The diagnosis of pancreatic cancer

Diagnosis of pancreatic cancer, especially in the early, difficult. It is necessary to take into account the sometimes slow the progression of the disease, rapidly progressive weight loss, pain and their character, symptoms pressing on nearby organs, mechanical jaundice (cancer of the head), pancreatic filiu events creatorii and steatorrhea, x-ray compression changes on the part of the duodenum and stomach, carbohydrate metabolism, changes in the contents of pancreatic enzymes in the blood, urine and duodenal contents, as well as anemia and accelerated ROHE. Pathognomonic signs of the disease there.
The results of functional and laboratory methods for the early diagnosis of pancreatic cancer compared with the General clinical and radiographic data are of secondary importance, since even in advanced lesions of the pancreas tumor process can be fully preserved its secretory and endocrine activity.
For pancreatic cancer, compared with chronic pancreatitis is more usually volume reduction secreta when possible retaining the concentration of bicarbonate and enzymes (Twiss and Oppenheim, 1955). This is because the cancer is more striking in the area of the excretory ducts, little disturbing the parenchyma of the authority.
A. A. Shalaurov, Lemon and others point to the well-known diagnostic value of cytological study of duodenal contents for tumor cells, especially after the introduction of pathogens secretion, increasing the likelihood that the revenues of cancer cells in the duodenum. It should be noted that the presence of atypical cells in the duodenal contents out of touch with other symptoms do not allow to solve the problem on the localization of the tumor. For the diagnosis of cancer using cytological test with fluorescence tetracycline. Last enter 1 g per os 3 days in a row, and then examine lyuminestsiruyushchikh duodenal content obtained through secretin; cancer cells while possess fluorescence (Kaplan and others, 1965).
Some diagnostic value gives the definition of the enzymatic activity of blood and urine. N. I. Leporsky (1951) hyperamylasemia was found in 40%, a Twiss and others (1955) - half of the patients. A. A. Shalaurov (1960) increased amylase blood and urine more often found in cancer of the head than the body of cancer.
A few more important for the diagnosis of cancer in the body and tail of the pancreas is given hyperlipasemia (Comfort, Osterberg, 1940). Currently, the recommended definition of enzymes of blood after the application of various stimulants pancreatic secretion, which allows to detect deviations, even in cases where conventional studies of enzymes do not detect changes, but literature data about this is controversial.
It should be noted that the increase of enzymes in the blood and urine happens only in case of obstruction by the tumor ductless. In total defeat cancer or caused by long clogged duct atrophy glandular tissue enzyme content, for example, can be reduced. Thus, determination of enzyme activity of the blood may be of diagnostic value mainly in cancer of Vater nipple or the pancreatic head and a much smaller for the diagnosis of cancer of the body and tail.
Steatorrhea and creatore with pancreas cancer is comparatively rare (4-10% of patients), and therefore have limited diagnostic value.
Disorders of carbohydrate metabolism also not pathognomonic for pancreatic cancer, but they are observed more often in this disease (especially cancer of the body and tail)than in cases of cancer in other organs.
Laboratory values for the diagnosis of pancreatic cancer are not specific, however, the discovery of their persistent deviations from the norm when conducting various samples forces with appropriate clinical picture to suspect the disease.
The establishment of topical diagnosis of cancer of the head, body and tail of the pancreas is not always reliable.
In cancer of the head is the most typical appearance of obstructive jaundice with symptom Courvoisier on the background of non-permanent pain in the upper abdomen, weight loss, indigestion, radiological signs of embarrassment duodenal ulcers, with more or less pronounced changes in functional activity of the pancreas.
In cancer of the body and the tail on the background of weight loss and diarrheal illness in the absence of mechanical jaundice in patients tend to be unbearable pain, occurs more often associated migrating thrombophlebitis in the vessels of the extremities, and abdominal cavity (splenic vein thrombosis). However, such thrombophlebitis possible with cancer of different localization (stomach, lungs and other). The development of metastases, of course, complicates diagnostics. In the localization of cancer in the body and tail cancer may be a systolic murmur in the left hypochondrium, due sdavlennoy splenic vein (Bauerlein and others, 1965).
The differential diagnosis between cancer of the pancreas head cancer and cancer of Vater nipple is difficult, but in some cases possible.
Cancer of Vater nipple is less common cancer of the head cancer; men more often than women. It develops from covering it epithelium, as well as from the epithelium of capsules, Wirsung duct occured or the terminal part of the common bile duct. It gives the basis to consider these tumors tumors periampular zone. Depending on the initial tumor localization initial symptoms can be different. In cancer of terminal part of common bile duct first sign of disease is mechanical jaundice; when cancer that originates in the walls of the duodenum, jaundice often combined with intestinal bleeding; cancer of Vater nipple in connection with infection of the bile ducts usually develops cholangitis, which causes fever, chills, jaundice before the full - flow. Patients usually loss of appetite, weight loss. Main symptom is progressing mechanical jaundice with an enlarged liver and sometimes a symptom of Courvoisier.
Some features of the symptoms of cancer periampular zone a certain extent, allow for differential diagnosis of cancer of the pancreas head, these include more frequent dull pain in epigastralna area occurring concurrently with develop jaundice, a phenomenon associated cholangitis with chills and fever, undulipodia nature of jaundice with long-term observation, the possibility of temporary remissions with complete disappearance of jaundice (restoration of patency of the disintegration of the tumor). A very important symptom is considered intestinal bleeding in the form melena (or firmly positive reaction of yens Gregersen collection)arising from the pitting of the tumor. This symptom is more likely to occur when cancer duodenal part of Vater nipple than in cancer ampoules and ductless. In cancer of the pancreatic head intestinal bleeding is rare. Chest x-ray is sometimes possible to detect local changes in the relief of the mucosa of the duodenum, but these symptoms usually are late. More valuable information can be obtained by the method of cholangiography during laparotomy, and research fibrobronchoscope, selective angiography.
Despite these clinical features of pancreatic cancer, his final diagnosis can often be solved only by the surgeon after a trial duodenotomy followed urgent biopsy.
Life expectancy at pancreas cancer ranges from six months to one and a half years, sometimes longer. Skirr gives greater the duration of the course than adenocarcinoma. Young cancer has more malignant course. Considerable importance is also the tumor location: lower life expectancy in cancer of the head and more with cancer of the body and especially the tail cancer.