What is Carcinoma of Pancreas?: Article

Carcinoma of Pancreas

Introduction

This tumor has been increasing in incidence during the twentieth century and now is second only to colon carcinoma which is the number one cause of gastrointestinal cancer-related deaths. Men are affected more commonly than women, and the average age at a presentation is 55 to 65 years.

Pancreatic cancer rarely occurs before the age of 40 or less, and more than half of cases of pancreatic adenocarcinoma occur over the age of 65 to 70. Risk factors for pancreatic cancer include diabetes, smoking, obesity, and certain rare genetic diseases. About 35% of cases are related to smoking, and 6-10% of cases are related to genetics. Pancreatic cancer is usually diagnosed through a combination of medical imaging techniques (such as ultrasound or computed tomography, blood tests, and tissue sample examinations (biopsy)). The disease is divided into early (stage I) to late (stage IV). It has not been found that screening for the general population is effective.



Causation / Etiology

The risk of pancreatic carcinoma is significantly increasing in patients with:
  1. Family history
  2. Smoking
  3. Diabetes
  4. Coffee
  5. Sometimes alcohol but unknown

Symptoms / Sign

Common symptoms are:
  1. About 75% of patients are pain that has been present for 3 - 4 months by the time of diagnosis. This pain typically is postprandial, epigastric, or periumbilical discomfort, which radiates to the back and is relieved by sitting up or bending both knees.
  2. Jaundice is present in about 65% of patients and weight loss is described in 60% of patients.
  3. Diarrhea and steatorrhea also are somewhat common.
  4. The gallbladder may be palpable in some cases.
  5. A palpable epigastric mass may be found in physical examination.
  6. Loss of appetite.
  7. Constipation is also a common factor for pancreatic disease.

Less common symptoms:
Unexplained thrombophlebitis, depression, and the new onset of diabetes mellitus.



Carcinoma Head of Pancreases

Rapid tumor enhancement and specific biochemical characteristics may indicate endocrine tumors. Although non-ductile tumors are usually solid, imaging confirmed cystic components in isolated pancreatic masses suggest that non-ductile tumors have a much better prognosis, with a 5-year survival rate of 40% to 60%.

In the case of suspected pancreatic head cancer, the first step is the stage of the disease and the assessment of the patient's health status. In some cases (advanced tumors or distant metastases), histological confirmation and non-surgical treatment (stents) are the best options. Various imaging techniques may suggest diagnosis or resectability (ultrasound, computed tomography, magnetic resonance imaging, angiography, endoscopy ultrasonography) or potential diagnostic methods, but even with all cytological techniques (endoscopic retrograde pancreaticobiliary duct Brush cytology during angiography, percutaneous fine needle aspiration (in 10-15% of cases, cancer and chronic pancreatitis cannot be distinguished. This means that in practice, one in five patients with suspected pancreatic cancer is There may be no diagnosis after completing the staging plan.



What is the difference between Carcinoma of the pancreas and Chronic pancreatic disease?

Even during surgery, it is difficult to distinguish chronic pancreatitis from cancer. The false-negative rate of intraoperative biopsy for detecting pancreatic cancer is about 8%. These results indicate that it is unreasonable to use nothingness for suspected but unproven malignant pancreatic head masses. If an experienced pancreatic surgeon cannot rule out pancreatic cancer, pancreaticoduodenectomy should be performed for any tumor even without histological confirmation.



Investigation
  1. Elevated serum alkaline phosphatase level in 80% of patients, which often is due to hepatic metastasis but may be due to compression of the pancreatic portion of the common bile duct.
  2. Elevated levels of CEA, lactate dehydrogenase(LDH), in 65% of patients and 25% of patients have high serum amylase levels.
  3. An upper gastrointestinal X-ray series may reveal a widened loop or an "inverted 3" sign due to indentation by the pancreas along the medical aspect of the duodenum.
  4. CT and ultrasonography of the pancreas demonstrate a mass in 57% to 80% of the cases.
  5. ERCP is abnormal in approximately 85% to 90% of patients.
  6. Angiography may reveal displacement or encasement of the pancreatic or duodenal arteries.
  7. Hyperglycemia, glycosuria, impaired glucose tolerance test are some of the other findings.


Treatment

Surgery is the mainstay of therapy, but only 15% of patients are candidates for curative resection.
Chemotherapy has a 15% TO 20% response rate but does not prolong survival.
Radiotherapy decreases the size of the tumor mass in about 60% to 70% of patients and can be used for pancreatitis.



Homeopathy

Symptomatic medicines can restrict any disease even pancreatic carcinoma because homeopathy believes in constitutional treatment.

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