The etiology of this disease is still inconclusive, and it has a certain relationship with environmental carcinogens. People who are depressed and addicted to alcohol and tobacco have a higher incidence. Chronic pancreatitis and hepatolithiasis may be related to this disease. The incidence of diabetic patients has increased significantly.
About 60% of pancreatic cancer occurs in the head, 25% in the body and 5% in the tail. More than 80% of them are vascular cancers, followed by acinar cell cancers, and other types of cancers are rare. The disease can metastasize to local lymph nodes in the early stage and mediastinal and supraclavicular lymph nodes in the late stage. At the time of diagnosis, 1/2 had liver metastasis, 1/3 had duodenal invasion, and 1/4 had peritoneal implantation. Bone metastases from the lung and spine are also common.
Clinical manifestations vary with the oppression and influence of tumor on adjacent organs.
1. Pancreatic head cancer (including periampullary cancer):
(1) General symptoms: anorexia, dyspepsia, nausea, vomiting, abdominal distension, diarrhea, constipation, etc. Early onset, then weight loss. Vomiting is more severe and persistent when cancer invades the duodenum or stomach and causes obstruction.
(2) Jaundice: Painless jaundice is the main symptom of pancreatic head cancer, which is caused by compression of common bile duct. Jaundice is obstructive. With the development of the disease, it gradually deepens, from light yellow to orange or dark green, with itchy skin, black tea urine and white mud stool. Jaundice is mostly persistent, and some patients can subside to varying degrees, but they cannot return to normal.
(3) Hepatomegaly and gallbladder enlargement: due to biliary obstruction and cholestasis. If the obstruction lasts for a long time, liver function damage may occur. Late cases may be accompanied by biliary tract infection. Fever or persistent stuffy pain occurs and radiates to the right upper abdomen and back, especially when the cancer spreads to the pancreatic body.
2. Pancreatic body cancer: it grows quietly in the early stage, but it is asymptomatic. With the progress of the disease, the surrounding organs are affected and corresponding symptoms appear.
(1) Pain: Because the cancer invaded the pancreatic body adjacent to the celiac plexus, all the pain occurred in the upper abdomen, right upper abdomen or periumbilical region. Persistent dull pain or paroxysmal severe pain, often radiating to the back and shoulders. When you sit up and bend your lower limbs, you can relieve the pain. Lying flat or sitting half, the pain is aggravated. Some nights there will be more severe pain, and severe pain may be accompanied by vomiting.
(2) Mass: The pancreas is located behind the peritoneum, and the smaller pancreatic body cancer is generally difficult to reach. If the mass can be felt in the upper abdomen, it is mostly late. The lump is hard, the boundary is unclear, it is fixed, and the tenderness is light or not obvious.
(3) Systemic symptoms: emaciation, fatigue, constipation, insomnia, depression, and splenomegaly if there is splenic vein infarction.
3. Pancreatic tail cancer: Symptoms are hidden, and symptoms such as anorexia, dyspepsia, emaciation and fatigue, and vague left upper abdominal mass may appear in middle and late cases. Pain is rare, and if it occurs, it can radiate to the left chest and left and right ribs.
diagnose
1. Symptoms and signs: If you are over 40 years old, you have anorexia, dyspepsia, obvious emaciation, painless progressive jaundice, or persistent and paroxysmal epigastric pain, and the pain is relieved when you sit up and bend your lower limbs, or you have a mass in your upper abdomen, you should consider pancreatic cancer and cooperate with various auxiliary examinations to make a diagnosis.
2. Laboratory examination: various experimental data of obstructive jaundice caused by pancreatic head cancer. Sometimes bleeding may occur due to intestinal ulcer and liver function damage, so occult blood in stool is positive. At the early stage of pancreatic duct obstruction, serum amylase increased. After the islet is destroyed by cancer in the later stage, the decrease of insulin secretion can lead to hyperglycemia.
(1) Determination of serum carcinoembryonic antigen (CEA): 70% of pancreatic cancer can be increased; However, chronic pancreatitis and digestive tract tumors also have positive results. CEA can be used as a dynamic follow-up before and after pancreatic cancer surgery, and regular determination of CEA is of reference value in predicting whether cancer recurs.
(2) Monosialic ganglioside (CA19–9) is the most promising marker of pancreatic cancer. According to Zhongshan Hospital of Shanghai Medical University, the diagnosis rate is 90%.
3.x-ray examination: Pancreatic head cancer may show signs such as widening of duodenal curvature, duodenal compression and deformation, intestinal stenosis or pyloric compression. Cancer of pancreatic body and pancreatic tail sometimes shows that the curvature of the stomach and the back wall of the stomach body is small, and the stomach, duodenum and transverse colon are displaced due to compression. Double contrast radiography and duodenal hypotonic radiography with barium injection and gas injection can make the lesions clearer.
4. Retrograde cholangiopancreatography: 60% meglumine diatrizoate (3 ~ 10 ml) was injected from duodenal papilla through fiberoptic duodenoscopy. Patients with pancreatic cancer show that the pancreatic duct wall is not smooth, narrow or truncated, and the narrow distal pancreatic duct is dilated or flexed or truncated, so the distal pancreatic duct is underdeveloped.
5. Selective celiac arteriography: In pancreatic cancer, the pancreatic artery may show signs of stenosis, displacement or interruption, or the blood vessels become thinner, curved and run irregularly due to the compression of cancer.
6.b-ultrasound examination: It has reference value for early diagnosis and differential diagnosis of pancreatic cancer.
7.CT and MRI examination: the diagnosis is more accurate, and the relationship with the surroundings and the metastasis of adjacent organs can be understood, which is a supplement to B-ultrasound examination.
8. Percutaneous cholangiography (PTC): Under the guidance of ultrasound, percutaneous cholangiography or biopsy is often more accurate and reliable than other examination methods.
differential diagnosis
1. Acute icteric hepatitis: acute onset, short course of disease, greasy aversion, abdominal distension and obvious liver function damage. After treatment, jaundice quickly subsided and liver function recovered quickly.
2. Liver cancer: the liver is swollen and hard, which can be identified by X-ray, B-ultrasound and CT examination.
3. Cholelithiasis: The onset is urgent, and the appearance of jaundice fluctuates with the appearance of symptoms such as fever and pain.
treat cordially
1. Surgery and integrated traditional Chinese and western medicine treatment:
(1) Surgical treatment: Although the 5-year survival rate is very low, surgery is still a common method.
① Radical surgery: including pancreaticoduodenectomy; Pancreatectomy of pancreatic body and pancreatic tail cancer; Total pancreaticoduodenectomy for total pancreatic cancer. Radical surgery should be performed in good general condition without distant metastasis, especially in early low-grade carcinoma of pancreaticobiliary duct, which has strong adaptability.
② Internal drainage: When the illness is serious or distant metastasis, internal drainage is often used to relieve jaundice, such as cholecystectomy and duodenectomy to relieve and prevent duodenal obstruction, which can improve symptoms and keep people for treatment.
(2) Pre-and post-operation Chinese and Western medicine conditioning: Due to long-term digestive dysfunction and disease consumption, patients have symptoms of yin-yang deviation, such as anemia, low plasma protein, prolonged prothrombin time, and imbalance of water and electrolyte, so it is necessary to adjust Chinese and Western medicine first to ensure the smooth operation. In addition to fluid replacement and blood transfusion, there are plasma proteins and electrolytes, vitamins K and C, etc. Traditional Chinese medicine should strengthen the body resistance and nourish yin, clear away heat and detoxify. Commonly used representative prescriptions:
Radix Astragali 20g Radix Ophiopogonis 12g Radix Glehniae 15g Poria 12g Coicis Semen 20g Radix Pseudostellariae 15g Radix Curcumae 10g Flos Lonicerae 12g dried Fructus Trichosanthis 20g malt 15g Jianqu 9g Mianyin/kloc.
After operation, in addition to continuing western medicine conditioning, we should also apply methods such as strengthening the body resistance and protecting the liver, benefiting gallbladder and expelling toxin. In order to promote the excretion of cholestasis, make the compressed liver cells recover quickly, thus enhancing the function of the body. Commonly used prescriptions:
Saussurea involucrata 30g Radix Curcumae 10g Herba Artemisiae Scopariae 15g Polyporus 15g Poria 15g Herba Lysimachiae 20g Radix Pseudostellariae 15g Radix Astragali 25g Coicis 20g Radix Ophiopogonis 15g Endothelium Corneum Gigeriae Galli/0g Atractylodis Macrocephalae/kloc-0.
2. Combination of traditional Chinese and western medicine chemotherapy and radiotherapy: In the past, it was thought that radiotherapy could only temporarily relieve the pain of pancreatic cancer, so pancreatic cancer was classified as radiation-resistant tumor. In recent years, it has been reported at home and abroad that the 1 year survival rate of unresectable cases after radiotherapy is 54%, and the 2-year survival rate is 26%. If postoperative radiotherapy, chemotherapy and TCM conditioning are combined, the curative effect will be higher. The short-term effective rate of single chemotherapy for pancreatic cancer is 10% ~ 15%. Effective monotherapy includes fluorouracil, mitomycin, adriamycin and streptozotocin.
In recent years, scholars have made a comparative observation between combined chemotherapy and single chemotherapy for pancreatic cancer. For example, compared with single chemotherapy of fluorouracil or mitomycin, it is difficult to see the advantages of combined chemotherapy over single chemotherapy. This situation shows that chemotherapy is ineffective for advanced pancreatic cancer, and that combined chemotherapy has not improved the curative effect.
5–FU+CF scheme: Fluorouracil+calcium formyltetrahydrofolate (CF2FH4) can enhance the curative effect of fluorouracil by 3-4 times. This method was originally used to treat gastrointestinal tumors, and the same effect was achieved in the treatment of pancreatic cancer.
Usage: CF 200 ~ 300mg/㎡/ day, add 200ml of normal saline for 2 hours, and then add 5-FU 400 ~ 500mg/㎡/ day for 5 days, and repeat every 2 1 day.
(2) radiotherapy plus chemotherapy: fluorouracil 300mg/㎡, twice a week for 6 weeks, radiotherapy 4 000 ~ 5 000 cgy/4 ~ 5 weeks.
3. Chinese medicine combined with radiotherapy and chemotherapy: In addition to radiotherapy and chemotherapy, commonly used Chinese medicine prescriptions can also be used as consolidation treatment. Intermittent long-term use can enhance physical fitness and prolong survival.
Codonopsis pilosula 15g Atractylodes macrocephala 10g Poria 10g Radix Glehniae 10g Radix Pseudostellariae 15g Caulis Polygoni Multiflori, 20g Radix Astragali, 25g Gynostemma pentaphyllum 15g Fructus Lycii 12g Flos Lonicerae 10g Herba Artemisiae Scopariae.
Add and subtract according to symptoms, refer to the third and fourth sections of Chapter 6 of the General Introduction.
4. TCM syndrome differentiation and treatment:
(1) Damp-heat stagnation type: equivalent to jaundice caused by pancreatic head cancer, periampullary cancer and common bile duct obstruction.
Main symptoms: yellow and red urine, heavy stool like clay, occasional itchy skin, bitter taste, anorexia, abdominal distension or low fever. After infection, there will be short-term high fever, greasy tongue coating, red or lavender tongue, normal or stringy or slippery pulse.
Treatment: clearing heat and promoting diuresis, promoting gallbladder and inhibiting cancer.
Prescription: Semen Coicis 30g, Caulis Solani Thunb, Radix Curcumae12g, Herba Artemisiae Scopariae15g, Massa Medicata Fermentata10g, Radix Pseudostellariae15g, Poria15g, and Polyporus15g.
(2) Qi stagnation and blood stasis type: it is equivalent to cancer invading the pancreatic body and its surrounding tissues and compressing the celiac ganglion.
Main symptoms: epigastric swelling and pain, involving the back, easy pain, pain relief in the front bow and legs, dry mouth and bitter taste, insomnia and irritability, sometimes touching the upper abdominal mass, or the liver is large, uneven and hard, and sometimes bleeding in the digestive tract. The tongue is red, reddish or blue, with ecchymosis. Striated or unsmooth veins.
Treatment: promoting blood circulation, removing blood stasis, regulating qi and relieving pain, softening and resolving hard mass.
Prescription: Danshen 18g Radix Paeoniae Rubra 12g Rhizoma Corydalis 12g Myrrha 15g Fritillaria thunbergii 10g canned pangolin 12g Poria 12g Atractylodes macrocephala 10g Radix Glycyrrhizae 3g Radix Ophiopogonis/kloc-0.
Zhilingdan capsule 3 capsules, 1, 3 times a day, taken during or after meals.
(3) Yin deficiency and heat toxin type: from onset to late stage, complicated with infection, and yin injury due to prolonged illness. Or after surgery, radiotherapy or chemotherapy.
Main symptoms: dry mouth and tongue, boredom and insomnia, emaciation and fatigue, loss of appetite, infection and fever, dull pain in the upper abdomen, constipation sometimes, short and red urine, occasional ascites, red tongue, crimson purple, no body fluid and no moss. Pulse count, or string.
Treatment: nourishing kidney and yin, clearing away heat and toxic materials.
Prescription: Dendrobium nobile 15g Anemarrhena rhizome 15g Glehnia littoralis 12g lotus root slices 12g dried Fructus Trichosanthis 20g Scutellariae 6g honeysuckle 10g Hedyotis diffusa 18g lobelia 20g radix Pseudostellariae1g.
Zhilidan capsule 3 capsules, 3 times a day, taken during or after meals.
(4) Sleep pattern of qi deficiency and spleen deficiency: late stage of illness, anemia, low plasma protein and digestive dysfunction.
Main symptoms: fatigue, shortness of breath, dull complexion, sweating when moving, loss of appetite, indigestion, edema of lower limbs, or ascites and abdominal mass. Normal stool, occasional diarrhea, tasteless or bitter tongue. The tongue is light and greasy or reddish with greasy fur, and the pulse is soft and weak, slow or fast.
Treatment: tonify qi and blood, strengthen spleen and strengthen body resistance.
Prescription: Codonopsis pilosula 15g Atractylodes macrocephala 15g Poria cocos 15g Glycyrrhiza uralensis 3g Sargentodoxa 20g Astragalus 30g Polyporus 15g Alisma orientalis 10g Radix Rehmanniae Preparata 15g Ligustrum lucidum 15g Placenta Hominis 15g.
5. Single prescription:
(1) Sedum Sedum) 250g Capsella bursa-pastoris 150g, decoct soup for several times instead of tea, or add a little rock sugar, daily 1 dose, and take it continuously for 1 ~ 3 months. Has the effects of eliminating jaundice, diminishing inflammation, promoting diuresis and inhibiting cancer. This prescription is suitable for yin deficiency, heat toxicity and damp-heat stasis.
(2) Rabdosia rubescens 20g Sarcandra 20g Hedyotis diffusa 20g Solanum lyratum 20g Herba Artemisiae Scopariae 15g Poria 12g Atractylodes macrocephala 12g Glycyrrhiza 3g.
Decoction instead of tea has the same indications as Sedum sarmentosum.
(3) Radix Pseudostellariae 9g Radix Astragali 30g Radix Angelicae Sinensis 15g Rhizoma Atractylodis Macrocephalae 9g Poria 9g Fructus Amomi Rotundus 9g Coicis 30g Fried Bupleuri 4g Pericarpium Citri Tangerinae 9g Rhizoma Cyperi 9g Radix Curcumae 9g Rhizoma Corydalis 9g Radix Aucklandiae 4g Oleum Citri Reticulatae 9g Fructus Trichosanthis 15g Pinellia 9g cuttlefish bone 9g.
Daily 1 dose, decocted in water twice, and served separately. Zhang Daizhao, Guang 'anmen Hospital, Institute of Traditional Chinese Medicine, treated 1 patients with head cancer. After the operation, they developed weakness, abdominal pain and loss of appetite. After treatment, they gained 5 kilograms and were cured for 5 years without recurrence.
(4) Li Yanfang, China-Japan Friendship Hospital: Endothelium Corneum Gigeriae Galli 30g indigo naturalis 15g artificial bezoar 15g purple gold ingot 10g wild chrysanthemum 60g grasshopper 30g notoginseng 30g, * * * ground into fine powder, 2g each time, twice a day.
(5) decoct indigo naturalis, artificial bezoar, purple gold ingot and wild chrysanthemum. (Anhui Provincial People's Hospital admitted more than 4 cases of pancreatic cancer, 1 case survived for 3 years and 5 months, 1 case survived for 2 years and 6 months. )
(6) Lexus capsules: take three capsules three times a day after meals. The author treated 1 patient with advanced pancreatic cancer with this drug. The course of treatment was 1.5 years, which made the lump and symptoms disappear and there was no recurrence in 3 years.
6. Symptomatic treatment of integrated traditional Chinese and western medicine: pancreatic cancer pain is difficult, and three-step analgesic treatment can be used. For other symptomatic treatment, refer to Chapter 7- 10 of the General Introduction.
More than 90% of untreated pancreatic cancer patients died within 1 year after diagnosis. It has been reported in China that the 5-year survival rate of one group after operation is 18%. The 5-year survival rate of group A, including periampullary carcinoma, was 36.6%, and the disease stage was early. Through surgery, radiotherapy and chemotherapy, Chinese and western medicine support therapy and immunotherapy, the quality of life is improved and the survival time is prolonged.
Lingzhi Capsule, the first patented new drug independently developed by China for the clinical treatment of tumor with the combination of traditional Chinese and western medicine, was recently listed in Shaanxi, with the telephone number of 029-87551113. The drug is a large compound preparation of 16 kinds of traditional Chinese medicines supplemented by 5 kinds of western medicines. It is another scientific research achievement after Professor Ji, a famous oncologist in China, was praised as a "cancer fighter" by the international medical community for his noble medical ethics and superb medical skills.
Lingzhi Capsule is the crystallization of Pan Ming's 50-year clinical experience and his pioneering theory of "strengthening the body resistance and consolidating the foundation" for cancer treatment. This medicine is a combination of traditional Chinese and western medicine, with complementary advantages, simultaneous attack and tonic, economical and convenient, short course of treatment and quick effect. It is suitable for the treatment of various types of malignant tumors in the early, middle and late stages, especially for various pains of cancer in the middle and late stages. As long as you take 1 ~ 2 days, it will take effect and be obvious within one week. Lu Jiaxi, President of China Academy of Sciences, wrote an inscription "To Professor Ji: Integrating Chinese and Western Medicine for the benefit of all mankind".