Is this pancreatitis or pancreatic cancer?

It's not pancreatitis Pancreatitis usually occurs after drinking a lot or overeating, and it is characterized by severe abdominal pain. Severe pancreatitis can lead to blue spots and shock symptoms in the abdomen. Pancreatitis generally does not require surgery, only severe cases need surgery.

Your father's performance is very consistent with the manifestations of pancreatic head cancer: middle-aged and elderly people, internal and external bile ducts dilated, common bile duct dilated, pancreatic duct dilated, corpus luteum (caused by pancreatic head cancer blocking the bile duct system), diagnosed by B-ultrasound. Pancreatic head cancer needs comprehensive treatment based on surgery.

It is recommended to go to a regular hospital for general surgery immediately (some hospitals are hepatobiliary surgery and abdominal surgery).

Note: Data related to pancreatic head cancer and pancreatitis.

Pancreatitis:

Pancreatitis refers to the inflammatory lesion of pancreatic tissue. Pancreatic edema, congestion or hemorrhage and necrosis. Clinically, there are abdominal pain, bloating, nausea, vomiting, fever and other symptoms. The content of amylase in blood and urine increased. It can be divided into simple edematous pancreatitis and hemorrhagic necrotizing pancreatitis. The latter is dangerous, with many complications and high mortality.

Pancreas is the second largest digestive gland and the organ with the strongest digestive function. The pancreatic juice it secretes is the most important digestive juice for human body. Under normal circumstances, pancreatic juice contains inactive or inactive pancreatic enzymes in glandular tissues. Pancreatic juice continues to flow into the duodenum along the pancreatic duct through the Oddi sphincter of the common bile duct. Due to the existence of bile in duodenum and the secretion of enterokinase by duodenal mucosa, pancreatin began to be transformed into a digestive enzyme with strong activity. If the outflow tract is blocked and the excretion is not smooth, pancreatitis can be caused.

Under normal circumstances, although both the home tube and bile duct flow into the duodenum through one channel, bile will not flow back into the pancreatic duct because the pressure in the pancreatic duct is higher than that in the bile duct. Only when Oddi sphincter spasm or pressure in bile duct increases, such as stones and tumor obstruction, bile will return to pancreatic duct and enter pancreatic tissue. At this time, lecithin contained in bile is decomposed into lysolecithin by lecithin enzyme A contained in pancreatic juice, which can have toxic effect on pancreas. Or biliary tract infection, bacteria can release kinase to activate pancreatin, and pancreatin can also become an active substance, destroying and dissolving pancreatic tissue. These substances convert pancreatin contained in pancreatic juice into trypsin, which has strong digestive activity, and can penetrate into pancreatic tissue to cause self-digestion and also cause pancreatitis.

Pancreatic head cancer and pancreatic cancer

Early manifestations of pancreatic cancer:

1. Abdominal discomfort: About 60% patients have upper abdominal discomfort in the early stage, which is easily confused with symptoms of gastrointestinal and hepatobiliary diseases.

2. Abdominal pain: Abdominal pain is the most common symptom of about 40% ~ 70% patients with pancreatic cancer. The causes of abdominal pain are as follows: ① Obstruction at the exit of pancreatic duct leads to its severe contraction, and abdominal pain is mostly paroxysmal and located in the upper abdomen; ② Visceral neuralgia caused by increased pressure of biliary tract or pancreatic duct, manifested as dull pain in the upper abdomen, aggravated at 1 ~ 2 hours after meals, and relieved after several hours; ③ The pancreas is rich in innervation. Nerve fibers mainly come from celiac plexus, left and right celiac nodes and superior mesenteric plexus, and their pain nerves are located in sympathetic nerves. If the tumor infiltrates and compresses these nerve fiber bundles, it will cause low back pain, which is serious. Patients often sit or lie on their backs all night, mostly in late stage.

3. Jaundice: Painless jaundice is the most prominent symptom of pancreatic head cancer, accounting for about 30%. Because of the biological characteristics of pancreatic cancer with periductal infiltration, jaundice can appear early, but it is not an early symptom. The color of stool becomes lighter with the deepening of jaundice, and finally becomes clay color, and the color of urine becomes thicker and thicker, showing soy sauce color. Most patients may have itchy skin due to obstructive jaundice, leading to scratching all over the body.

4. Gastrointestinal symptoms: Most patients have symptoms such as loss of appetite, aversion to greasy food, nausea, vomiting and indigestion.

5. emaciation and fatigue: due to reduced food intake, indigestion and tumor consumption.

6. Fever: Most patients have different degrees of fever during the onset, and intermittent low fever often does not attract attention. Chilling and high fever can occur when biliary tract infection occurs.

7. Thrombophlebitis: It is a special manifestation of pancreatic cancer. About 15% ~ 25% patients have thrombophlebitis during the onset, and the most common is thrombophlebitis of lower limbs.

What do you need to see a doctor in time?

Early pancreatic cancer often has no specific symptoms and signs, and laboratory and other examination results are also lack of specificity, so diagnosis and treatment are often delayed. In order to realize early diagnosis, patients over 40 years old who have the following clinical manifestations recently should see a doctor in time and think about the possibility of pancreatic cancer:

1. If you have unexplained upper abdominal pain or intractable upper abdominal pain or low back pain.

2. Unexplained anorexia and emaciation.

3. unexplained progressive obstructive jaundice.

4. Fatty diarrhea.

5. Recurrent pancreatitis.

6. There is no obvious reason for depressive psychosis.

7. Patients suspected of pancreatic cancer and recent diabetes.

8. Unexplained thrombophlebitis of lower limbs.

Various inspection methods and precautions:

1. Physical examination: The purpose of physical examination is to check whether there is visible jaundice and left supraclavicular lymph node metastasis, and to check some related symptoms, such as hepatomegaly, gallbladder enlargement, upper abdominal mass, etc.

2. Laboratory inspection:

1) general laboratory examination: due to lower biliary obstruction, serum bilirubin in patients with pancreatic head cancer can be significantly increased, mainly the content of direct bilirubin, others such as serum amylase and fasting blood sugar. , but they are not specific.

2) Special laboratory examination: In recent years, efforts have been made at home and abroad to find specific antigen substances of pancreatic cancer, such as carcinoembryonic antigen (CEA), pancreatic embryonic antigen (POA), pancreatic cancer-associated antigen (PCAA), CA 19-9, pancreatic cancer-specific antigen (PaA) and leukocyte adhesion inhibition test (LAIT), among which CA19. At present, all kinds of antigens used in clinic have a certain positive rate for pancreatic cancer, but they are not specific and can only be used for clinical reference. Four pancreatic cancer markers, CA 19-9, CA242, CA724 and CA 125, were identified by the Pancreatic Cancer Clinic of Huashan Hospital, and it was found that they can significantly improve the sensitivity and specificity of pancreatic cancer diagnosis. Combined with B-ultrasound and CT, it can be used as a screening test for pancreatic cancer.

3. Image examination:

1) B-ultrasound: It is the first choice for patients with suspected pancreatic cancer. This method can detect biliary dilatation and pancreatic duct dilatation at an early stage. It is possible to find tumors with a diameter greater than 1cm, and it is more likely to find tumors with a diameter of 2cm. The advantages of this method are not only safety, non-invasive and convenient, but also repeated follow-up. For patients in high-risk age groups who have symptoms such as epigastric discomfort, unexplained weight loss and anorexia, this method can be used for screening. When suspicious and uncertain, further CT examination can be done.

2) CT: CT can also be used as the first choice for patients with suspected pancreatic cancer. Its diagnostic accuracy is higher than that of B-ultrasound, and the diagnostic accuracy can reach more than 80%. The X-ray dose received is very small, which is a safe method. Pancreaticobiliary duct dilatation and tumors with a diameter greater than 65438±0cm in any part of the pancreas can be found, and retroperitoneal lymph node metastasis and intrahepatic metastasis can be found, which is helpful to judge whether the tumors can be resected before operation. Because of these advantages, although the examination is expensive, it is still the first choice for doctors. In recent years, Huashan Hospital has applied spiral CT to the diagnosis and preoperative staging of pancreatic cancer with high accuracy. Through the three-dimensional imaging reconstruction method, a clear image with three-dimensional and 360-degree rotation can be obtained, thus improving the reliability of preoperative staging diagnosis.

3) Magnetic resonance imaging: pancreatic tumors larger than 2cm can be found, but the overall image detection effect is not better than ct. Magnetic resonance angiography (MRA) combined with three-dimensional imaging reconstruction method can provide a clear image rotated 360 degrees, which can replace angiography. MRCP (magnetic resonance cholangiopancreatography) can partially replace ERCP (endoscopic retrograde cholangiopancreatography), which is helpful to find pancreatic head cancer.

4) X-ray examination: Barium meal duodenography can find the image of pancreatic head cancer invading and progressing duodenum. Selective celiac arteriography (DSA) has certain diagnostic value for pancreatic cancer. The sensitivity and accuracy of ERCP in the diagnosis of pancreatic cancer can reach 95%. Because it is a traumatic examination, it is only used when B-ultrasound and CT can't diagnose it. Through ERCP, pancreatic juice or cells can be collected for examination. Positron emission tomography (PET) has a high detection rate of pancreatic cancer, but the examination cost is expensive.

5) Radionuclide pancreatic imaging: As a pancreatic imaging agent, 75Se- methionine has certain diagnostic value for large pancreatic cancer.

4. Other inspections:

1) Pancreatic endoscopy: With the continuous development of endoscopic technology, pancreatic endoscopy has entered clinical application in recent years. It can directly enter the lumen of pancreatic duct for observation, collect pancreatic juice and exfoliated cells for analysis, and detect K-ras gene.

2) Fine needle aspiration cytology: More than 80% of fine needle aspiration cytology guided by B-ultrasound or CT can get a correct diagnosis.

Advantages and disadvantages of various treatment methods:

1. Surgical treatment:

Radical surgery: At present, it is still the only effective cure for pancreatic cancer, but the operation is complicated, traumatic and has a high incidence of complications.

Pancreatic head cancer: It mainly includes pancreaticoduodenectomy (Whipple), pancreaticoduodenectomy with preservation of stomach and pylorus (PPPD) and extended pancreaticoduodenectomy. Whipple is the most classic radical operation for pancreatic head cancer. The scope of resection generally includes the distal stomach, duodenum, pancreatic head and the lower end of common bile duct, and the lymph nodes around the pancreatic head, superior mesenteric artery, transverse mesenteric root, common hepatic artery and hepatoduodenal ligament are cleaned up. PPPD operation preserved the normal physiological function of the stomach, partially prevented gastrointestinal reflux and improved the nutritional status. In addition, partial gastrectomy is not needed, and duodenojejunostomy is simple, which shortens the operation time. However, some scholars believe that this operation is not sufficient for lymph node dissection under pylorus and around hepatic artery, which may affect the postoperative effect, so it is only suitable for small pancreatic head cancer, duodenal bulb and pylorus without injury; In addition, it can be found that a few patients have gastric retention after operation. Pancreatic cancer is mostly invasive, and it is easy to invade the peripheral portal vein and superior mesenteric artery and vein. In the past, many scholars used whether the tumor invaded mesenteric vessels and portal vein as a sign to judge whether pancreatic cancer could be resected, so the resection rate was low. In recent years, with the improvement of surgical methods and techniques and perioperative management, extended pancreaticoduodenectomy was performed on some patients involving superior mesenteric vessels and portal vein, and the tumor and the involved vessels were removed together, and the vascular access was reconstructed with autologous blood vessels or artificial blood vessels. But whether this operation can improve the survival rate is still controversial. Extended pancreaticoduodenectomy is traumatic, time-consuming and technically demanding, which may increase the incidence of complications and should be carefully selected.

Cancer of pancreatic body and tail: there are simple resection of pancreatic body and tail, extended resection of pancreatic body and tail and combined organ resection.

Total pancreatectomy: Total pancreatectomy for pancreatic cancer is based on the multicenter pathogenesis theory of pancreatic cancer. After total pancreatectomy, the possibility of pancreatic leakage complications after pancreaticoduodenectomy is fundamentally eliminated, but there are sequelae such as diabetes and pancreatic exocrine dysfunction. Studies have shown that total pancreatectomy has no obvious advantages in short-term and long-term curative effects, and the indications should be strictly controlled. Only total pancreatic cancer is the absolute indication.

Internal drainage surgery:

Single bypass operation: common bile duct jejunostomy, mainly including cholecystectomy, cholecystojejunostomy and common bile duct jejunostomy. Advantages: it can drain bile, relieve jaundice and prepare for radiotherapy and chemotherapy; The disadvantage is that some patients may have duodenal obstruction in the future and cannot solve the problem of pancreatic juice drainage.

Double bypass operation: biliary-intestinal anastomosis+gastrointestinal anastomosis, suitable for patients with duodenal obstruction. Advantages can relieve duodenal obstruction; The disadvantage is that the pancreatic juice is missing, the digestive function is reduced, and the internal and external secretion functions are affected.

Three kinds of bypass surgery: biliary-intestinal+gastrointestinal+pancreaticojejunostomy. Has the advantages that the problem of pancreatic juice is solved; The disadvantage is that the operation is relatively complicated and difficult, and there is postoperative pancreatic fistula.

External drainage surgery:

Cholecystostomy or common bile duct T tube drainage: simple and effective for patients with unresectable tumors. In the preparation before radical surgery, we can not only improve liver and kidney function, improve blood coagulation function, reduce infection rate and improve immunity, but also preliminarily explore the tumor during surgery to determine whether the second-stage radical surgery can be carried out.

Endoscopic drainage of nasobiliary duct or stent (ERCP+ENBD): the advantage is less trauma; The disadvantage is that the edema around bile duct is serious after operation, which increases the difficulty of the second stage operation, and because the guide wire, catheter or stent pass through the tumor site repeatedly during operation, it may cause tumor metastasis.

PTCD or ITCD: generally used for patients with poor general condition, unable to tolerate surgery or ERCP, and uncertain drainage effect.

2. Chemotherapy:

Intravenous chemotherapy: Commonly used chemotherapy drugs include 5-Fu, mitomycin and cisplatin. In recent years, gemcitabine, as a first-line drug for pancreatic cancer, has been used in clinic, and achieved better curative effect than previous drugs. However, the overall effect of intravenous chemotherapy is not ideal whether it is single drug or combined drug.

Interventional chemotherapy: Huashan Hospital took the lead in applying interventional chemotherapy to the treatment of pancreatic cancer in China, and found that it can increase the therapeutic concentration of local drugs and reduce the systemic toxicity of chemotherapy drugs. At the same time, according to years of clinical practice, we found that interventional chemotherapy can not only improve the postoperative adjuvant treatment effect of pancreatic cancer, but also improve the surgical resection rate of large pancreatic cancer and prolong the preoperative survival of patients, which is the first choice for adjuvant treatment.

3. radiotherapy: it can be used before or after surgery, especially for unresectable pancreatic cancer, which can relieve intractable pain after radiotherapy.

4. immunotherapy: the occurrence and development of tumors are accompanied by low immune function, and pancreatic cancer is no exception. Therefore, improving the immunity of patients is also an important link in the treatment of pancreatic cancer. Immunotherapy can increase patients' anti-cancer ability and prolong their survival time. Commonly used drugs include thymosin, IL-2, staphylococcin, interferon and tumor necrosis factor.

5. Gene therapy: Gene therapy is the research direction of tumor treatment, and it is still in the experimental stage.

6. Other treatments: Chinese medicine, hyperthermia, endocrine therapy, etc. It can be used in the treatment of pancreatic cancer, but the curative effect is not exact. It is generally used in advanced tumors or as an auxiliary measure of radiotherapy and chemotherapy.