Pancreatic carcinoma (cancer) refers to cancer that develops in the pancreas, primarily arising from the pancreatic ductal epithelium and acinar cells. It is a common malignancy. The exact cause of pancreatic cancer remains unclear, but factors such as long-term heavy smoking, alcohol consumption, a high-fat and high-protein diet, exposure to certain chemicals, and the presence of chronic pancreatitis and diabetes can increase the risk of developing the disease. Early symptoms are often subtle, but as the disease progresses, symptoms such as abdominal pain, diarrhea, loss of appetite, weight loss, and fatigue may develop. While early-stage pancreatic cancer can be cured with surgery, advanced pancreatic cancer carries a poor prognosis and a short survival time.
Clinical classification
1. Classification according to the site of onset
(1) Pancreatic head cancer: the most common, accounting for about 60% to 70%.
(2) Pancreatic body and tail cancer: accounting for 20~25%.
(3) Pancreatic cancer: approximately 5% to 10%.
2. Classification by organizational origin
According to the WHO classification, pancreatic cancer pathological types can be divided into epithelial and non-epithelial origins according to tissue origin. Epithelial tumors include ductal adenocarcinoma, acinar cell carcinoma, neuroendocrine tumors and various mixed tumors derived from epithelial, acinar cells and neuroendocrine cells.
Epidemiology
Contagious
Not contagious.
Incidence
Pancreatic cancer is the most common type of pancreatic malignancy. According to the World Health Organization (WHO), pancreatic cancer ranked 13th among malignant tumors globally in 2012. In 2015, pancreatic cancer ranked 9th among malignant tumors in my country.
mortality rate
Pancreatic cancer mortality rates are showing a clear upward trend worldwide. In 2015, pancreatic cancer mortality in my country ranked sixth among malignant tumors. Data released by the American Cancer Society in 2017 showed that pancreatic cancer ranked fourth among malignant tumor-related causes of death in the United States.
Incidence trend
The incidence of pancreatic cancer is increasing rapidly.
High-risk population
It is more common in men, African Americans are more likely to get the disease than whites, and the age of onset is mostly between 40 and 65 years old.
Causes
Overview
The cause of pancreatic cancer is still unclear, but long-term heavy smoking, heavy drinking, high-lipid and high-protein diets, exposure to certain chemicals, chronic pancreatitis, diabetes and other adverse factors may increase the risk of the disease.
Basic cause
When pancreatic cells grow out of control, it can lead to pancreatic cancer. Studies have shown that mutations in genes such as CDKN2A, BRCA2, and PALB2 are closely associated with familial pancreatic cancer.
Risk factors
1. Smoking
The risk of pancreatic cancer in long-term heavy smokers is nearly twice that of non-smokers. After 20 years of quitting smoking, the risk can be reduced to the same as that of normal people.
2. Obesity
Those with a BMI greater than 35kg/m2 have a 50% increased risk of pancreatic cancer. Even if your weight is normal, if your waist circumference is outside the normal range, your chances of developing pancreatic cancer will increase.
3. Long-term heavy drinking
Long-term heavy drinking increases the risk of pancreatic cancer.
4. Chronic pancreatitis
Patients with chronic pancreatitis, especially familial pancreatitis, have an increased risk of developing pancreatic cancer.
5. Diabetes
A history of diabetes for more than 10 years increases the risk of pancreatic cancer by 50%.
6. Long-term exposure to certain chemicals
Exposure to chemicals such as N-nitrosomethylamine and hydrocarbons will increase the risk of pancreatic cancer.
7. High-fat and high-protein diet
Long-term high-fat and high-protein diet, no vegetables, and nutritional imbalance can easily lead to pancreatic cancer.
8. Familial clustering
People with multiple immediate family members who have been diagnosed with the disease before the age of 50 have an increased risk of pancreatic cancer.
9. Patients with certain genetic syndromes
People with Peutz-Jeghers syndrome, familial atypical multiple mole and melanoma syndrome, autosomal recessive ataxia telangiectasia, Lynch syndrome, familial adenomatous polyposis, etc., have a higher risk of pancreatic cancer.
symptom
Overview
Pancreatic cancer develops insidiously, with no early symptoms. By the time obvious symptoms appear several months later, the disease is usually in its late stages. Key clinical manifestations include abdominal pain, indigestion, jaundice, and weight loss. The disease typically progresses rapidly, with a short course and rapid deterioration.
Typical symptoms
1. Abdominal pain
Abdominal pain is often the first symptom, which is often persistent, progressively worsening pain in the upper abdomen or persistent severe pain in the lower back, which is more obvious at night; the pain worsens when lying on the back and extending the spine, and lying prone, squatting, sitting with a bent back, or lying on the side with knees curled up can relieve the abdominal pain.
2. Indigestion
The lower end of the common bile duct and the pancreatic duct are blocked by tumors, and bile and pancreatic juice cannot enter the duodenum. In addition, due to pancreatic exocrine insufficiency, most patients have lack of appetite, indigestion, foul-smelling stool, and steatorrhea (greasy or foamy stool and large amount).
3. Jaundice
Approximately 90% of patients develop jaundice during the course of their illness. This is primarily due to bile duct obstruction caused by cancer cell erosion and is the primary clinical manifestation of pancreatic head cancer. Jaundice can manifest as yellowing of the skin and sclera, dark yellow urine, clay-colored stools, and may be accompanied by itching.
4. Anxiety and depression
Abdominal pain, indigestion, and insomnia can lead to personality changes, anxiety, and depression in patients.
5. Weight loss
Poor digestion and absorption, along with anxiety, can lead to weight loss. In the late stages, the disease often presents as cachexia, with patients experiencing extreme emaciation, sunken eye sockets, loose skin, and severe muscle atrophy, leaving them “skin and bones.” They experience general weakness, anemia, and may even become completely bedridden, suffering from systemic exhaustion.
6. Symptomatic diabetes
50% of pancreatic cancer patients have diabetes at the time of diagnosis, and new-onset diabetes is often an early sign of the disease.
7. Others
(1) The tumor compresses adjacent organs, such as affecting gastric emptying and causing abdominal distension and vomiting.
(2) A small number of pancreatic cancer patients may experience upper gastrointestinal bleeding due to invasion of the stomach and duodenal walls by the lesions.
(3) Continuous or intermittent low-grade fever.
(4) Migratory thrombophlebitis or arterial thrombosis: patients may experience leg pain, swelling, etc.
complication
Diabetes, thromboembolism, upper gastrointestinal bleeding, chronic pancreatitis, etc.
examine
Scheduled inspection
The doctor will first perform a physical examination and blood biochemical test on the patient to understand the patient’s general condition, and then selectively let the patient undergo tumor marker testing, genetic testing, X-ray barium meal angiography, B-ultrasound, CT, endoscopic retrograde cholangiography, magnetic resonance cholangiopancreatography, selective arterial angiography, endoscopic ultrasound, cytology or tissue biopsy, etc. to further clarify the diagnosis.
Physical examination
Pancreatic cancer may present with no abnormal physical signs in its early stages. As the disease progresses, symptoms such as yellowing of the skin and sclera and upper abdominal tenderness may develop. Doctors may also feel an enlarged liver and gallbladder. In advanced stages, enlarged lymph nodes may be felt above the clavicle, and nodular, firm, immobile masses may be felt in the upper abdomen.
Laboratory tests
1. Blood biochemistry test
In the early stages, there are no specific biochemical changes in the blood. However, when the tumor invades the liver and obstructs the bile duct, it may cause corresponding biochemical changes, such as elevated levels of alanine aminotransferase, aspartate aminotransferase, bile acid, and bilirubin. In the late stages of the disease, cachexia, electrolyte imbalances, and hypoproteinemia may occur. In addition, some patients may experience dysglycemia.
2. Tumor marker testing
(1) Carbohydrate antigen 19-9 (CA19-9): It is the most sensitive indicator among the tumor markers currently used to diagnose pancreatic cancer. It will increase when pancreatic cancer occurs. CA19-9 level detection is also an important means to determine postoperative tumor recurrence and evaluate the effectiveness of radiotherapy and chemotherapy.
(2) Pancreatic cancer-associated antigen (PCAA) and pancreatic specific antigen: These two antigens are elevated when tested together, which is suggestive for the diagnosis of pancreatic cancer.
(3) Pancreatic embryonic antigen (POA): POA is elevated in pancreatic cancer patients. It decreases significantly after tumor resection and returns to normal 1-2 months after surgery. It increases during recurrence. This test can be a predictor of pancreatic cancer recurrence.
(4) Others: Carcinoembryonic antigen (CEA) and carbohydrate antigen 12-5 (CA12-5) may be elevated in pancreatic cancer.
3. Genetic testing
It can determine whether pancreatic cancer is caused by gene mutation.
Imaging examinations
1. X-ray barium meal angiography
In pancreatic head cancer, widening of the duodenal flexure or an inverted “3” shape on the inner side of the descending duodenum may be found; stiffness of the duodenal wall, destruction of the mucosa, or stenosis of the intestinal cavity may be found; or compression and displacement of the stomach, duodenum, and transverse colon may be found.
2. B-ultrasound
It can show pancreatic enlargement, irregular shape, or masses within the pancreas, but it is not ideal for diagnosing tumors smaller than 2 cm.
3. CT
With excellent spatial and temporal resolution, it is currently the best noninvasive imaging method for examining the pancreas, primarily used for the diagnosis, differential diagnosis, and staging of pancreatic cancer. Plain scans can demonstrate the size and location of lesions but cannot accurately diagnose pancreatic lesions and poorly visualize the relationship between the tumor and surrounding structures. Triple-phase enhanced scans can better demonstrate the size, location, morphology, internal structure, and relationship of pancreatic tumors to surrounding structures, and can accurately determine the presence of liver metastases and demonstrate enlarged lymph nodes.
4. Endoscopic retrograde cholangiography (ERCP)
This procedure allows for direct observation of the duodenal wall and ampulla for cancer infiltration. It also allows for direct collection of pancreatic fluid for cytology and ampulla biopsy for pathological examination, improving diagnostic yield. If necessary, a biliary stent can be placed for drainage to alleviate jaundice and prepare for surgery.
5. Magnetic resonance cholangiopancreatography (MRCP)
It can display the pancreaticobiliary system non-invasively and without contrast agents, and can observe whether there is cancer infiltration in the duodenal wall and ampulla.
6. Selective arteriography
Selective arteriography of the superior mesenteric artery, hepatic artery, and splenic artery is performed through the celiac artery to show pancreatic masses and signs of vascular displacement, which helps to determine whether there is cancer cell blockage in the blood vessels, the extent of the lesion, and the possibility of surgical resection.
7. Endoscopic ultrasound (EUS) examination
EUS can explore the entire pancreas from the posterior wall of the stomach and duodenum, avoiding interference from gastrointestinal gas and abdominal wall fat. This makes it highly valuable for the diagnosis of pancreatic cancer, including early-stage pancreatic cancer, and can accurately describe the presence of regional lymph node metastasis and vascular involvement. Furthermore, endoscopic ultrasound can be used for puncture and histological or cytological examination to determine the nature of the tumor.
8. Positron Emission Tomography-Computed Tomography (PET-CT)
It can detect pancreatic lesions and assess whether there is metastasis.
Pathological examination
Under the positioning and guidance of endoscopic ultrasound, transabdominal ultrasound or CT, or by fine needle aspiration during laparotomy, multiple cytological or biopsy examinations can be performed to clarify the nature of the biopsy tissue. This examination has a high diagnosis rate.
diagnosis
Diagnostic principles
Diagnosis is generally not difficult based on the patient’s medical history, clinical manifestations, and analysis of relevant examinations. During the diagnosis process, doctors must rule out diseases such as chronic pancreatitis, autoimmune pancreatitis, hepatopancreatic ampullary cancer, and common bile duct cancer.
Differential diagnosis
1. Chronic pancreatitis
Chronic pancreatitis, characterized by gradual onset of upper abdominal distension and discomfort, indigestion, diarrhea, poor appetite, and weight loss, must be differentiated from pancreatic cancer, especially mass-forming chronic pancreatitis. Chronic pancreatitis often presents with a chronic course, a history of repeated acute attacks, prominent diarrhea (or steatorrhea), and rare jaundice. The discovery of pancreatic calcifications on imaging studies can aid in the diagnosis of chronic pancreatitis. However, differentiation can still be difficult, and even during surgery, the pancreas of chronic pancreatitis may appear rock-hard or exhibit nodular changes. If differentiation remains difficult after laparotomy, deep fine-needle aspiration or pancreatic biopsy is necessary for differentiation.
2. Autoimmune pancreatitis
It is often manifested by elevated serum IgG4, and is effectively treated with hormones.
3. Hepatopancreatic ampulla cancer and common bile duct cancer
The common bile duct, hepatopancreatic ampulla, and pancreatic head are anatomically located adjacent to each other, and their clinical manifestations are very similar. However, common bile duct and ampulla cancers have better surgical outcomes and prognosis than pancreatic head cancers, making differential diagnosis essential. ERCP is performed for differentiation.
4. Common bile duct stones
Common bile duct stones often recur, have a long history, and have large fluctuations in jaundice levels. Attacks are often accompanied by the triad of abdominal pain, chills, fever, and jaundice, and most are not difficult to identify.
5. Other pancreatic space-occupying lesions
It mainly includes pancreatic pseudocyst, insulinoma, solid pseudopapillary tumor, etc. Clinically, the tumor grows slowly and has a long course. At the same time, there may be specific clinical manifestations. For example, insulinoma may show symptoms of paroxysmal hypoglycemia. Most patients with pancreatic pseudocyst have a history of acute pancreatitis. It is generally not difficult to identify them in combination with imaging examinations such as CT. If necessary, puncture biopsy and pathological examination can assist in diagnosis.
treat
Treatment principles
Treatment for pancreatic cancer depends primarily on the stage and type of cancer. Common treatments include surgery, chemotherapy, radiotherapy, interventional therapy, and targeted therapy.
General treatment
Intravenous high-energy nutrition and amino acid solution infusion can be used to improve the patient’s nutritional status.
Drug treatment
1. Painkillers
(1) Nonsteroidal anti-inflammatory drugs, such as indomethacin, can be used for mild pain.
(2) Weak opioids, such as tramadol extended-release tablets, can be used for moderate pain.
(3) Severe pain can be treated with opioids such as morphine and pethidine.
2. Pancreatic enzyme preparations
It can improve indigestion and relieve steatorrhea. Commonly used drugs include pancreatic enzyme tablets and multienzyme tablets.
3. Insulin
It can be used to treat concurrent diabetes.
Related drugs
Indomethacin, tramadol extended-release tablets, morphine, pethidine, pancreatic enzyme tablets, multienzyme tablets
Surgical treatment
Early surgical resection is the most effective treatment for pancreatic cancer, but the resection rate is low after symptoms appear. If the tumor invades other tissues or organs or surrounds major abdominal blood vessels, surgery should be contraindicated. Therefore, preoperative tumor staging plays a significant role in predicting prognosis. Common surgical options are as follows:
1. Radical surgery
(1) Whipple procedure: This is a common procedure for radical pancreatic resection, suitable for early-stage pancreatic head cancer. This procedure involves removing the head of the pancreas, the first part of the small intestine, the gallbladder, part of the bile duct, and nearby lymph nodes. In some cases, part of the stomach and colon may also be removed. The pancreas, stomach, and remaining intestines are then reconnected to allow the patient to digest food normally.
(2) Pancreatic body and tail resection: This procedure is suitable for pancreatic body and tail cancer with a diameter of less than 2 cm, no pancreatic membrane invasion, no peripancreatic lymph node metastasis, and no distant metastasis. This procedure involves removing the tumor in the body and tail of the pancreas. To prevent heavy bleeding, the spleen may also be removed.
(3) Total pancreatectomy: This is used when cancer cells have invaded the entire pancreas. The surgery involves removing the entire pancreas, spleen, part or all of the stomach, and part of the transverse colon.
2. Palliative surgery
Patients with obstructive jaundice or duodenal obstruction may undergo palliative surgery to alleviate clinical symptoms, prolong survival, and improve quality of life. For example, percutaneous transhepatic biliary drainage (PTCD) and biliary stent placement can alleviate jaundice, while intestinal stent placement can alleviate intestinal obstruction.
Chemoradiotherapy
1. Chemotherapy
Chemotherapy uses chemically synthesized drugs to kill tumor cells or inhibit their proliferation. Currently, there is no effective single chemotherapy drug or combination chemotherapy regimen that can prolong the life of pancreatic cancer patients or improve their quality of life. Therefore, chemotherapy is usually used to shrink the lesion before surgery to create an opportunity for surgery; to provide consolidation therapy after surgery to prevent recurrence; and to target other systemic diseases when the tumor metastasizes. Chemotherapy drugs can be taken orally or intravenously. Commonly used chemotherapy drugs include gemcitabine, 5-fluorouracil, cisplatin, docetaxel, epirubicin, paclitaxel, and capecitabine. Among them, gemcitabine primarily acts on tumor cells during the DNA synthesis phase, making it the most commonly used chemotherapy drug for pancreatic cancer.
2. Radiotherapy
Radiation therapy involves using a machine to deliver high-energy radiation to a specific area of the patient, aiming to kill or inhibit the growth of cancer cells. While radiotherapy for pancreatic cancer is less effective than chemotherapy, it can be used as a secondary option or in combination with chemotherapy for patients who are not responding well to chemotherapy. It can help improve patients’ quality of life, alleviate cancer pain, and prolong their lives.
Other treatments
1. Interventional therapy
Interventional therapy is an important means of treating pancreatic cancer, especially for patients in the middle and late stages.
(1) Regional arterial perfusion interventional therapy: refers to the infusion of chemotherapy drugs into the blood vessels of the tumor through a catheter, which can affect the reproduction of cancer cells or directly kill cancer cells.
(2) Ablation therapy: refers to killing cancer cells by physical means. Commonly used methods include radiofrequency ablation, microwave ablation, cryoablation, alcohol ablation, etc.
(3) Intra-arterial embolization therapy: Embolic agents are injected into the pancreatic cancer blood supply artery through a catheter to block the blood supply to the tumor, causing ischemia and necrosis. This has a certain therapeutic effect in clinical application.
Targeted therapy
This refers to the use of specific therapeutic drugs that kill only tumor cells through specific selective action points, without affecting surrounding normal tissue cells. Commonly used drugs include erlotinib, olaparib, bevacizumab, and cetuximab.
Treatment cycle
The treatment cycle for pancreatic cancer is generally 3-6 months, but there may be individual differences due to factors such as the severity of the disease, treatment plan, timing of treatment, and personal constitution.
Treatment costs
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.
Prognosis
General prognosis
The prognosis of pancreatic cancer is related to the stage and type of pancreatic cancer. Generally, the prognosis is poor. Without treatment, the survival period is short.
Hazards
1. Patients often experience varying degrees of pain, nausea, vomiting, loss of appetite and other symptoms, which seriously affect their daily lives.
2. Venous thrombosis may occur. If the thrombus reaches the lungs, it may cause pulmonary embolism and endanger the patient’s life.
3. This disease is a malignant disease. After knowing about it, patients often have negative emotions such as worry, fear, and anxiety, which may aggravate the condition.
Self-healing
It usually does not heal on its own.
Curative
A considerable number of patients with early pancreatic cancer can be cured through surgical treatment.
Cure rate
Some early-stage patients can be cured through surgery; late-stage patients are more difficult to cure.
Radical
If pancreatic cancer is detected in the early stages, it can be cured through surgical resection.
Recurrent
There is also a risk of recurrence after surgery.
Metastatic
Pancreatic cancer is prone to early metastasis, which can occur through direct spread, lymphatic metastasis, hematogenous metastasis, and metastasis along the nerve sheath. Direct spread often involves the terminal common bile duct, duodenum, stomach, transverse colon, small intestine, and peritoneum; lymphatic metastasis often involves lymph nodes in the stomach, liver, peritoneum, and mesentery; hematogenous metastasis often spreads via the portal vein to the liver and then to organs such as the lungs and kidneys; and metastasis along the nerve sheath often involves the duodenum, pancreas, and gallbladder wall nerves, as well as the celiac plexus.
Lifecycle
The average survival time after symptoms appear is less than one year, and untreated patients survive about four months. For patients who undergo radical surgery, the five-year survival rate (the proportion of patients who survive for more than five years) is between 10% and 25%.
daily
Overview
Patients should fully understand the crucial role of healthy lifestyle habits and mental well-being in the treatment of pancreatic cancer. Strengthening one’s physical fitness and maintaining a balanced diet also play a positive role. Patients undergoing chemotherapy, radiotherapy, or surgery should visit the hospital regularly for follow-up visits to monitor any changes or recurrences.
Psychological care
1. Patients may have severe abdominal pain, often accompanied by negative emotions such as anxiety and irritability. They can distract their attention by reading newspapers, listening to music, talking with family members, deep breathing, relaxing massage, etc. to relieve pain.
2. Most patients are middle-aged, around 40 years old, with heavy family responsibilities. They find it difficult to accept a diagnosis and often experience negative emotions such as denial, sadness, fear, and anger. Furthermore, pancreatic cancer patients often present late, with limited surgical options and a poor prognosis, leading to a lack of confidence in treatment. Family members should communicate with patients frequently to understand their true feelings, spend more time with them, and address their emotional needs, so they can actively cooperate with treatment.
3. Patients should maintain an optimistic attitude towards the disease, communicate with medical staff about their condition, enhance their confidence in treatment, and consult a psychologist if necessary to relieve psychological stress.
Medication care
1. When infusing chemotherapy drugs, pay attention to the infusion site. If swelling or pain occurs, notify the doctor and nurse immediately.
2. After using chemotherapy drugs, you should pay attention to whether there are any systemic bleeding tendencies such as skin bruises, bleeding gums, hematuria, bloody stools, etc. If so, report to the doctor in time for treatment.
3. After using chemotherapy drugs, if someone vomits, family members should promptly clear the vomit, help the patient rinse his mouth, and keep the mouth clean.
4. Patients who need to inject insulin should be aware of the possibility of hypoglycemia if they experience dizziness, palpitations, cold sweats, fatigue, etc. after the injection, and should immediately consume sweets or sugar water.
Postoperative care
1. Monitor body temperature, respiration, pulse, and blood pressure after surgery; pay attention to changes in consciousness and jaundice.
2. Observe the drainage tube to prevent it from falling out, being squeezed or folded. Observe the nature of the drainage material. If there is any abnormality, report it to the doctor in time.
3. Observe the wound for bleeding, exudation, redness, swelling, heat, pain, etc. If any, report to the doctor immediately.
4. Use antibiotics as directed by your doctor after surgery.
5. Postoperative fasting is recommended. Nutrition can be supplemented intravenously during gastrointestinal decompression. After the gastric tube is removed, a small amount of liquid food can be given, and then gradually transitioned to a low-fat diet.
Life Management
1. Patients should pay attention to rest and avoid overwork.
2. Cancer patients are physically weak and have poor hematopoietic function, making it difficult to stop bleeding. Therefore, it is important to avoid bleeding. Patients should avoid picking their noses to prevent nasal bleeding and use a soft-bristled toothbrush to prevent gum bleeding.
3. The skin is prone to itching when jaundice occurs. Avoid scratching with your hands and do not let your nails be too long to prevent skin rupture and infection. Try not to use soap or other detergents to clean itchy areas. Use warm water sponges 1 to 2 times a day.
4. Once your strength has recovered, you can choose to engage in some physical exercise or activity within your ability, such as walking, jogging, doing radio gymnastics, practicing Tai Chi, practicing Tai Chi sword, etc. Exercise can increase energy consumption and lower blood sugar; it can also lower blood cholesterol and slow or prevent atherosclerosis. Furthermore, it can improve cardiopulmonary function, relieve stress, and boost your spirits. However, it’s important to proceed gradually and consistently, and to avoid feeling fatigued.
5. Maintain an optimistic attitude and relieve excessive stress by participating in social interactions, such as participating in reading clubs and exchange meetings, and communicating with others.
Follow-up Instructions
Patients who are clinically highly suspected of pancreatic cancer and who are undergoing radiotherapy and chemotherapy after surgery or in the late stage should follow the doctor’s advice for regular checkups so that the doctor can assess their nutritional status, tumor progression, recurrence, etc., and adjust the treatment plan in a timely manner.
1. Follow-up visit time
(1) When pancreatic cancer is clinically suspected but it is difficult to differentiate it from other diseases such as autoimmune pancreatitis and chronic pancreatitis, close follow-up should be performed. The recommended follow-up time is once every 2 to 3 months.
(2) For pancreatic cancer patients, follow-up is recommended every 3 months in the first year after surgery; every 3-6 months in the second to third year; and every 6 months thereafter. The follow-up period should be at least 5 years.
(3) Patients with advanced pancreatic cancer or those with distant metastasis should be followed up at least once every 2 to 3 months.
2. Review items
(1) Routine blood tests, biochemical indicators, and serum tumor markers such as CA19-9, CA125, and CEA.
(2) Ultrasound, X-ray, thin-slice chest CT scan, upper abdominal enhanced CT and other imaging examinations, and PET-CT if necessary. For patients suspected of liver metastasis or bone metastasis, liver MRI and bone scan should be performed.
diet
Dietary adjustment
A scientific and reasonable diet can ensure the normal functioning of the body, help control the disease, maintain the treatment effect, and promote recovery from the disease.
Dietary recommendations
1. Choose a diet that is rich in nutrients, easy to digest, less irritating and low in fat.
2. You can eat more fruits rich in pectin, such as peaches, pineapples, bayberries, cherries, etc., which can increase the secretion of insulin and lower blood sugar.
3. You can eat more black sesame seeds, carrots, etc., which can help improve fatigue symptoms caused by eating too little starch and lower blood sugar.
4. You can often eat foods such as eel, water spinach, grapefruit, pumpkin, konjac, bitter melon, spinach roots, etc., which contain ingredients that lower blood sugar.
5. It can be combined with foods that have the functions of softening and dispersing lumps, soothing the liver and regulating qi, such as hawthorn, malt, kelp, seaweed, laver, etc.
6. During chemotherapy, a diverse diet is recommended. To prevent chemotherapy-induced decreases in white blood cell and platelet counts, it is recommended to eat more fish, chicken, and jujubes. Mushrooms and wood ear mushrooms can also be added to boost immune function. To increase appetite and prevent vomiting, change your diet and cooking methods to enhance the color, aroma, and flavor of food. Eat small, frequent meals and incorporate light, refreshing salads.
Dietary taboos
1. Quit smoking and drinking, and avoid overeating and overeating to avoid aggravating the condition.
2. Avoid greasy foods and high-animal fat foods, such as fatty meat, mutton, meat floss, shellfish, peanuts, sesame seeds, pastry, snacks, etc., so as not to cause excessive secretion of bile and aggravate the condition.
3. Avoid sour, spicy and irritating foods, such as onions, garlic, ginger, peppers, chili peppers, etc., so as not to irritate the gastrointestinal tract and aggravate the condition.
4. Avoid hard, sticky, indigestible, rough and fiber-rich foods, such as leeks, celery, corn, glutinous rice, etc., to avoid gastrointestinal irritation.
5. Avoid pickled or moldy foods, such as salted fish and pickled vegetables.
prevention
Preventive measures
The cause of pancreatic cancer is still unclear, and there are currently no effective preventive measures. However, the following measures may reduce the risk of developing the disease:
1. Change your diet. Avoid burnt or charred foods and eat less high-fat, high-protein, and high-salt foods. Eat regularly, 3 to 5 times a day, and avoid snacks. This can reduce pancreatic secretion, lighten the burden on the pancreas, and lower the risk of pancreatic cancer.
2. Overeating is strictly prohibited, because overeating can cause acute pancreatitis, even endanger life, and also lay the hidden dangers of pancreatic cancer.
3. Maintain physical activity and avoid being overweight and obese.
4. Eat more whole grains and less high-cholesterol foods. Cereals, beans, sweet potatoes, and other foods rich in non-starch polysaccharides and dietary fiber can reduce the risk of pancreatic cancer, while animal offal containing high cholesterol can increase the risk of pancreatic cancer.
5. People over 40 years old, those with newly diagnosed diabetes, chronic pancreatitis, long-term smokers, or a family history of cancer should undergo regular pancreatic cancer screening.
6. People with diabetes and chronic pancreatitis should actively treat the primary disease.
7. Quitting smoking and drinking can reduce the risk of pancreatic cancer.
8. Try to avoid contact with harmful chemicals, such as N-nitrosomethylamine, hydrocarbons, etc.
Medical Guide
Outpatient indications
1. Persistent and progressively worsening abdominal pain.
2. The skin and sclera appear yellow, and the urine is dark yellow.
3. Digestive system symptoms such as nausea, vomiting, loss of appetite, and indigestion.
4. Progressive weight loss without clear cause.
5. A physical examination revealed an abnormal mass in the abdomen.
6. People with a family history of pancreatic cancer or chronic pancreatitis experience the above symptoms.
Treatment department
1. For your first visit, you can go to the gastroenterology department.
2. If it is confirmed that surgery is needed, you can go to the general surgery and gastrointestinal surgery departments for treatment.
3. After being diagnosed with pancreatic cancer, or during early or late radiotherapy and chemotherapy, you can seek treatment in the oncology department.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. You may need to have a blood test. Do not eat after midnight the night before the test until the end of the test.
3. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
4. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
5. Family members can be arranged to accompany the patient to seek medical treatment.
6. Patients can prepare a list of questions they want to ask in advance.
Questions your doctor may ask
1. What symptoms do you have? How long have you had these symptoms? Are they constant or intermittent?
2. Do your symptoms tend to get worse?
3. Have you ever encountered a similar situation before?
4. Have you ever sought medical treatment? How was your treatment? How effective was the treatment?
5. Has anyone in your family suffered from pancreatic cancer?
6. How is your diet? Do you like to eat high-fat foods?
7. Do you have a history of chronic pancreatitis?
8. Have you ever been diagnosed with diabetes?
9. Do you smoke or drink alcohol? How long have you been doing this?
What questions can patients ask?
1. What caused me to suffer from this disease?
2. Is my condition serious? Do I need to be hospitalized?
3. What tests do I need to do?
4. What treatment do I need? Do I need surgery?
5. Are there any risks associated with treatment? I have other medical conditions; will this affect my treatment?
6. What precautions should be taken during treatment?
7. Can it be cured? Will it recur?
8. What should I pay attention to in my diet?
9. Do I need a follow-up examination? When should I come for a follow-up examination?