The third Thursday in November every year is World Pancreatic Cancer Day. Pancreatic cancer is one of the most malignant human malignant tumors. Pavarotti, one of the "Three Tenors in the World", and Professor Chen Minzhang, the former Minister of Health of my country, have all passed away as a result of this, known as the "King of Cancer." It is called "pancreas" discoloration. "With the advancement of science and technology and the improvement of the medical level of pancreatic specialists at home and abroad, the prognosis of pancreatic cancer has improved significantly in recent years. The overall cure rate has risen from less than 5% to more than 10%; if there is a chance to accept high Quality radical surgery for pancreatic cancer combined with standardized postoperative chemotherapy, the five-year survival rate of patients can even exceed 40%. Such treatment effects are unimaginable in the past." Jiangsu Provincial People’s Hospital (No. 1 in Nanjing Medical University) The Affiliated Hospital) Pancreas Center Professor Jiang Kuirong said, “At the same time, the incidence of pancreatic cancer is also increasing year by year, and patients tend to be younger. At this moment, it is even more important for the public to have a correct understanding of pancreatic cancer and face it scientifically. , In order to finally defeat pancreatic cancer through the joint efforts of society, doctors and patients."

Understand the king of cancer, why is pancreatic cancer "difficult to treat"?
Director Jiang introduced that the reason why pancreatic cancer is "difficult to treat" is that, in addition to its extremely high degree of malignancy, the main reason is the lack of early screening and diagnosis methods and the extreme difficulty of high-quality radical surgical techniques.
Data shows that patients with early pancreatic cancer account for only 10% of all new pancreatic cancers, and the implementation of surgery and postoperative chemotherapy can bring them a good treatment effect; more than 50% of patients have systemic metastases when they are discovered. Missed the opportunity to undergo radical surgery; while the remaining 40% of patients had no systemic metastases at the time of diagnosis, but the lesions involved important blood vessels in the abdomen. Radical surgery is extremely difficult, and can only be performed in high-volume pancreatic centers. pancreas centers) safe and effective implementation. So far, there is no effective method for screening for pancreatic cancer in the general population. Fortunately, the incidence of pancreatic cancer itself is not high. About 10 people out of every 100,000 people will develop pancreatic cancer every year. Calculating with a population of 9.32 million in Nanjing, there are about 900-1000 new pancreatic cancer patients in Nanjing every year.
High-quality radical resection of pancreatic cancer is a type of surgical operation that is difficult, has a high technical threshold, and requires strict perioperative management. Not any medical institution or any abdominal surgeon can perform it safely and effectively. Because the pancreas itself is closely related to the surrounding organs such as the stomach, small intestine, gallbladder/bile duct, spleen, etc., radical surgery for pancreatic cancer is almost never limited to the removal of a single organ of the pancreas, but must always include the whole removal of the surrounding organs (en- bloc resection); therefore, in addition to the pancreas, the pancreatic surgeon must also be proficient in gastrointestinal, hepatobiliary, and even vascular surgery techniques. "Pancreaticoduodenectomy", a radical resection of pancreatic head cancer, is known as abdominal surgery "The jewel in the crown." Data from all over the world show that the safety and long-term treatment effect of pancreatic cancer patients undergoing related operations at large pancreatic centers are significantly better than that of units with a smaller amount of surgery. "There are even reports from American scholars that patients with pancreatic cancer who live closer to the big center will have a better prognosis after surgery." Director Jiang said.

Facing pancreatic cancer, how to find it?
Director Jiang said that the symptoms caused by pancreatic cancer are often mild or atypical and difficult to detect; at the same time, because it is located deep in the abdomen, the density of pancreatic cancer is close to the surrounding normal pancreatic tissue, and it is not easy to perform conventional abdominal ultrasound and flat-scan CT physical examinations. Early detection of lesions; the most widely used pancreatic cancer-related physical examination tumor markers so far are sugar chain antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA) and sugar chain antigen 125 (CA125).
Although the specificity is not high, patients with pancreatic cancer still have the following relatively common subjective symptoms: (1) Digestive dysfunction: anorexia, steatorrhea, unexplained weight loss, etc.; (2) Abdominal pain: mainly manifested as upper abdominal pain, Severe abdominal pain is not common in pancreatic cancer, but in patients with sympathetic ganglia involved, there may be more obvious waist, back and even shoulder pain; (3) Jaundice: pancreatic cancer located in the head of the pancreas If it progresses to block the common bile duct, it can cause yellow staining of the skin and sclera, and the color of urine will deepen to the color of strong tea or soy sauce. At the same time, the color of stool will become lighter. In severe cases, gray-white stools such as clay may appear.
It is worth noting that the incidence of pancreatic cancer in special populations such as patients with Peutz-Jeghers syndrome, patients with familial atypical multiple mole melanoma, and individuals in the family of familial pancreatic cancer is significantly increased, and regular medical screening is required. At the same time, patients with diabetes after the age of 50, especially those who have not had obvious hyperinsulinemia, or who have been diagnosed with type II diabetes who have not risen but lost weight recently, have a significantly higher probability of developing pancreatic cancer. They need to go to the pancreatic disease specialist clinic for consultation.

Beat it! Diagnosis and treatment strategies for pancreatic cancer
Director Jiang told reporters that high-quality radical resection of pancreatic cancer is an essential condition for pancreatic cancer patients to obtain long-term survival. "But because there are more and more treatments that may bring survival benefits to patients with pancreatic cancer that have emerged in multiple medical fields, including chemotherapy, radiotherapy, and immunotherapy, only professional pancreatic surgeons are at the core, including tumors. A multidisciplinary team of experts in the fields of science, digestive endoscopy, and interventional radiology can formulate the most appropriate diagnosis and treatment strategy according to the specific conditions of each patient."
In addition to the doctor himself, the most commonly used diagnostic tool for pancreatic cancer is enhanced CT. "Enhanced CT, especially the'enhanced pancreatic CT' specially designed to show pancreatic lesions, is the most important imaging examination for diagnosing pancreatic cancer, evaluating the possibility of surgery and formulating surgical plans." Combined with the tumor location, volume, and blood vessels prompted by imaging Invasion, peripheral organ infiltration or metastasis, those patients with earlier stage and higher resectability are recommended to receive high-quality radical surgery for pancreatic cancer as soon as possible after excluding personal conditions that make the patient unable to tolerate the operation. It is feasible according to the specific conditions of the disease. In classic open surgery or laparoscopic/robot-assisted minimally invasive surgery, adjuvant chemotherapy is performed based on the patient's pathological examination results. Part of the local progress, involving important abdominal blood vessels, cancer that was considered unresectable in the past, in today's large pancreatic centers can also be used to preserve the blood vessels or combined with surgical techniques of vascular resection and reconstruction for safe and effective surgical resection. "In addition, for some patients with local progression or even distant metastases, specific chemotherapy, radiotherapy and even immunotherapy programs can now be used to "transform" the disease, so that the tumor shrinks or even downgrades before surgery is performed. This can also be used for this part. Patients bring opportunities for cure. “It can be seen that in the diagnosis and treatment of pancreatic cancer, in addition to experienced and skilled pancreatic surgeons, the close cooperation of a multidisciplinary team in the entire diagnosis and treatment process is indispensable. "Excellent surgery is a prerequisite for pancreatic cancer treatment, but only a highly qualified pancreatic cancer multidisciplinary team can maximize the benefits of patients." Director Jiang Kuirong said.


Pancreas Center, Jiangsu Provincial People's Hospital and the First Affiliated Hospital of Nanjing Medical University
The Pancreatic Surgery Specialty Group of the First Affiliated Hospital of Nanjing Medical University was established in 1986. It is one of the earliest pancreatic specialized groups established in the country. Under the leadership of Professor Ma Yunping, Professor Du Jinghui, Professor Liu Xunliang, and Professor Miao Yi, the development of the discipline of pancreatic surgery has achieved fruitful results. Results. In 2014, Professor Miao Yi pioneered and innovated. Based on the original pancreatic surgery, he founded the Pancreas Center of the First Affiliated Hospital of Nanjing Medical University and the Pancreatic Research Institute of Nanjing Medical University, integrating pancreatic surgery, intensive care, digestive endoscopy, oncology, and imaging. Excellent talents in the fields of science, pathology and other professional fields provide one-stop services for patients with pancreatic diseases including surgery, endoscopy, intervention, drugs, and intensive care. Subject (Real-time MDT) diagnosis and treatment mode. In 2020, the center has 1076 pancreatic surgeries annually, which is among the highest in the world.