When it comes to pancreatic cancer, it is a pain in my heart. A good friend, colleague and best friend of mine passed away some time ago, the cause of death was pancreatic cancer, from discovery to death in three months, which is really worthy of the name of "the king of cancer". Today, I'm going to talk about the whole diagnosis process of my best friend, so that I can tell you how to find out pancreatic cancer?

It was May 31, 2020, this time is too special, because the next day is Children's Day, originally also thought of the next day to call the two families of the children to play together, that afternoon she called me to say that the last two weeks of recurrent abdominal pain, accompanied by vomiting, vomiting can be relieved after the pain, but the last few days after the vomiting, the pain symptoms no longer reduce. I wondered if it could be something I ate that was not right. So I came to the hospital to check it out.

First to consider ultrasound examination of the most cost-effective and short time, first to do a color ultrasound, I accompanied her. Under normal circumstances, an abdominal ultrasound does not take 10 minutes to finish, but this time the ultrasound of the colleague in his upper abdomen to change the orientation, multiple scans, more and more serious face, but also with the eyes gazed at me, I move with the direction of its probe, see a huge mass. This colleague also did not give a report card, and politely said that there was a mass in the upper abdomen pressing on the stomach, so there would be vomiting and pain, and that an MRI would be needed to match the diagnosis. I took my friend back to the ward and gave her some fluids to protect her stomach and prevent vomiting, as well as to maintain her water-electrolyte balance.

After getting my friend settled in and not long after leaving the house, my colleague who had just done the ultrasound called me and said that pancreatic cancer was a very high possibility, so I rushed to call her date and booked an MRI flat scan and enhancement scan. The next day, an MRI and enhancement scan of the upper abdomen was done early in the morning, coupled with the tumor marker test of carcinoembryonic antigen CA19-9, which was also markedly elevated, the diagnosis was almost 95% confirmed at that time. However, the MRI results also showed that multiple metastases had occurred, and the value of surgery was lost. After that, a transendoscopic retrograde cholangiopancreatography was performed, a stent was put in to relieve the bile duct obstruction and some secretions were taken, and the diagnosis of pancreatic cancer was confirmed. Several courses of chemotherapy were administered, but there was no significant effect, and the metastatic progression of the tumor, abdominal pain, and vomiting were not relieved. In the last month, not even anesthesia could relieve her pain.

I wondered at that time why China could not have euthanasia. At that time, I also told my partner that if I had been diagnosed with a malignant disease, please be sure to explain it to me. I am a doctor, I have my own judgment, and I hope that I can have the right to choose to commit suicide before I lose my consciousness, instead of living painfully and unconsciously. Really, the last period of time, watching her just "living", no consciousness, no cognition, painkillers continued to use, life tenaciously clinging to life, the heart is like pins and needles.

The probability of early detection of pancreatic cancer is extremely low, because there are no special symptoms in the early stage, and most of them have already entered the advanced stage when symptoms appear. Once it is found, the course of the disease is short, and the condition will deteriorate and die rapidly, which is also the origin of the name of "King of Cancer".

Let me tell you about the tests that are meaningful in the diagnosis of pancreatic cancer!

• 1. of tumor markers in patients with adenocarcinomaCA19-9 and carcinoembryonic antigen (CEA)It is often elevated. So that's why it's recommended that when you get your annual health checkup, you should always get a tumor marker, even though it's expensive, six or seven hundred dollars.

• 2colour scheme. Color ultrasound is relatively inexpensive, but he is almost meaningless for pancreatic cancer, why is that? Because abdominal ultrasound can detect the pancreatic cancer is mostly in advanced stages.

• 3.ultrasound endoscopy

This one is relatively stronger than color ultrasound alone because it can detect small tumors about 5mm in diameter, but it is an invasive test, so most people will not undergo an optional invasive test during a routine physical examination. So he has no significance for screening for pancreatic cancer, but if it is coupled with endoscopic fine-needle aspiration, it can improve the diagnosis rate of early pancreatic cancer.

• 4.CT scan。

This is relatively expensive, is a low-dose spiral CT, may have to two or three hundred or more, but it can detect pancreatic cancer greater than 2cm in diameter, if the application of enhancement scanning, but also can find the dilation of the pancreatic duct stenosis, or pancreatic duct peripheral vascular compression lymph nodes, or metastasis, especially liver metastasis.

• 5. Two more checks areTransendoscopic retrograde cholangiopancreatography, also called ERCP and magnetic resonance cholangiopancreatography MRCPThe main purpose of these two tests is to look at the infiltration of pancreatic cancer. However, ERCP is a relatively invasive test, and the advantage is that ERCP can collect pancreatic fluid for cytologic examination to improve the diagnosis rate. ERCP can also put a stent in the bile duct when necessary to alleviate the patient's bile duct obstruction and jaundice, so these two tests have to be clinically dependent on what is the specific use?

Therefore, from the above means of examination, we can see that relatively speaking, in the annual health check-up, there are only two convenient and highly feasible ones, one is CT of the upper abdomen and the other is the examination of tumor markers. This is also the reason why in recent years, it is recommended that CT and tumor marker examination should be perfected at least once in 2 to 3 years if there is no abnormality, or even once a year if there are conditions and risk factors.

Having ranted so much, you should basically be able to get a general idea of this pancreatic cancer test and understand it, but I don't expect you to use it. Just like what Li Shizhen said, "I would rather have dusty medicines on the shelf, but I wish the people in the world were unharmed."

Hello, I'm oncologist Orange Orange Mom. Pancreatic cancer is highly prevalent in people over 40 years old, with more male patients than female, and smokers are at higher risk. Because the pancreas is hidden and wrapped by various peripheral organs, it is difficult to detect the lesion, and requires a combination of patient's symptoms, physical examination and test results. Here is what Orange Mom will tell you about pancreatic cancer from 3 aspects.

1. What are the symptoms of pancreatic cancer?

2. How can pancreatic cancer be detected?

3. What should I do when I am tested for pancreatic cancer?

What are the symptoms of pancreatic cancer?

There are no obvious symptoms in the early stages of pancreatic cancer, and when symptoms appear, they are often already in the middle or late stages. Its main symptoms include:

• 腹痛: About 60% of patients go to the doctor for abdominal pain, usuallyEpigastric pain is commonIt is sometimes not possible to pinpoint the exact location. When the pain first appears it is mild and without a clear pattern.Relatively significant pain after eatingThe pain gets progressively worse in the back, evenIt radiates to the low back and is reduced when in the chest and knee position (see below) or when lying on the side.。

• jaundice: It is a typical symptom of pancreatic head cancer, which is characterized byYellowing of the skin and sclera. In fact, malignant tumors of the liver, gallbladder, and pancreas basically show signs of jaundice. Sometimes.Accompanied by itchy skin, caused by the irritation of bile salts.

• weight loss: The pancreatic cancer patients I've seen are basically very, very thin, and in advanced stages they can be malignant and skin and bones. Because pancreatic cancer patientsPoor digestion and absorption, so wasting is evident, though tumor consumption andloss of appetiteIt is also a cause of weight loss.

• Other symptoms: may haveNausea, vomiting, loss of appetiteand other digestive symptoms. Because the bile ducts are blocked, bile cannot enter the intestines, leading toDeepening of urine color, white clay-like stools, with occasional diarrhea in the late stages, clinically known as"Lipodystrophy."The feces are pale in color and large in volume, with a greasy or foamy substance on the surface, which may float on the water surface, accompanied by a foul odor.

How can pancreatic cancer be detected?

with regards toMiddle-aged and elderly people aged 50-60 with persistent loss of appetite, indigestion, and significant weight lossIt's important to consider the possibility of pancreatic cancer, if it's alsoJaundice with abdominal pain, progressively increasing in severityThe diagnosis is even more important to consider. This is when the appropriate ancillary tests need to be done to clarify the diagnosis.

• The first thing to do is to test for tumor markers, which is relatively simple and easy to do since it is a blood draw program.CA19-9is the most sensitive marker, but there are still a small number of patients who may be negative for CA19-9 by the time they reach an advanced stage.Often combined with CEA, CA125。

• Thin-section CT enhancement scanning is the most clinically recommended for diagnosing pancreatic cancerThe images are more intuitive and help the surgeon to assess the feasibility of the operation, not only to see the mass, but also to clarify the extent of invasion and the relationship with the surrounding organs.

• It has been suggested that pancreatic magnetic resonance (MRI) is the test of choice for the diagnosis of small pancreatic cancers, but there is no clear evidence that MRI is superior to CT, and comparatively more CT is used, with MRI often used as a complementary test.

• Pancreas ultrasoundBecause of its simplicity, it is more suitable for use in screening, and can confirm the diagnosis of pancreatic displacements in more than 80% of cases. There is another type of ultrasound calledultrasound endoscopyIn addition, a probe can be placed inside the stomach to see the extent of pancreatic infiltration, the presence of surrounding lymph nodes, etc. Ultrasonographic endoscopic puncture cytology can also be done in this way to obtain a pathologic diagnosis.

• The other thing is that one of the more expensive tests-PET/CT examinationthat it can show how metabolically active the lesion is.Can define benign and malignant, with higher metabolic activity favoring malignancy，It can also determine if there are metastases in other parts of the body.. This test is recommended when there is a high level of suspicion of pancreatic cancer or when the diagnosis of pancreatic cancer has been clearly established and you need to determine if there are metastases in your systemic areas.

• If pancreatic cancer is suspected, pathologic results are needed to clarify.Only pathologic diagnosis is the gold standard. Ultrasound-guided and CT-guided percutaneous fine needle aspiration cytology can usually be used.

• If pancreatic cancer has been diagnosed, chest CT, whole abdomen CT and pelvis CT are also needed to clarify whether there are distant metastases or not, of course, if PET/CT has been done there is no need to do the above tests.

What should I do after being tested for pancreatic cancer?

If pancreatic cancer is diagnosed it is best to be able to bring together general or hepatobiliary and pancreatic surgery, medical oncology, radiation therapy, radiology, pathology and other related departments.Conducting MDT (Multidisciplinary Comprehensive Treatment) discussions. A comprehensive assessment of the patient's physical condition, tumor stage, and extent of invasion is conducted, and the opinions of various departments are integrated before an appropriate treatment plan is formulated.

• Surgical treatment:Surgery is the most effective way to treat pancreatic cancer. If the tumor is very early, radical resection may be performed. When pancreatic cancer is highly suspected clinically, by blood tests and imaging, and an experienced surgeon considers it completely resectable, surgery may be performed without obtaining a pathologic diagnosis. In patients with advanced disease, palliative surgery may be used to relieve jaundice, obstruction, and pain.

• Chemotherapy: although pancreatic cancer is less sensitive to chemotherapy, some studies have confirmed that compared to surgery alone, thePostoperative chemotherapy can prevent or delay tumor recurrence, thereby improving long-term survival after surgeryHowever, the specific decision of whether or not to chemotherapy depends on the patient's physical condition. If the pancreatic tumor is too large or has developed local lymph node metastasis or the CA19-9 index is too high and so on, it can be considered in thepreoperative chemotherapyThis is called neoadjuvant chemotherapy or induction chemotherapy. Patients who have developed systemic metastases must be treated with systemic therapy such as chemotherapy.

• Radiotherapy: surgery for pancreatic cancer is difficult and is needed for patients with residual tumorpostoperative radiotherapyPrevention of recurrence is usually not necessary in patients with complete resection. It is also feasible if the patient has a pancreatic mass that cannot be completely resected and is in significant painPalliative radiotherapy for pain relief and tumor shrinkage. Usually radiotherapy is combined with chemotherapy.

• Other anti-tumor therapy: If distant metastasis has occurred, and genetic testing shows that there is a gene mutation, corresponding targeted therapy is feasible, such as BRCA1/2 mutation can be given to Olaparib treatment.Patients with distant metastases in good health may be considered for appropriate clinical trialsThe first thing you need to do is to make sure that you are not using your patients as guinea pigs. Here we need to explain to you, clinical trials are not taking patients as mice, for example, certain drugs have been popularized and used abroad, in order to be able to enter the clinical use in the country, into the medical insurance, it is necessary to do clinical trials, basically in the case of safety and security to do. AndClinical trials aren't just for patients who want to be in them, there are strict criteriaThe first thing you need to do is to get a good understanding of the drug and how to use it. However, there are some clinical trials to evaluate the safe dose of drugs, you need to consult your doctor in detail before entering a clinical trial Oh.

• Optimal supportive careIf the patient's physical condition is poor and he/she cannot tolerate the above treatments, he/she can be treated with TCM conservative treatments, symptomatic treatments such as pain relief, and nutritional supportive treatments.

Orange Mom has something to say: For people over 40 years old with persistent symptoms such as loss of appetite, indigestion, significant weight loss, abdominal pain, jaundice, etc., it is important to have timely checkups to rule out the possibility of pancreatic cancer. If unfortunately diagnosed with pancreatic cancer, you should also actively cooperate with your doctor to receive treatment.

I'm @OncologistOrangeOrangeMom and will continue to share more medical related knowledge with you. Thank you for your patience in reading, if it helps, please like, favorite, retweet. If you like my popular science content, please remember to click the upper right corner of the attention oh.

If you have questions about pancreatic cancer, leave them in the comments section and we'll discuss and share them together.

Pancreatic cancer is a very malignant tumor and can be considered the king of cancers, with a very high mortality rate. After diagnosis, most patients die within six months to one year, and the probability of surviving more than five years is only 5%.

Because the pancreas is located in the deep side of the human abdomen, there are no signs and symptoms in the early stage of cancer, so when the patient develops abdominal pain, jaundice, fever, emaciation and other symptoms, it is often the advanced stage of cancer. Pancreatic cancer has another very annoying feature, that is, pancreatic cancer is insensitive to radiotherapy and chemotherapy, and pancreatic cancer is very difficult to operate, which needs to resect a part of the stomach, the duodenum, the pancreas, bile ducts, gallbladder, and requires reconstruction of the intestine and biliary tract. It also requires the removal of part of the stomach, duodenum, pancreas, bile duct, and gallbladder, and requires intestinal reconstruction and biliary reconstruction, with a high probability of postoperative complications.

Since there are no symptoms in the early stage of pancreatic cancer, the only way to detect pancreatic cancer early is through regular medical checkups. The commonly used means of examination are as follows:

First, color ultrasound

This is the most commonly used physical examination procedure, ultrasound has no radiation, the examination is very convenient and can be repeated. Pancreatic cancer appears as a nodule in the pancreas on top of the ultrasound.

Second, CT scan

CT examination is more advantageous than ultrasound, CT not only can be plain scan, but also can do enhancement scan to understand whether the tumor has invaded blood vessels, whether there is lymph node metastasis, and how it is related to the surrounding organs.

Third, MRI

MRI has a higher soft tissue resolution compared to CT and can also look at the bile ducts, which can complement CT.

Fourth, ERCP examination

The full name of the ERCP test is transendoscopic retrograde cholangiopancreatography, which shows the pancreatic and bile ducts and also takes biopsies that can help confirm the diagnosis.

Of course, there are also blood tests to check the bilirubin level and the level of the tumor marker CA199.

Therefore, pancreatic cancer can only be detected at an early stage through regular medical checkups, and treatment is mainly surgical, but overall, the prognosis is very poor.

Pancreatic cancer can be detected by several methods, including laboratory tests, imaging, and histopathology:

Laboratory examination: 1. Blood biochemical examination: there is no abnormality in biochemical indexes in the early stage of pancreatic cancer, but when the tumor obstructs the bile ducts, liver function abnormality will appear, accompanied by the elevation of alanine aminotransferase and glutamine aminotransferase.2. Tumor marker examination: serum CA19-9 can be elevated more than 10 times in the case of pancreatic cancer, and other markers of pancreatic cancer also include carcinoembryonic antigen, glycoantigen CA242, glycoantigen CA50, and glycoantigen CA241, and so on. antigen CA242, glycan antigen CA50.

Imaging examination: 1. Abdominal ultrasonography: if the pancreas is found to have unclear boundary, hyperechoic and limited enlargement, it is suggestive of pancreatic cancer. 2. Endoscopic ultrasonography: it can accurately show whether the tumor foci involve surrounding blood vessels and lymph nodes and whether there is any metastasis. 3. Endoscopic ultrasound: it can accurately show whether the tumor lesion involves the surrounding blood vessels and lymph nodes with or without metastasis, which is of great significance for the early diagnosis of pancreatic cancer, but it is also easily affected by the level and experience of the operator.3. CT:1) Scanning: it can show the size and position of the lesion, but the relationship between the lesion and the surrounding structures is poorly displayed.2) Enhancement: it can show the size, position, internal structure of the lesion and the relationship between the lesion and the surrounding structures.4. (MRI): it can detect lesions less than 50px, and it can detect lesions that are suspected of pancreatic cancer but not detected by CT scanning and enhancement. If the patient wants to do enhanced CT but is allergic to iodine contrast agent, he/she can do nuclear magnetic resonance.

Third, histopathological examination: this examination is the gold standard for diagnosing pancreatic cancer, and patients must undergo pathological examination to confirm the diagnosis before radiotherapy.

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More than 95% of pancreatic cancers in clinical practice are exocrine cancers, so today we will take exocrine pancreatic cancer as the target and talk about how to detect the disease.

The clinical presentation of pancreatic cancer lacks specificity, and by lack of specificity, I mean that what pancreatic cancer can have can be found in other diseases, so the doctor needs to decide what tests to use based on the patient's specific clinical presentation.

Typically, there are two main types of tests for pancreatic cancer, blood tests and ancillary tests.

blood test

For example, the most common clinical manifestations of pancreatic cancer are jaundice and right upper abdominal pain because hepatobiliary related diseases (e.g., acute hepatitis, bile duct cancer, etc.) also often manifest as jaundice and right upper abdominal pain. Therefore, for laboratory tests, the doctor may check the levels of liver enzymes (aminotransferases, alkaline phosphatase), bilirubin and pancreatic lipase, and tumor markers (CA 199) to rule out the possibility of other diseases or to further clarify the diagnosis. If it is the liver enzyme and bilirubin levels that are significantly elevated, then the cause may be in the hepatobiliary system, and if the pancreatic lipase is significantly elevated, then it is possible that inflammation of the pancreas rather than cancer is the cause.

complementary checkup

If jaundice is the main manifestation and there is no abdominal pain, the doctor may choose abdominal ultrasound because it is very sensitive to biliary dilatation and has a high sensitivity (>95%) for pancreatic tumors >3 cm (pancreatic cancer appears on ultrasound as an "irregularly bordered hypoechoic area"). However, ultrasound is less sensitive for pancreatic tumors <3 cm in size, probably due to gas interference in the ileum.

If patients with abdominal pain as the main clinical symptom, doctors may use abdominal CT first, because if it is acute pancreatitis, abdominal CT can play a good role in identification; if pancreatic cancer is suspected, abdominal CT not only has an important reference value, but also helps to determine whether it is feasible for surgical treatment. Therefore, abdominal CT is an important examination for all patients with suspected pancreatic cancer.

In clinical practice, because of the popularity, convenience and relatively low price of abdominal ultrasound, abdominal ultrasound is often performed first, and if abnormalities are detected, then abdominal CT is performed to obtain more detailed information.

Tests to confirm the diagnosis of pancreatic cancer

Pancreatic cancer does not necessarily require preoperative pathologic biopsy; if abdominal CT is highly suspicious of pancreatic cancer and surgery is possible, surgery can be performed directly; conversely, if the diagnosis cannot be determined on the basis of abdominal CT, or if it cannot be determined whether or not surgery is possible, then follow-up examinations should be performed.

For patients suspected of having bile duct stones, the doctor may recommend ERCP (Endoscopic Retrograde Cholangiopancreatography), which refers to the technique of injecting contrast through the duodenoscope to visualize the pancreatic and biliary ducts, not only diagnostically, but also therapeutically to relieve the obstruction. For patients who cannot undergo ERCP, the doctor may recommend MRCP (Magnetic Resonance Cholangiopancreatography), which has the advantage of being non-invasive.

For patients whose previous tests have been negative and there is a high suspicion of pancreatic cancer, the doctor may recommend an endoscopic ultrasound fine-needle aspiration biopsy, which has a high sensitivity and specificity.

In conclusion, the final diagnosis of pancreatic cancer is still the pathology examination, because only the pathology examination can know the most definite information about the cancer, such as what type of pathology it is and how differentiated it is.

Reference:

UpToDate：Clinical manifestations, diagnosis, and staging of exocrine pancreatic cancer

Pancreatic cancer is highly malignant with limited treatment and a very poor prognosis.

From the beginning of pancreatic cancer, patients will experience severe pain in the abdomen and lower back, difficulty in eating, jaundice and other symptoms, and after the diagnosis of pancreatic cancer, they will also undergo traumatic treatments such as surgeries, radiotherapy, chemotherapy and other treatments with many side effects. However, even after a standardized program of full treatment, its effect is still limited, and the whole course of the disease is more painful.

Course of two cases of typical pancreatic cancer

Case 1 Resectable pancreatic cancer: A male, 46 years old, who eventually died after treatment of pancreaticoduodenectomy, adjuvant chemotherapy, recurrence, radiotherapy, and re-chemotherapy starting with the diagnosis of pancreatic cancer, with an overall survival of 15 months.

Case 2 Unresectable pancreatic cancer: Male, 72 years old, started with the diagnosis of pancreatic cancer, underwent surgical exploration, chemotherapy, tumor progression, and re-chemotherapy and eventually died, with an overall survival of 5 months and 29 days.

More than 80% of pancreatic cancers are found at an advanced stage.

Why is it that most people find pancreatic cancer at an advanced stage? This is related to the special anatomical location of the pancreas and its own biological characteristics.

Pancreatic cancer has no relatively obvious clinical symptoms, is due to the anatomical location of the pancreas in the interior of the abdominal cavity, with the spleen on the upper left, the liver on the upper right, the colon and stomach in front, and blood vessels, nerves, muscles, and the spine behind. When there is a problem with the pancreas, it is often related to all of the surrounding organs in some way, and it is easy to mistake the diagnosis for a problem elsewhere.

For example, repeated epigastric fullness and discomfort are misdiagnosed as gastrointestinal diseases; low back pain is treated as lumbar muscle strain, lumbar disc herniation and other orthopedic diseases; sudden eye sclera yellowing is simply thought to be hepatitis. The new discovery of uncontrollable elevated blood sugar thought diabetes and other endocrine diseases at work ......

On the other hand.It's hard to detect pancreatic cancer on a normal routine physical exam.. It is difficult to see the pancreas, which is obscured by the stomach and intestines and gas, with the ultrasound of the routine medical checkup, and it is difficult to promote the high-resolution CT, which has the function of screening, in the routine medical checkup program due to its high price. More people are lack of awareness of health checkups, and early detection of signs of disease is even more impossible to talk about.

Screening: starting around age 50

For people at high risk for pancreatic cancer, it is best to start screening around age 50.

(1) Tumor marker tests

Carcinoembryonic antigen (CEA)The assay is elevated in about 70% of patients with pancreatic cancer, but is also nonspecific.Digestive tract cancer-associated antigen (CA19- 9)It is considered an indicator for the diagnosis of pancreatic cancer.

(2) PET/CT examination

The mainstay of treatment for pancreatic cancer is surgery, but only 20% of patients have access to surgical treatment.On the one hand, this is due to the lack of histologic diagnosis; on the other hand, it is impossible to confirm whether pancreatic cancer tumors are benign or malignantThe patient will not be able to get a good chance of removing the malignant pancreatic tumor. Thus, the patient misses a good opportunity to remove the malignant pancreatic tumor at the same time it will bring great pain to the patient.

PET/CT examination integrates PET and CT, i.e. PET image provides molecular information such as metabolism and function, and CT provides fine pathological and anatomical information, and through the fusion technology, the pathophysiological changes of pancreatic cancer tumors can be obtained at the same time as the morphological changes, which has the characteristics of clear imaging and high sensitivity, and the results are also more comprehensive, so that it can provide effective bases for the patients to formulate the treatment plan. It can provide effective basis for patients to formulate treatment plan.

In conclusion, with more eyes on pancreatic cancer and regular screening for high-risk groups, I believe early detection is no longer difficult.

Two elements are needed to confirm the diagnosis of any disease one is the symptoms and signs, but the results of the examination, the same is true for pancreatic cancer, the figure below is the CT image of pancreatic head cancer:

CT reveals a distinct mass in the head of the pancreas, which is hypointense, enhances into mixed mild enhancement with indistinct margins, and involves the surrounding vascular wall.

What are the clinical symptoms of pancreatic cancer?1, pain and fullness in the upper abdomen is a common symptom of pancreatic cancer, usually the pain is in the middle of the upper abdomen and the left position, and some patients will have pain in the right abdomen, and some patients will have pain in the right abdomen, and some patients will have pain in the right abdomen, that is, the pain will be aggravated by pressing the painful position. 2, pancreatic cancer is a very important digestive organ, so in the early stage, there will be digestive symptoms, such as loss of appetite and loss of appetite. The pain of pancreatic cancer will be aggravated at night, and the pain will be slightly relieved when keeping the upper body curled up.2. Pancreas is a very important digestive organ, so in the early stage of the disease, there will be digestive symptoms, such as loss of appetite, nausea, vomiting, constipation, or diarrhea, and if accompanied by gastrointestinal hemorrhage, then there may be vomiting of blood, black stools (i.e., there is blood in the stools).3. Because of the secondary occurrence of biliary tract obstruction, patients with pancreatic cancer will have progressive pain, which will be aggravated by pressing hard on the location of pain. Pancreatic cancer patients will have progressive jaundice, that is, the skin, urine, and the whites of the eyes are yellow, and at the same time, the stools will become typical clay-like stools.4. Generally, in the late stage, the abdomen can be palpated with lumps.6. Blood glucose or other endocrine indexes are abnormal all of a sudden.

Pancreatic cancer related examination: b ultrasound, ct, nuclear magnetic resonance (NMR) can be used to check whether there is any pancreatic occupation, abnormality, etc. If suspicious occupation is found, CT and MRI enhancement examination are needed, and it should be said here that MRI can also be used to do mrcp (pancreatic cholangio-peritoneal imaging), to observe whether there is any obstruction or dilatation of bile duct system. In addition, pancreatic enzyme test, corresponding tumor marker test will also find abnormalities, take tumor tissue for pathology test can also be used to confirm the diagnosis of pancreatic cancer.

For the diagnosis of pancreatic cancer, various examinations on the one hand, and various physical signs and symptoms are not to be ignored, and the two should be combined for joint reference and diagnosis.

Pancreatic cancer has the name of "king of cancer", because the pancreas is located deep, long tumors, early and often no special performance, even if there are some symptomatic manifestations, there is no specificity, easy to be mistaken for other indigestion and other problems, it can be said that pancreatic cancer is very difficult to early detection. Some people will say, then take the initiative to check, but at present there is no clear and effective means of screening for pancreatic cancer, in this way, pancreatic cancer is often diagnosed in most cases is already advanced. And advanced pancreatic cancer, there is no effective means of treatment, the existing treatment, its efficacy is very unreasonable like, pancreatic cancer death rate is very high, the prognosis is very poor, let a person heard the color.

However, it is still important to pay attention to some of the manifestations, and once these manifestations occur, it is important to consult a doctor for examination, even though it may not be in the early stages, it is better to examine them earlier than later.If you are over 40 years old and have the following manifestations, you should be alert to the possibility of pancreatic cancer and go to the hospital for further examination in time to make a clear diagnosis.(1) unexplained obstructive jaundice; (2) recent unexplained weight loss of more than 10%; (3) recent unexplained epigastric or low back pain; (4) recent vague and unexplained dyspepsia with normal endoscopy; (5) sudden onset of diabetes mellitus without predisposing factors, such as a family history or obesity; (6) sudden onset of steatorrhea with unexplained diabetes; (7) spontaneous episodes of pancreatitis; (8) and chronic smokers, doubly so.

When the possibility of pancreatic cancer is suspected, the next step is further testing, and how?

1, tumor markers, especially CA199 on pancreatic cancer sensitivity and specificity are okay, and simple and convenient, can be used as a reference, but it must be remembered: you can not only use the results of this test to determine whether the pancreatic cancer, especially when the results are normal, do not be mistaken for not having pancreatic cancer, which can be a mistake.

2. Imaging tests, such as ultrasonography, enhanced CT, enhanced MRI and other tests.

3、Pathological examination: If the imaging examination finds pancreatic space-occupying lesions and the blood test suggests that CA199 is elevated, the clinical diagnosis of pancreatic cancer should be considered regardless of whether there are those manifestations mentioned above or not, and the final diagnosis requires pathological examination (biopsy or surgery).

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I am Dr. Shadow, an imaging doctor. Pancreatic cancer is also known as the king of cancers. It is highly malignant and metastasizes quickly, and a small lesion can invade the surrounding vascular tissues, making it inoperable and insensitive to radiotherapy and chemotherapy, and there is no good treatment for pancreatic cancer at present. The survival rate of pancreatic cancer is very low, and the famous Steve Jobs went away because of this disease.

Why pancreatic cancer has a poor prognosis

Pancreas is located in a deeper position, early pancreatic cancer often does not have any symptoms, even if there is a little bit of hidden pain symptoms, many people do not care about it, and some of them treat it as stomach pain, thus delaying the treatment. Early stage pancreatic cancer can be treated by surgery, but even if it is surgical treatment, the operation is very difficult and often the surrounding tissues and organs have to be cut off together in order to reduce the possibility of recurrence and metastasis. As the cancer increases in size, the risk of invading surrounding organs and metastasis is also increasing. A very small lesion can cause biliary obstruction, jaundice, metastasis to other organs and lymph node metastasis, and at this time, there is often no good treatment for it, and it cannot be operated. Pancreatic cancer is insensitive to chemotherapy and radiotherapy, and so the prognosis is very poor.

This is a case last month, due to left upper abdominal pain for 1 day, did CT found pancreatic cancer with obstructive jaundice, multiple lymph node metastasis, large amount of fluid in the abdominal cavity, like this condition for at least a month, but only one day of pain, so it is difficult to detect pancreatic cancer in the early stage, and can be detected very late, more than a year of survival rate are very few.

What are the tests for pancreatic cancer?

To detect pancreatic cancer, as an imaging physician, ultrasound is not recommended. This is because ultrasound is very dependent on luck for the observation of the pancreas, and also on the level of the doctor doing the ultrasound. Luck means that the interference of intestinal gas affects the observation. So sometimes there are small lesions that can't be detected. Usually it is very big to be seen.

Recommended to do CT or MR scan + enhancement scan, CT can be a 1mm layer of thin layer scanning, can detect very small lesions. Pancreatic cancer is a cancer with a lack of blood supply, so enhancement is needed to detect it. It is very difficult to detect early pancreatic cancer by scanning alone, CT scanning + enhancement can not only indicate pancreatic cancer, but also observe the tumor invasion of the surrounding tissues, whether there is any invasion of blood vessels, and whether it can be surgically resected, which are all evaluated by CT.

Tumor markers in the blood, may see some indicators are elevated, but only as a hint of significance, to see high tumor markers and then go to find out where the cancer may grow. CT or MR scanning + enhancement scanning of the upper abdomen can actually see the lesions and can also be staged.

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Dr. Yu Xianjun, Chief Physician of Pancreatic Surgery Department, Affiliated Cancer Hospital of Fudan University, introduced:

Some patients may ask why pancreatic cancer is not detected early even though they have physical examination every year. It is because it is very difficult to detect early pancreatic cancer by ordinary physical examination. The most common physical examination is ultrasound, but because the pancreas is covered by the gastrointestinal tract and there is a lot of gas, ultrasound is not sensitive, so it is very easy to miss the diagnosis. At present, the commonly used serum markers such as CA19-9 in early diagnosis, whether sensitivity or specificity, is still a certain distance from the clinical requirements, so it is also not the best way to detect.

So what is an effective screening method for pancreatic cancer? In terms of imaging, nowadays the pancreatic CT with thin spiral can detect pancreatic tumors as small as one centimeter or even five millimeters, so CT is a very important tool, both for early detection of tumors and for the perception of the structural relationship between the tumor and the surrounding organs and blood vessels, which gives us a very great convenience. However, we should not be superstitious about magnetic resonance, of course, magnetic resonance is also a very good method. Perhaps some patients may think very simply that magnetic resonance is better than CT because it is more expensive, but in actual examination, what is expensive may not necessarily be good, and the practical method is the best. Magnetic resonance also has its role in identifying fat gaps and blood vessel gaps to help the surgeon determine the resectability of the surgery.

Another very important test is ultrasound endoscopy. The emergence of ultrasonic endoscopy is a technological breakthrough. A set of ultrasonic probes is installed on the gastroscope, which can go to the stomach and examine the pancreas with ultrasonic waves, which is very close to the pancreas and can see it very clearly, and more importantly, it can directly puncture the pancreas, conduct biopsy, clarify the nature of pancreatic tumors, and determine the further treatment strategy, which has been proved by a large number of clinical practices. However, ultrasonic endoscopy is a technical work, which is very demanding on the doctors who perform and operate it, and requires long-term training and very high requirements on the equipment.

Another important test is PET-CT, which is very good in that it can diagnose the benign and malignant nature of pancreatic cancer, and it has an advantage that ultrasound endoscopy does not have - it is non-invasive, and it can also scan the whole body to find out whether there is any metastasis in the distant places. However, PET-CT is economically demanding and has some false positives and false negatives.