the cancer is localized in the head of the gland, large vessels - if the mutated cells are located in the body of the gland, the spleen if the tumor spreads from the tail. This phenomenon is not called metastasis, but tumor penetration.

Pancreatic cancer development process

There are 4 stages of pancreatic cancer:

If stage 4 occurs with liver metastases, the following are noted:

• yellowing of the skin and whites of the eyes;
• urine becomes darker and feces become lighter;
• bleeding of gums and mucous membranes increases, spontaneously occurring bruises can be detected;
• enlargement of the abdomen due to the accumulation of fluid in it;
• bad breath.

At the same time, an ultrasound, CT or MRI of the liver reveals metastasis in it, which is possible - due to the similarity of symptoms and the presence of a tumor - and will be mistaken for the primary tumor. It is possible to understand which cancer is primary and which is metastasis only with the help of a biopsy of the tumor.

If metastases develop to the lungs, the following are noted:

• shortness of breath: initially after physical activity, then at rest;
• if the metastasis has destroyed the vessel, there may be hemoptysis.

Metastases in the bone are manifested by local pain in the bones, which intensifies when palpating or tapping the skin of this localization.

If the daughter tumor has been introduced into the kidneys, changes appear in the urine (blood and protein often appear in it, which makes it cloudy).

Metastatic brain damage can have one or more different manifestations:

• inappropriate behavior;
• personality change;
• facial asymmetry;
• change in muscle tone of the limbs (usually on one side);
• disturbance (weakening, strengthening or change) of taste, smell or vision;
• unsteadiness of gait;
• shiver;
• choking when swallowing;
• nasal voice;
• inability to perform simple steps or complex but memorized work;
• incomprehensibility of speech for others;
• impaired understanding of speech by the patient himself, and so on.

Diagnosis confirmation

The following tests help in making a diagnosis:

• determination of tumor marker CA-242 and carbohydrate antigen CA-19-9 in the blood;
• pancreatic amylase in blood and urine;
• pancreatic elastase-1 in feces;
• blood alkaline phosphatase;
• level of insulin, C-peptide, gastrin or glucagon in the blood.

The above tests will only help to suspect pancreatic cancer. Other laboratory tests, such as urine, stool, blood glucose, and liver tests, will help determine how much homeostasis is disrupted.

The diagnosis is made on the basis of instrumental studies:

1. Ultrasound of the abdominal cavity. This is a screening study that only allows you to determine the location that needs to be examined in more detail;
2. CT is effective, based on x-ray radiation, method of detailed examination of the pancreas;
3. MRI is a method similar to computed tomography, but based on magnetic radiation. It will provide better information about the tissues of the pancreas, kidneys, liver, and lymph nodes located in the abdominal cavity than CT;
4. Sometimes a tumor in the head of the pancreas, the extent of its damage to the papilla of Vater of the duodenum, its relationship with the bile ducts can only be seen on ERCP - endoscopic retrograde cholangiopancreatography. This is a research method when an endoscope is inserted into the duodenum, through which an X-ray contrast agent is injected into the papilla of Vater, where both the pancreatic duct and bile ducts open. The result is examined using x-rays.
5. Positron emission tomography. Also accurate modern method research. It requires preliminary injection into a vein of a contrast agent, which is not an iodine preparation, but isotope-labeled sugar. According to its accumulation in various organs and an inspection is carried out.
6. Endoscopic retrograde cholangiography. It is performed if the previous research method was unavailable. Here, under ultrasound guidance, a puncture of the liver is made, and contrast is injected into the bile ducts. Then it flows down the bile ducts and enters the duodenum.
7. Laparoscopy. Like the previous method, this is an invasive technique that requires injections. Here under local anesthesia in the front abdominal wall a hole is made through which gas is pumped into the stomach, separating the organs and moving the abdominal wall away from them (so that the device that is inserted into this hole subsequently does not cause injury to the intestines or other structures). Internal organs are examined through a percutaneously inserted endoscope, and if the tumor is visualized, a biopsy can be performed immediately.
8. A biopsy - pinching off pieces of a tumor for further examination under a microscope - is the method that allows you to establish a diagnosis. No one has the right to say “pancreatic cancer” without a biopsy. Therefore, doctors - either during laparoscopy or during endoscopic examination, or already during the operation, the material is necessarily selected for histological examination.

To identify metastases, computed tomography of the lymph nodes of the abdominal cavity, spine, liver, lungs, kidneys, MRI or CT of the brain are performed.

The above studies allow you to make a diagnosis, determine the histological type of the tumor, and also find out the stage of cancer according to the TNM system, where T is the size of the tumor, N is damage to the lymph nodes, M is the presence or absence of metastases to distant organs. The index “X” means no information about the size of the tumor or metastases, “0” means absence, “1” regarding N and M indicates the presence of regional or distant metastases, regarding the T indicator indicates the size.

How is the treatment performed?

Treatment of pancreatic cancer is based on the stage of the disease, that is, how large the tumor is, where it has managed to grow, and what it has damaged. Ideally, the cancerous tumor and nearby lymph nodes should be removed, then this localization should be irradiated with gamma rays. But this is only possible at the “cancer in situ” and stage 1 stages. At other stages, combinations of different methods outlined below can be used.

Surgery

The following types of operations are performed here:

a) Whipple operation: removal of the head of the pancreas along with the tumor, part of the duodenum, stomach, gall bladder, and all nearby lymph nodes. This operation executed only on initial stages, it is impossible to decide for a long time and put it off, as time will be lost.

b) Complete resection of the pancreas. It is used when cancer has developed in the body of an organ and has not spread beyond its boundaries.

c) Distal resection of the gland. It is used when cancer has developed in the body and tail of the organ; They are removed and the head is left.

d) Segmental resection. Here, only the central part of the gland is removed, and the other two are sewn together using an intestinal loop.

e) Palliative operations. They are carried out for unresectable tumors and aim to make a person’s life easier. It could be:

• removal of part of the tumor in order to eliminate pressure on other organs and nerve endings, reducing the tumor load;
• removal of metastases;
• eliminating obstruction of the biliary tract or intestines, thickening the stomach wall or eliminating organ perforation.

f) Endoscopic stent. If the bile duct is blocked by an inoperable tumor, a tube can be inserted into the latter, through which the bile will either enter the small intestine or exit out into a sterile plastic receiver.

g) Gastric bypass surgery. It is used when a tumor interferes with the passage of food from the stomach to the intestines. In this case, it is possible to suture these 2 digestive organs, bypassing the tumor.

Operations can be performed with a scalpel, or with a Gamma Knife, when simultaneous removal of cancerous tissue and irradiation of adjacent tissue are performed (if the cancer was not completely removed, its cells will die under the influence of gamma rays).

The intervention can be performed through micro-incisions, especially in the case of an inoperable tumor (so as not to cause dissemination of cancer cells). The DaVinci programmable robot can do this. He can also use a gamma knife without the risk of radiation.

After surgery, radiation or chemoradiotherapy is performed.

Chemotherapy

Here, various types of drugs are used that block the proliferation of cancer cells, both the youngest and most immature. At the same time, there is an impact on the growing normal cells, which is the reason great amount side effects of this treatment: nausea, hair loss, severe weakness and pallor, neuroses, mild incidence of infectious pathologies.

Chemotherapy can be given as:

1. monochemotherapy – one drug, courses. Effective in 15-30% of cases;
2. polychemotherapy - a combination of drugs different mechanism actions. The tumor partially regresses. The effectiveness of the method is 40%.

To improve the tolerability of such treatment, drink plenty of fluids, exclude alcohol, and include fermented milk products into the diet. The person is prescribed anti-nausea medications - “Cerucal” or “Osetron”, and is advised to visit a psychologist.

Targeted therapy

This is a new branch of chemotherapy that uses drugs that act exclusively on cancer cells, without affecting living structures. Such treatment is easier to tolerate by patients, but has a much higher cost. An example of targeted therapy for pancreatic cancer is Erlotinib, which blocks the signal transmission pathway to the tumor cell nucleus about its readiness to divide.

Radiation therapy

This is what irradiation of a tumor is called:

• before surgery - to reduce the volume of cancer;
• during and after surgery - to prevent recurrence;
• in case of inoperability - to reduce the activity of cancer and inhibit its growth.

Radiation therapy can be carried out in three ways:

1. bremsstrahlung;
2. in the form of remote gamma therapy;
3. fast electrons.

New treatments

US scientists are working on a new method - introducing into the body a vaccine consisting of a weakened culture of the bacterium Listeria monocytogenes and radioactive particles. The experiments clearly show that the bacterium infects only cancer cells and mainly affects metastases, leaving healthy tissue intact. If she becomes a carrier of radio particles, she will carry them into the cancerous tissue, and it will die.

Drugs are also being developed that target the immune system to fight cancer. Such a drug, for example, is the drug Ipilimumab from the group of monoclonal antibodies.

Treatment depending on the stage of cancer

Forecast

The general prognosis for pancreatic cancer is unfavorable: the tumor grows quickly and metastasizes, without making itself felt for a long time.

The question of how long people live with pancreatic cancer does not have a clear answer. It all depends on several factors:

• histological type of cancer;
• the stage at which the tumor was discovered;
• initial state of the body
• what treatment is done.

Depending on this, you can obtain the following statistics:

• If the tumor has spread beyond the gland, only 20% of people live for 5 or more years, and this is only if active treatment is used.
• If surgery was not used, they live for about 6 months.
• Chemotherapy prolongs life by only 6-9 months.
• Radiation therapy alone, without surgery, allows you to live for 12-13 months.
• If a radical operation was performed, they live 1.5-2 years. 5-year survival is observed in 8-45% of patients.
• If the operation is palliative, from 6 to 12 months. For example, after an anastomosis (connection) is made between the bile ducts and the digestive tube, a person lives after that for about six months.
• With a combination of palliative surgery and radiation therapy, they live an average of 16 months.
• At stage 4, only 4-5% survive over a year, and only 2% survive to 5 years or longer. The more intense the pain and poisoning by cancer toxins, the shorter the life.

By histological type:

The causes of death in pancreatic cancer are liver, cardiac, or those that arise from metastasis together with cachexia (exhaustion) due to cancer intoxication.

Prevention of pancreatic cancer

To avoid this truly terrible disease, scientists advise the following:

• Quit smoking. The changes caused by smoking are reversible for all organs.
• Eat foods with a low glycemic index (a measure of sweetness that affects the functioning of the pancreas). Preference should be given not to simple carbohydrates, but to legumes, non-starchy vegetables and fruits.
• Do not use large quantities protein, periodically resorting to protein-free fasting days.
• Increase the content of cabbage in your diet: Brussels sprouts, cauliflower, broccoli and others.
• Among the spices, I prefer turmeric (found in curry seasoning). It contains curcumin, which interferes with the production of interleukin-8, a mediator that affects the development of pancreatic cancer.
• Include in diet more products with ellagic acid: pomegranates, raspberries, strawberries, strawberries, some other red berries and fruits.
• Avoid products with nitrates.
• Use daily norm vitamins C and E – natural antioxidants.
• If you like nuts and legumes, make sure they are fresh. Last year’s nuts, and even more so “suspiciously” looking nuts, may be contaminated with aflatoxin.
• The diet must contain green vegetables rich in chlorophyllin.
• You need to eat fish and fortified milk products, which contain vitamin D, which blocks the spread of cancer cells.
• Eat as little fat as possible, especially from animals: no more than 20% of total calories. Red meat, yolk, and offal are dangerous for the pancreas.
• Eat enough foods with B vitamins, vitamin A and carotenoids.

Malignant neoplasms in the pancreas are rare and practically incurable pathologies. The organ itself is anatomically divided into three parts: head, body and tail. Most often, the tumor is localized in the head of the organ, accounting for over 60% of all diagnosed cases. The body is affected in 20% of cases, and cancer of the tail of the pancreas occurs least often in 5-7% of all diagnosed patients.

Cancer of the body and tail of the pancreas has common symptoms; they appear later than with the lesion, which further aggravates the situation and prognosis for the patient. Symptoms are primarily associated with the growth of the tumor and compression of its surrounding organs and tissues. A characteristic feature An oncological process in the tail of the gland is pain in the left hypochondrium. It occurs as a result of the growth of a neoplasm through nerve endings. Pain when the process is localized in the head occurs in the right hypochondrium, and if the entire organ is affected, the pain is girdling in nature. Discomfort increases when lying on your back and when eating food, especially heavy for digestive tract(fatty, fried).

In addition to severe pain, the formation of a gland in the tail is characterized by:

• enlargement of the spleen due to tumor growth into the splenic vessels and portal vein;
• darkening of urine, to the color of dark beer;
• stool discoloration;
• intestinal obstruction may occur;
• obstructive jaundice occurs extremely rarely, in no more than 10% of cases, it is more typical for localization in the head of the pancreas;
• As a result of intoxication, the temperature rises, weakness and loss of ability to work occur. Weight loss and loss of appetite.

These signs are characteristic of different types cancer process in late stages and are considered general symptoms pathology.

How to detect cancer of the tail and body of the pancreas?

Establishing a diagnosis is complicated due to the special location of the organ. As a result, even in the presence of individual symptoms, it is not always possible to immediately recognize malignant process. To accurately establish a diagnosis, a whole range of clarifying diagnostic procedures is required.

Among the instrumental methods, the following examinations can be proposed:

• ultrasonography;
• CT scan;
• Magnetic resonance imaging;
• fluoroscopy of the stomach;
• relaxation duodenography;
• irrigoscopy;
• fibrogastroduodenoscopy;
• peroral cholangiopancreatoscopy;
• percutaneous transhepatic cholangiography;
• angiography;
• radionuclide research;
• biopsy.

Laboratory tests are offered as follows:

• general blood and urine analysis;
• blood chemistry;
• analysis for: , CA 50, ;
• histological and morphological examination of pathological tissues.

Treatment of cancer of the tail and body of the pancreas, prognosis for patients

The oncological process of the pancreas is complicated by many factors, as a rule, it is late, the prevalence of the process and old age patients with concomitant diseases. The basis of treatment is, it can be of two types: radical and palliative.

Radical surgery

TO radical way resorted to when the tumor is operable.

This indicator is determined by various factors:

• size of education;
• presence or absence of metastases;
• tumor growth into vital anatomical structures;
• the patient’s health condition, their ability to undergo such a complex operation.

As a rule, the tumor is operable only in 15-20% of cases. If the tail or body of the gland is affected, radical operations include left-sided (distal) resection in combination with splenectomy. But even the results of distal resection are not reassuring. Pancreatic tail cancer has a negative prognosis, after radical surgery life expectancy is about 12 months. Just over 5% of patients reach the five-year mark. Radiation or chemotherapy in combination with surgery slightly improves performance and prolongs life by no more than 1-2 months.

Palliative treatment of cancer

If cancer of the tail of the pancreas is detected or the tumor has grown into the vital important organs, execute radical surgery it won't be possible anymore. In this case, resort to palliative measures, main goal which is to improve the patient’s quality of life and prolong his life.

For palliative purposes, the following operations can be performed:

• percutaneous recanalization of hepaticocholedochus;
• percutaneous hepaticocholangiostomy;
• endobiliary prosthetics;
• external and external-internal drainage of the bile ducts.

Also refers to palliative treatments. As an independent procedure, it is used in cases where it is completely impossible to perform a palliative operation, for example, due to old age and the inability to endure anesthesia. It is believed that polychemotherapy is slightly more effective than monochemotherapy, but no more than 40% of patients experience improvements.

Just like chemotherapy is unable to lead to a cure, but only slightly reduce the rate of decay and growth of the tumor and, accordingly, the intoxication process. In combination with palliative operations, in some cases it is possible to prolong the patient’s life by a little more than a year.

After palliative treatment, the average survival time for pancreatic tail cancer is 6 months. Without one or another therapeutic measures, the patient does not live to see six months. According to the American Cancer Society, at the beginning of this millennium, the five-year survival rate was 5% among all patients with pancreatic cancer. This figure can only be improved by timely detection of the disease, urgent surgical intervention and further supportive therapy.

Informative video

IN human body it is difficult to detect a counterpart to the pancreas. The organ performs both an exocrine (digestive) function and is an important part of the endocrine system. Therefore, a neoplasm on the pancreas has a serious impact on the digestive processes (lack of enzymes) and causes disruption of all types of metabolism through a primary disruption of the production of the hormone insulin.

Disappointing statistics

Of all tumors, up to 95% are cancer. According to statistical studies of oncologists in Russia, among general morbidity By malignant pathology, the pancreas is in tenth place in terms of damage in men, and in thirteenth place in women.

Over the past 10 years in the Russian Federation, the annual increase in cases of pancreatic cancer was 3.5% among the male population and 15.6% among the female population. Mortality remains stubbornly at the same level and ranks fifth among both sexes.

Comparing the prevalence of the disease in countries around the world is incorrect, since the level of healthcare development is not the same. A significant number of cases are under-detected.

Diagnosis of volumetric processes in the pancreatic zone is difficult. Here, a person has several organs anatomically and functionally tightly connected (stomach, duodenum, gallbladder and ducts). It is practically impossible to detect a formation emanating from the pancreas at an early stage.

What can lead to the development of the disease?

The reasons for the development of tumor formation in the gland have not been definitively established. It is common to talk about risk factors for the disease and the likely impact on cell degeneration. We present the most significant and studied ones.

Smoking tobacco products- associated with tumor growth in the pancreas in 20–30% of patients. Negative impact possess polycyclic hydrocarbons of nicotine. The role of poison is confirmed for every fourth patient. The risk increases as the duration of the smoker's “experience” increases.

Dietary features - many scientists believe that the risk of pancreatic tumors is greater in people who eat predominantly fatty foods meat products. What matters is the passion for coffee, the lack of vegetables and fruits ( vegetable fiber). However, not everyone agrees with this hypothesis.

Obesity - the gland may not be able to withstand the load of excessive intake of carbohydrates and fats from food. With weight gain associated with hypothalamic-pituitary pathology, all types of metabolism suffer.

Age - the maximum prevalence of pancreatic neoplasia is recorded in people after 60 years of age. According to some authors, it is more common in men than in women.

Diabetes mellitus - the accumulated experience of treating and monitoring people with diabetes suggests that the risk of developing a neoplasm is increased by 60%. Especially if a person is over 50 years old and has had diabetes for more than 10 years.

Chronic pancreatitis - sluggish inflammation in the parenchyma of the gland causes increased fluid influx and swelling of the tissue. At the same time, the swollen acini put pressure on the pancreatic duct, making it difficult for the produced gland secretion to pass through it. As a result, internal enzymes “eat away” their own cells.

Stimulation of the epithelium of small ducts with simultaneous disruption of recovery processes leads to changes in the structure of the organ, the formation of cystic cavities, and neoplasms. Studies have shown a 10- to 20-fold increase in tumor risk if a patient has had pancreatitis for five years. This also applies to alcoholic pancreatitis.

Heredity appears in different ways. Some scientists believe that “hereditary pancreatitis” occurs. In such patients, a tumor is expected in 40% of cases. Others attribute the possibility to genetic mutations at the level of the PRSS1 gene, which inactivates trypsinogen. Inheritance occurs through autosomal dominant transmission to the next generation of the family. The risk of developing a neoplasm in family members who have already had similar cases increases from 6 to 32 times.

Infectious diseases - in particular, a connection has been identified with previous viral hepatitis B and exposure to Helicobacter pylori infection of the antrum of the stomach.

One of the versions is previous operations on the stomach (gastrectomy), removal of the gallbladder (cholecystectomy).

Classification of tumors in the pancreas

The classification of neoplasms involves dividing them into benign tumors (in statistics, they have an ICD code of D13) and malignant tumors – C25–C25.9. They are formed in the exocrine zone, which produces digestive enzymes, and the endocrine zone, where hormones are synthesized.

It is important that exocrine neoplasms more often have a malignant course.

Among malignant tumors tumors are differentiated by location:

• head of the pancreas;
• bodies;
• tail;
• duct;
• islet cells;
• other parts.

Based on their prevalence, they are classified as those that go beyond the boundaries of the listed localizations.

Benign formations

The benign quality of the tumor is determined by its slow growth rate, lack of invasion into adjacent tissues and distant metastases. They are formed from various types cells.

Epithelial benign growths have:

• adenoma - a rare tumor of glandular cells;
• papilloma - the basis is represented by the surface epithelium;
• cyst - neoplasm with internal cavity, filled with liquid;
• insulinoma - formed from the cellular apparatus that produces insulin, is considered a neuroendocrine tumor.

Not related to epithelium in origin:

• lipoma - wen;
• leiomyoma - from smooth muscle fibers;
• fibroma - proliferation of scar tissue;
• hemangioma - based on a collection of blood vessels;
• neuroma - limited only to nerve nodules;
• lymphangioma - grows from the walls of lymphatic vessels.

Benign tumors have virtually no symptoms and are discovered accidentally on ultrasound during examination for pancreatitis. Signs appear with hyperplasia (increase in size), compression of neighboring organs, and the small intestine.

Treatment is not complete without surgical removal. It should be taken into account that benign formations cause:

• chronic pancreatitis;
• internal bleeding.

In an unfavorable situation, they can transform into cancer.

Malignant tumors

Malignant neoplasms vary according to cellular composition. 95% of all tumors are ductal adenocarcinomas. Their growth originates from the epithelium lining the main pancreatic ducts.

All other tumors account for a total of 5%. These include rare types of adenosquamous, colloid, hepatoid, medullary, and signet ring cell cancer. The name is due to the histological picture of the cells. When the components of the acini are identified, the cancer is called acinar cell.

The combined participation of several types of cells in tumor growth is possible; such a process is considered mixed (acinar-neuroendocrine, acinar-neuroendocrine-ductal).

There is a type of undifferentiated tumor. At the present stage, it is impossible to identify the source of its transformation.

For oncologists different countries a unified TNM classification has been adopted. It takes into account the location and extent of the tumor, damage to the lymph nodes, immediate and distant metastases. Using a combined alphanumeric designation, specialists judge various characteristics of the process and choose optimal method treatment.

Ductal adenocarcinoma is the most aggressive form of cancer; a neoplasm occurs on the head in ¾ of cases, in the body in 18% of patients, and in the tail in 7%. Sometimes it is impossible to accurately determine the initial location of the tumor. Atypical growth occurs along the main and auxiliary ducts.

By the appearance of the removed organ, one can judge the fairly dense consistency of adenocarcinoma. On the outside, it has no clear boundaries and is sclerotic. The lobulation characteristic of the pancreas is not visible from the inside. The most typical size for a tumor located in the head is 2.5–3.5 cm, the tail and body are slightly larger. Cyst formation is possible. The color is gray-yellow. Even large nodes are not characterized by areas of necrosis and hemorrhage.

Particular importance for the formation of relapses is given to the growth of adenocarcinoma along the nerve plexuses from the uncinate process on the head to the superior mesenteric ganglion, from the upper part to the perigastric ganglion. From the body and tail, cancer cells are directed towards the splenic, left perigastric ganglion, and superior mesenteric.

Ductal adenocarcinoma metastasizes most often in the liver (53–60% of cases), lung tissue and peritoneum were detected in 10–16%. Less common is the transition to:

• adrenal glands;
• kidneys;
• pleura;
• mesentery of the small intestine;
• diaphragm;
• bones.

Rarely, metastases are found in the brain, heart, and spleen.

Metastasis is typical for the location of the tumor in the tail and body of the pancreas. This is explained by the preservation of the patient’s life and the long-term supportive treatment process.

Symptoms of pathology

The initial symptoms of a pancreatic tumor are either absent or “masked” as chronic diseases of the gastrointestinal tract, cholecystitis, pancreatitis.

Clinical picture of a benign tumor

Benign tumors are asymptomatic. It has been established that only when the size reaches 5 cm do patients feel dull pain in the epigastrium and hypochondrium on the right, nausea, and stool disorders.

Signs are associated with impaired supply of digestive enzymes and compression of the duodenum.

Signs of malignant neoplasms

Symptoms of cancer are conventionally divided into manifestations of the primary tumor, its effect on neighboring organs and tissues, lymph nodes, and the presence of metastases. These include:

• pain syndrome(girdling pain, radiating to the right in case of cancer of the head, to the left and to the back in case of damage to the tail area, in the shoulder, lower back, constant aching, sometimes severe attacks), due to the involvement of the nerve ganglia, stretching of the gland capsule, bile ducts;
• enlarged liver with ascites;
• nodes, tubercles, growths on the dense liver, enlarged lymph nodes above the collarbone identified by palpation;
• loss of appetite is a consequence of intoxication;
• significant reduction in body weight;
• weakness;
• the addition of infectious diseases due to a sharp suppression of immunity;
• possible primary manifestations of diabetes mellitus (thirst, itchy skin in 20% of cases).

Signs of stagnation in the bile ducts, duodenum, due to a mechanical obstacle:

• bursting pain in the right hypochondrium;
• jaundice;
• enlarged liver and gall bladder;
• belching, nausea, vomiting;
• hemorrhages on the skin;
• diarrhea, constipation, flatulence - caused by secretory insufficiency in food digestion;
• obstruction in the small intestine area.

Ductal carcinoma is different high speed currents, severe symptoms. In the tumor area, spastic contraction of the arteries occurs, as a result of which additional disturbances in the nutrition of the organ appear.

In the clinic, cancer located in the head of the pancreas is divided into 2 stages (pre-icteric and icteric). In many patients, yellowing of the skin and itching are the first and only symptom of adenocarcinoma. At the same time, in 1/3 of patients the pain syndrome is absent or of low intensity.

Impaired digestion contributes to the development of mixed anemia (iron deficiency and B12 deficiency).

An increase in temperature indicates joining inflammatory processes in the gallbladder, ducts.

Diagnosis of malignant tumors

Examination of a patient with suspected pancreatic tumor begins with general tests and biochemical tests. Only at a late stage is a moderate decrease in hemoglobin and red blood cells and an acceleration of ESR detected.

Biochemical tests can detect a low protein content (hypoalbuminemia), with jaundice - increased bilirubin, alkaline phosphatase, aspartic and alanine transaminases.

Of greater importance is the detection of tumor markers in the blood. It is believed that embryonic carbonic anhydrate glycoprotein (CA-19-9) has the greatest specificity (almost 90%). Normally, its content is 37 units, and in case of a malignant tumor of the pancreas it can increase from tens to hundreds of times. The disadvantage of the method is the lack of changes at an early stage.

The informativeness of the test with the CA 494 antigen for the early diagnosis of cancer is being studied. It has been found to be effective in identifying differences with chronic pancreatitis.

The main importance is attached to the development of instrumental available ways research.

By X-ray method, by introducing a barium suspension into the stomach, it is possible to detect indirect signs volumetric process in the pancreas. They are associated with compression of neighboring organs. The radiologist finds:

• deformation of the stomach, its protrusion forward, displacement of the lesser curvature;
• calcifications (deposits of calcium salts) with focal pancreatitis;
• “unfolding” of the horseshoe-shaped duodenum due to compression of the descending section;
• “filling defect” in the duodenum, stenosis.

On tomographic sections, the tumor is defined as a hypodense formation; it has more dark color than parenchyma.

Application ultrasound diagnostics made it possible to judge the tissues of parenchymal organs by their ability to reflect waves (echogenicity). The higher the ability of the compacted tissue to reflect the wave, the lighter the visible formations become.

The transcript uses definitions for the pancreas:

• isoechoic - the entire organ normally looks gray;
• the hypoechoic area is darker;
• hyperechoic - looks light in tone, almost white, such areas are characteristic of a dense tumor;
• anechoic, also called echo-negative - the entire structure is black (for example, in the case of a cyst filled with fluid, its contours will be visible).

Various ultrasound techniques (transcutaneous, Doppler scanning, use of a signal amplifier) ​​allow you to see not only the size of the organ:

• contrast in detail a tumor-like formation in the parenchyma up to 1 cm in size, its structure;
• identify enlarged lymph nodes;
• moderate volume of fluid in the abdominal cavity.

Oncologists receive important information from the vessels adjacent to the tumor. It is necessary to assess the degree of vascularization before surgery to predict hematogenous metastasis. Studying zones of hypervascularization from newly formed vessels allows us to judge the degree of organ damage.

The method has now been improved. Endoscopic ultrasound of the pancreas is used by introducing a microsensor into the duodenal zone, bile duct, and vessels. It is possible to examine a tumor less than a centimeter in size.

MRI - the magnetic resonance reflection method is considered more harmless and is used in diagnosing damage to the pancreas in a child. The transcript also draws attention to hypodense areas of tissue.

To definitively confirm the diagnosis, a puncture biopsy under ultrasound or computed tomography guidance is used. It is possible to accurately determine the type of tumor in 90% of cases.

How to identify a benign tumor?

During the diagnostic process, it is necessary to distinguish a benign tumor from a malignant one. All listed research methods are used.

The combination of ultrasound and endoscopy is considered the most modern. Since the distance to the tumor is reduced to a minimum, based on feedback from researchers, minimal changes can be detected with maximum sensitivity.

Methods of treating neoplasms

Pancreatic tumors cannot be treated either by diet or by folk recommendations. Patients should not waste time searching for fabulous advertised remedies. Combination combination modern methods includes:

• surgical stage - resection of part of the pancreas or together with surrounding organs (gastropancreatoduodenal, subtotal, pancreatectomy);
• consolidation of the operation with multi-course chemotherapy.

The role of diet

The importance of therapeutic nutrition is to maximally support the functions of the pancreas. Pancreatitis necessarily develops against the background of a tumor. Therefore, it is necessary to comply with food requirements:

• give up spicy fatty foods, fried foods;
• reduce easily digestible carbohydrates in the diet (sweets, honey, jam);
• eat at least 8 times a day, but reduce portions by half;
• all dishes should be steamed or boiled;
• prohibited fresh vegetables, fruits, salads;
• salt is limited, seasonings, ketchups, and mayonnaise are excluded.

To improve absorption, food should be in a semi-liquid state, pureed, meat in the form of minced meat.

Surgical intervention

The extent of the operation is determined during the examination. The location of the tumor, size, and growth into nearby vessels and lymph nodes are important. The result should minimize the risk of relapse and digestive disorders. Surgeons resect the surrounding vascular branches very carefully. Unnecessary deletion vessels causes disruption of intestinal innervation. The development of diarrhea does not make it possible to carry out subsequent full-fledged chemotherapy.

When removing ductal adenocarcinoma, it is usually necessary to simultaneously remove adjacent organs (spleen, colon, part of the stomach, left adrenal gland, half of the diaphragm).

Other tumors are removed if there is compression of neighboring organs or bleeding. The method of choice is partial resection of the gland and angioplasty. The doctor will tell you whether it is necessary to be treated with chemotherapy after a complete cytological analysis.

Chemotherapy is used to prepare the patient for radiation. Its goal is to bring the tumor to an operable state. The drugs used are administered intravenously (Gemcitabine, Erlotinib, Capecitabine, 5-fluorouracil), they increase the sensitivity of tumor cells to radiation therapy.

There is ongoing debate among scientists about whether it is worth treating a patient with chemotherapy drugs only. It is believed that the patient can be prepared for surgery without subsequent radiation. Typically, a course of chemotherapy is carried out for 2–3 months before surgery and the same amount after. It has been proven that the survival prognosis is the same.

The drugs are often difficult to tolerate and have negative effects (joint pain, nausea, yellowing of the skin).

Irradiation

If the disease does not progress during chemotherapy, then external radiotherapy is added. The radiation dose is calculated individually for each patient.

In addition to remote irradiation, the following forms of irradiation are used:

• fast electrons;
• Bremsstrahlung radiation.

Radiation therapy is prescribed before and after surgery, and less often - instead of surgery.

Targeted therapy is a targeted therapy aimed at a specific target of malignant cells. The created drugs primarily affect tumor cells and suppress their growth. Do not affect surrounding tissues.

Targeted therapy drugs “teach” the body to produce antibodies; they must block the mutating gene that causes the cells to transform into malignant ones. So far, few of them have been synthesized, and the price is too high for general use.

Avastin is suitable for treating pancreatic tumors. One course of treatment will cost $50,000.

Survival prognosis

Postoperative mortality during resection of the gland with surrounding organs averages from 5 to 15%. After removal of the tumor in the tail, patients live about 10 months. Combination with chemotherapy and radiation increases the patient's life to 13–16 months. The five-year survival rate of patients does not yet exceed 8%.

Unfortunately, medicine still has nothing to reassure patients with damage to the pancreas. There are insufficient methods for early diagnosis, and treatment does not provide long-term remission.

Bibliography

1. Sokolov V.I. Surgical diseases of the pancreas. M. 1998
2. Patyutko Yu.I., Kotelnikov A.G. Pancreatic cancer: diagnosis and surgical treatment at the present stage. Annals of surgical hepatology. 1998, volume 3, no. 1, pp. 96–111.
3. Kubyshkin V.A., Vishnevsky V.A. Pancreas cancer. M., 2003
4. Lubensky Yu.M., Nikhinson R.A. Pancreatobiliary cancer. Krasnoyarsk University Publishing House 1984

Pancreatic tumors are quite common in both women and men. They can be caused by alcohol abuse, smoking, poor diet, diabetes mellitus, pancreatitis and other diseases. A benign pancreatic tumor is a proliferation of cells without mutation and metastasis.

A malignant tumor of the head of the pancreas and other parts of the organ is caused by mutated cells. They can lead to metastases to neighboring organs. At the first stages, tumors do not differ from each other in appearance, and it is possible to understand what exactly doctors are dealing with only by analyzing blood and tumor cells.

Benign pancreatic tumor In this case we're talking about about the proliferation of cells of the gland itself without their mutation. Such tumors grow for a long time, do not metastasize, and are relatively easily removed during surgery.

The main causes of benign pancreatic tumors are:

1. Heredity;
2. Bad habits;
3. Poor nutrition (abuse of animal fats, lack of fiber);
4. Poor environmental conditions in the place of residence or work;
5. Pancreatitis.

In general, the exact causes of this type of pancreatic tumor are not well understood.

Main symptoms benign tumor pancreas:

• dizziness, weakness;
• sweating;
• fear;
• pain (when the tumor reaches a large size);
• jaundice;
• vomiting, digestive disorders, etc.

Symptoms of cancer are not typical for a benign pancreatic tumor. And vice versa. For example, pain is common with non-cancerous tumors. For one reason: pancreatic tumors of this nature cannot grow beyond the boundaries of their membrane. As a result, the pancreatic tumor grows and begins to put pressure on other organs.

Cancer symptoms of a benign pancreatic tumor are not inherent for one simple reason: it does not weaken the immune system, does not lead to intoxication and other serious consequences.

Treatment of tumors of the head of the pancreas and other benign neoplasms

A benign pancreatic tumor is not a fatal disease (with some exceptions), but this does not mean that it does not need to be treated. In advanced cases, the patient may experience strong willpower and suffer from accompanying symptoms, including intestinal obstruction (if the tumor compresses part of the intestine).

Treatment of tumors of the head of the pancreas and other parts of the organ is carried out using surgery, removing the tumor. This is followed by rehabilitation period and taking medications to speed up recovery.

Malignant tumor of the pancreas: symptoms, causes and treatment

A pancreatic tumor that is malignant is quite dangerous and should be detected as early as possible. In some cases, its symptoms are similar to those of benign tumors, but there are also serious differences.

These symptoms of malignant tumors of the pancreas include:

• pain occurs only at the very later stages(with metastasis) and are of a different nature;
• weakness is an accompanying symptom general intoxication body, and not by lowering blood sugar levels;
• Weight loss, loss of appetite, depression and other signs of cancer are often observed.

In some cases, cancer can be more accurately detected. For example, a clear symptom of a tumor of the head of the pancreas is an enlarged gallbladder, which can be felt during a routine examination. A malignant tumor of the head of the pancreas often affects the gallbladder itself and other organs that are nearby.

A special case is the neuroendocrine tumor of the pancreas, which causes changes in the endocrine system and has a number of striking symptoms. Thus, a neuroendocrine tumor of the pancreas is characterized by:

• frequent flushes of blood to the face or body, bronchospasms;
• diarrhea;
• fibrosis;
• intestinal ulcers.

Neuroendocrine tumor of the pancreas has varying degrees malignancy. The success of her treatment depends on this. Causes of malignant pancreatic tumors:

1. Wrong lifestyle;
2. Genetic predisposition;
3. Environmental factor.

TO possible reasons Pancreatic tumors also include some diseases - pancreatitis and cirrhosis of the liver.

Unfortunately, the exact causes of pancreatic tumors are unknown, although there is evidence that some diseases can lead to similar consequences.

Treatment of a tumor on the pancreas when malignant cells are detected

Treatment of a tumor on the pancreas is carried out using surgery. Like benign pancreatic tumors, cancer can be removed surgically. if it has not metastasized to vital organs. But in any case, chemotherapy is used after surgery. It helps prevent the growth of pancreatic tumors in the future. When treating a tumor of the head of the pancreas, you should not refuse surgery: chemotherapy alone will only briefly delay the growth of cancer cells.

What to do if you find symptoms of a pancreatic tumor? First of all, don't panic: certain cases symptoms of a pancreatic tumor may indicate other, less dangerous diseases. But you should still check with a doctor.

Patients often turn to therapists or gastroenterologists - most often this happens with a neuroendocrine tumor of the pancreas. But it is best to immediately contact an oncologist, who will help rule out cancer by analyzing the symptoms of a tumor of the head of the pancreas or other parts, prescribing tests and diagnostics. If a tumor of the head of the pancreas or other parts of the organ is nevertheless detected, the doctor will prescribe treatment. It's not worth delaying with him.