Author: Bi Xiaofeng (Chinese Academy of Medical Sciences Cancer Hospital)
Pancreatic cancer has fast progression, high malignancy, and short survival time. The 5-year survival rate is less than 6%. It is known as the “king of cancers”. Because the clinical diagnosis is often at an advanced stage, less than 15% of pancreatic cancer patients are likely to undergo surgical treatment, but even if there is an opportunity for surgery, the median survival of patients after surgery is only 13.3 months. Inoperable patients survived only 3.5 months, resulting in nearly the same incidence and mortality rates for pancreatic cancer (1:0.99). According to the pathological examination of the cases of pancreatic cancer resection, only 3.8% of T1 and T2 pancreatic cancers without peripancreatic tissue infiltration and limited to the pancreas, which means that even the cases of pancreatic cancer that can be operated are the vast majority. It’s late. Why is it so difficult to detect pancreatic cancer early? The main reasons are as follows:
Image source: Zhanku Hailuo
First, the anatomical location makes pancreatic cancer more difficult to detect early
Because the pancreas is a retroperitoneal organ, it is deep and covered in front by the stomach and transverse colon. Because of the deep location and the interference of gas in the gastrointestinal tract, it is difficult to detect early by conventional physical examination methods (such as ultrasound), so the convenience and ease of examination are greatly reduced. In addition, the pancreas has no fibrous capsule, and the surrounding blood vessels and nerves are densely surrounded by important organs, resulting in the rapid progress of pancreatic cancer, leaving us a short time for early diagnosis and early treatment.
Second, early symptoms of pancreatic cancer are not obvious
Pancreatic cancer has an insidious onset, and the early symptoms are atypical and lack specificity, often manifesting as upper abdominal discomfort, low back pain, indigestion or diarrhea. Symptoms are often relieved after symptomatic treatment, which is easily confused with other digestive system diseases, thus delaying the time for early diagnosis and treatment. By the time patients develop symptoms such as fatigue, weight loss, and jaundice, it is already in the middle and late stages.
Third, there is a lack of highly sensitive laboratory testing methods
Carbohydrate antigen CA19-9 is currently the most commonly used diagnostic marker for pancreatic cancer. Serum CA19-9 greater than 37 U/ml is used as a positive index. The sensitivity and specificity for the diagnosis of pancreatic cancer are respectively reached 78.2% and 82.8%. However, about 10% of pancreatic cancer patients do not have elevated CA19-9, which brings difficulties to the early diagnosis of pancreatic cancer. Other biological examination methods have yet to be confirmed and cannot be routinely used clinically.
Image source: Zhanku Hailuo
Fourth, there is a lack of simple and easy-to-use imaging methods
Basic principles of imaging requirements for the diagnosis of pancreatic cancer include:
complete (shows the entire pancreas);
Fine (thin scans with a layer thickness of 1~3 mm);
Dynamic (dynamic enhancement, regular follow-up);
Stereo (multi-axial reconstruction. Comprehensive understanding of adjacency).
Therefore, it is difficult to detect small pancreatic tumors in the early stage by simple and non-invasive ultrasonography. Some studies have reported that the sensitivity of conventional ultrasonography in pancreatic cancer is 75% to 89%. The main reason is that the pancreas is located in the Retroperitoneal ultrasound has limited penetration and is easily affected by the patient’s physical condition and gastrointestinal gas. It is not easy to see the lesions of the pancreas, and it is even more difficult to detect early pancreatic tumors less than 2 cm in diameter. Even for experienced sonographers, it is not easy to accurately capture the early lesions of the pancreas, and it is even more difficult to differentiate pancreatic cancer from other diseases such as pancreatitis, and tumors in the surrounding organs of the pancreas. On ordinary CT scan, pancreatic cancer can be manifested as irregular pancreas contour, uneven echo, or iso- or low-density. Only enhanced three-dimensional dynamic CT thin-slice scan can clearly display tumor size, location, density and blood supply, so it is the most commonly used method for diagnosing pancreatic cancer. In addition, nuclear magnetic resonance, nuclear magnetic resonance cholangiopancreatography, endoscopic ultrasonography and PET-CT examinations, but due to the high cost and complicated operation of these examinations, it is difficult to become a routine examination item in the usual physical examination work.
Therefore, in order to detect pancreatic cancer early, we still need to maintain a healthy lifestyle, raise awareness of cancer prevention, and pay attention to those pancreatic cancers such as epigastric discomfort, indigestion, low back pain, etc. “Unobvious symptoms” of cancer should be combined with ultrasound examination and tumor markers, such as CA125, CA242, CEA and other auxiliary diagnosis. Once any abnormality occurs, go to the hospital for further examination in the pancreatic hepatobiliary surgery or general surgery department to rule out the possibility of pancreatic cancer. Do not take it lightly and delay treatment.
Image source: Station Cool Sealo
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