Truninger K
Medizinische Klinik, Kantonsspital Aarau, Schweiz.
Praxis (Bern 1994). 2000 Aug 17;89(33):1299-304.
Biliopancreatic carcinoma has a poor prognosis since the diagnosis of the tumor occurs late when advanced disease is present. The identification of potential causes and earlier diagnosis are needed to prevent the disease or identify it early enough to improve survival. The main risk factors for pancreatic cancer include advanced age, cigarette smoking, high-fat diet, diabetes mellitus, chronic pancreatitis (especially hereditary pancreatitis) and a positive family history of pancreatic cancer. The most important etiologic factor for the development of gallbladder cancer is gallstone disease. Patients with anatomic abnormalities and chronic inflammatory conditions (primary sclerosing cholangitis, infections with parasites) have an increased incidence of bile duct cancers. Several new and promising imaging techniques have recently become available and our understanding of the mechanisms of carcinogenesis are growing rapidly. However, there is currently no effective screening strategy applicable and it is unknown when to begin screening. For pancreatic cancer, reduction of risk is likely to occur with avoidance of smoking and promotion of healthful diets. Cholecystectomy rates have increased since the introduction of new laparoscopic techniques and will eventually reduce the incidence of gallbladder cancer. Improved imaging techniques, the identification of new genes and a better definition of genetic alterations that characterize preinvasive lesions will hopefully allow to develop sensitive and specific technologies to screen and to detect early biliopancreatic cancer for even premalignant lesions to improve the mostly fatal prognosis if this tumor.
由于胆管胰腺癌在出现晚期疾病时才得以诊断，所以其预后较差。需要确定潜在病因并进行早期诊断，以预防该疾病或尽早发现疾病从而提高生存率。胰腺癌的主要危险因素包括高龄、吸烟、高脂饮食、糖尿病、慢性胰腺炎（尤其是遗传性胰腺炎）以及胰腺癌家族史阳性。胆囊癌发生发展的最重要病因是胆结石病。有解剖学异常和慢性炎症性疾病（原发性硬化性胆管炎、寄生虫感染）的患者胆管癌发病率增加。最近有几种新的且有前景的成像技术可供使用，并且我们对致癌机制的理解正在迅速发展。然而，目前尚无适用的有效筛查策略，且不知道何时开始筛查。对于胰腺癌，避免吸烟和推广健康饮食可能会降低风险。自从引入新的腹腔镜技术以来，胆囊切除术的比例有所增加，这最终将降低胆囊癌的发病率。改进的成像技术、新基因的鉴定以及对侵袭前病变特征性基因改变的更好定义，有望开发出敏感且特异的技术来筛查和检测早期胆管胰腺癌甚至癌前病变，以改善这种大多致命肿瘤的预后。
