Pancreatic cancer is advanced once discovered? How should it be treated?

The topic of pancreatic cancer discussion these two days is "lived" on the hot search list, every day in front of people's eyes
.

Pancreatic cancer, a disease, has become a topic
of concern for more and more people.

This Xiaobian today takes you to understand what pancreatic cancer surgery is like, why it is the largest surgery in surgery, and why pancreatic cancer is called "the king of cancer"?

Pancreatic cancer surgical steps

Most of the surgery for pancreatic cancer is whipple surgery, also known as Whipple surgery, which is pancreatic and duodenectomy, which is used for the surgical treatment
of diseases such as middle and lower bile duct cancer, lacked periabdominal cancer, duodenal malignancy, pancreatic head cancer, serious pancreas, duodenal injury and other diseases.

Procedure in general:

(1) There are two commonly used incisions, one is the oblique incision under the right rim; Another commonly used incision is a straight incision in the right upper abdomen
.

(2) C-section exploration
.

(3) Free the duodenum segment 2 together with the pancreatic head from the peritoneum forward
.

(4) Free duodenum and pancreatic head
.

(5) Free transverse colon hepatic curvature and right end
of transverse colon.

(6) Check the changes in the pancreas and their relationship
with the mass.

(7) Gastroresection, gastrojejunal anastomosis
according to Hoffmeister surgery.

(8) Separate the lymphatic - adipose tissue around the artery and remove
it together with the pancreas and duodenum.

(9) In general, it should be removed
together with the gallbladder.

(10) Cut the pancreas
.

(11) The portal vein leaves
the hook process of the pancreatic head.

(12) Completely remove the hook process of the
pancreatic head.

(13) Reconstruction
of the digestive tract after pancreatic duodenectomy.

(14) Bile duct jejunal anastomosis
.

(15) Placement of drainage in the abdominal cavity
.

Treatment of pancreatic cancer

Pancreatic cancer varies according to the stage of the disease
.

First, surgical treatment: surgery is the only way to cure the cure, pancreatic cancer if found relatively early, limited location, can be radical resection, is currently the most effective method, for obstructive jaundice, and can not be removed pancreatic cancer, you can choose gallbladder or bile duct jejunal anastomosis, intervention under stent implantation, thereby reducing jaundice, improve the patient's liver function, improve the quality of
life.

Second, chemotherapy: including neoadjuvant chemotherapy, postoperative chemotherapy, local progression, can not be surgically removed or transferred to the patient's palliative chemotherapy, commonly used chemotherapy drugs are gemcitabine, 5-fluorouracil, as well as capecitabine, oxaliplatin, paclitaxel (albumin-conjugated type), these drugs can be used in
combination.

Third, radiotherapy: it is decided after comprehensive evaluation that radiotherapy must be combined with chemotherapy, and patients who cannot tolerate chemotherapy can be radiotherapy alone
.

Pancreatic cancer has high resistance to radiation therapy, and there are many cavity organs around the pancreatic head, which cannot tolerate high doses of radiation, thus limiting the effect of
radiotherapy.

For patients with pancreatic cancer with long-term metastases, radiotherapy can alleviate the abdominal and back pain
caused by cancer to some extent.

Fourth, other treatments: including molecularly targeted drug therapy, immunotherapy, interventional embolization therapy, traditional Chinese medicine therapy and other symptomatic supportive therapy
.

Pancreatic cancer detection

Pancreatic cancer, the degree of malignancy is very high, the treatment effect is very poor, it is not easy to find early, more importantly, the surgical trauma is particularly large, the largest surgery in surgery, almost hollowing out the upper abdomen
.

The USPTSF's Evidence Report states: "If screening (MRI/EUS, etc.
) contributes to surgical resection of early pancreatic cancer, then the discovery of pancreatic cancer and its early lesions can improve survival
.
"
Because pancreatic cancer is rare, identifying the highest risk population for pancreatic cancer is critical
to developing a meaningful screening or early detection plan.

”

In the general population, the lifetime risk of pancreatic cancer is about 1.
3%.


If the lifetime risk of pancreatic cancer is more than 5%, we call it a person at high risk of pancreatic cancer (high-risk population).


In pancreatic cancer, 85 to 90% are sporadic, 5 to 10% are familial, and 3 to 5% are inherited genetic syndromes (CDKN2A, BRCA1/2, PALB2, etc.

).

Guide recommendations

According to the "Chinese Pancreatic Cancer Diagnosis and Treatment Guidelines (2021)" recommendations

1. Patients with unresectable advanced pancreatic cancer should be actively treated systematically based on their fitness status, with combination regimens
   preferred.
   
   

   
   

2. All patients with unresectable advanced pancreatic cancer are recommended to participate in relevant clinical studies and perform genetic testing to determine the best drug therapy
   .
   
   

   
   

3. Genetic testing for embryonic pancreatic cancer susceptibility is recommended for all patients with confirmed pancreatic cancer; Carriers of pathogenic or potentially pathogenic germline variant genes are screened
   at specialized institutions for genetic counseling or at high-flow pancreatic centers.
   
   

   
   

4. Pancreatic cancer patients should undergo BRCA1/2, PALB2, MSI-H/dMMR, TMB testing; Priority is given to the use of tumor tissue for genetic testing, and if tumor tissue testing is not feasible, free cell DNA testing may be considered
   .