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Pancreatic Cancer

Pancreatic cancer
    Pancreatic cancer is known as “the king of cancer” for its critical conditions and low survival rate. Pancreatic cancer is more likely to occur among men, and the morbidity is 2 – 4 times higher than that of women. People between 40 – 65 years old are the most vulnerable group. The morbidity of pancreatic cancer rises as people age. The pathogenesis of pancreatic cancer still remains unclear and it is often related to cancerogenic substances in the environment as well as chronic pancreatitis and chronic cholelithiasis. Besides, the morbidity is higher among depressed people, heavy smokers and drinkers and obese people.

    Clinically speaking, most pancreatic cancer patients are diagnosed at terminal stages. The reason is because the pancreas is located deep inside the abdomen, the early stage symptoms are not typical and there are few effective diagnostic methods. More than 90% untreated pancreatic cancer patients will die one year after being diagnosed.

The early stage symptoms of pancreatic cancer are multitudinous and atypical, and many of which are similar to upper gastrointestinal diseases, so they are often treated as stomach illness in outpatient department.
    It is difficult to diagnose pancreatic cancer though, there are still patterns—
    The most common symptoms of pancreatic cancer include intractable epigastric pain which normally occurs in epigastrium, peripheral umbilicus or right upper quadrant, and it is often paroxysmal or durative. The pain stretches to the small of back in most cases. Please be alerted in case of similar pain.
    The second one is relatively obvious, which is progressively deepened jaundice, accompanied by cutaneous pruritus etc.
    The third symptom is emaciation, which is typical. Approximately 90% patients experienced rapid weight loss. The weight of former Apple CEO, Steve Jobs, dropped from 175 pounds (79kg) to 58kg and he even needed support when walking.
Previous symptoms may appear in case of hepatitis or biliary tract disease, so it is not uncommon that early pancreatic cancer can be mistaken as hepatitis or cholecystitis or cholelithiasis.
    In addition, many pancreatic cancer patients may experience irregular defecation. If you defecation suddenly becomes frequent recently, especially after oily food. Increased defecation is especially worth noting. Besides, lack of strength and loss of appetite are common in symptoms of pancreatic cancer too, accompanied by gastrointestinal symptoms like diarrhea, constipation and nausea.
    What described above are regular symptoms. Pancreatic symptoms may also vary according to different lesion locations. Pancreatic head carcinoma often oppresses common bile duct, and obstructs bile secretion, making bile permeate into blood and ultimately leading to jaundice, hepatomegaly and stools become lighter in color and resemble argil. Therefore, pancreatic head carcinoma is more likely to be detected in early stages; the symptoms of carcinoma of body of pancreas are mostly pain because pancreatic body is right next to plexus coeliacus, so that nerves can be easily violated by lesions. The pain is often intermittent or durative and may intensify at night; the symptoms of carcinoma of tail of pancreas are difficult to find and pain is rarely seen. Sometimes the patient may experience abdominal mass other than regular emaciation, lack of strength, anorexia and malnutrition, and it can be easily mistaken as left kidney diseases.


Pancreatic cystic tumors
    As routine physical examination becomes popular, some people may find out that they have a “cyst” on their pancreas with B ultrasonic or CT test. Studies showed that nearly 20% people who receive routine physical examination may find out that they have “pancreatic cystic tumors”. So, what should we do?
    The truth is, the term “pancreatic cystic tumors” is exactly medically correct, nor can we simply determine whether they are “benign” or “malignant”. In fact, it includes a pile of pancreatic “cystic diseases” or known as “cystic space-occupying lesions” where you may find complete benign lesions, low-grade malignant lesions, and malignant cystadenocarcinoma. The following questions shall be answered in order to understand its very nature.


    “Real cyst” or “Pseudo cyst”?
    Covering epithelium is absent inside a “pseudo cyst” and it is often subsequent and commonly discovered in pancreatitis (acute and chronic pancreatitis), pancreatic trauma or resulted from pancreatic operation. Covering epithelium exists inside a “real cyst” and it is divided into “non-tumorous” and “tumorous cyst”.
    “Non-tumorous” cyst: Rarely seen. Some congenital diseases such as cystic fibrosis, polycystic disease (i.e. VHL syndrome, multiple hepatic, renal and pancreatic cysts) may cause multiple pancreatic cyst, and retention cyst can be caused by pancreatemphraxis. Others include parasite and dermoid cyst.
    “Tumorous” cyst is relatively more common which mainly consists of four types of pancreatic cystic tumors.
    1、Serous cystadenoma (SCN)
    2、Mucinous cystadenoma (MCN) and cystadenocarcinoma
    3、Solid pseudopapillary neoplasm of the pancreas (SPN)
    4、Intraductal papillary mucinous neoplasm (IPMN) and IPMN secondary cancerization


    What do we do if we are diagnosed with “pancreatic cyst”?
    To sum up, the types of the so-called pancreatic cyst are multitudinous, and the natures of benign ones and malignant ones are greatly differed. Therefore, you may not make light of “pancreatic cyst” nor should you become overly worried. Go to pancreatic surgery to receive treatment in time since most cases of “pancreatic cyst” are benign and of low malignance.


    Is surgical treatment necessary?
    It depends on the very nature of the cyst. Normally, non-tumorous cyst of pseudocyst and real cyst doesn’t necessarily need surgical treatment. All tumorous cysts need surgical treatment in addition to small serous cystadenoma and small IPMN.
People have a misunderstanding that any cyst smaller than 3cm doesn’t need any treatment, which is wrong. Mucinous cystadenoma, solid pseudopapillary neoplasm all need surgical removal regardless of size.


    The surgical treatments of pancreatic cystic tumors
    In most cases, regional or segmental removal of pancreas is recommended in order to preserve pancreatic tissues and neighboring organs since most cases of “pancreatic cystic” are benign and of low malignance. A study showed that the morbidity of diabetes is about 18% after distal pancreatectomy. The morbidity of diabetes is as high as 40% if the patient already has chronic pancreatic inflammations. Therefore, it is very important to preserve pancreatic tissues while removing lesions.
    1、Pancreatic head cystic tumor: Regional excision (removal)
    2、Pancreatic neck, body cystic tumor: Medial pancreatectomy
    3、Pancreatic tail cystic tumor: Distal pancreatectomy while preserving the spleen
    4、Minimally invasive - laparoscopic surgery of pancreatic cystic tumors

    Minimally invasive - laparoscopic surgery is of advantages such as small incision and quick recovery, as well as enlarging view and more precise dissection, making it the primary choice in distal pancreatectomy.