Freelove Robert, Walling Anne D
Smoky Hill Family Medicine Residency Program, Salina, Kansas 67401, USA.
Am Fam Physician. 2006 Feb 1;73(3):485-92.
Although only 32,000 new cases of adenocarcinoma of the pancreas occur in the United States each year, it is the fourth leading cause of cancer deaths in this country. The overall five-year survival rate is 4 percent, and localized, resectable disease has only a 17 percent survival rate. Risk factors include smoking, certain familial cancer syndromes, and familial chronic pancreatitis. The link between risk of pancreatic cancer and other factors (e.g., diabetes, obesity) is less clear. Most patients present with obstructive jaundice caused by compression of the bile duct in the head of the pancreas. Epigastric or back pain, vague abdominal symptoms, and weight loss also are characteristic of pancreatic cancer. More than one half of cases have distant metastasis at diagnosis. Computed tomography is the most useful diagnostic and staging tool. Ultrasonography, magnetic resonance imaging, and endoscopic retrograde cholangiopancreatography may provide additional information. The majority of tumors are not surgically resectable because of metastasis and invasion of the major vessels posterior to the pancreas. Resectable tumors are treated with the Whipple procedure or the pylorus-preserving Whipple procedure. Adjuvant fluorouracil-based chemotherapy may prolong survival. For nonresectable tumors, chemotherapy with gemcitabine prolongs survival. Other agents are being studied. Radiation combined with chemotherapy has slowed progression in locally advanced cancers. Throughout the illness and during end-of-life care, patients need comprehensive symptom control.
尽管美国每年仅出现32000例胰腺癌新发病例，但它却是该国癌症死亡的第四大主要原因。总体五年生存率为4%，局限性、可切除疾病的生存率仅为17%。风险因素包括吸烟、某些家族性癌症综合征和家族性慢性胰腺炎。胰腺癌风险与其他因素（如糖尿病、肥胖）之间的联系尚不清楚。大多数患者表现为由胰头胆管受压引起的梗阻性黄疸。上腹部或背部疼痛、模糊的腹部症状和体重减轻也是胰腺癌的特征。超过一半的病例在诊断时已有远处转移。计算机断层扫描是最有用的诊断和分期工具。超声检查、磁共振成像和内镜逆行胰胆管造影可能提供更多信息。由于转移和胰腺后方主要血管的侵犯，大多数肿瘤无法手术切除。可切除的肿瘤采用惠普尔手术或保留幽门的惠普尔手术治疗。基于氟尿嘧啶的辅助化疗可能延长生存期。对于不可切除的肿瘤，吉西他滨化疗可延长生存期。正在研究其他药物。放疗联合化疗已减缓局部晚期癌症的进展。在整个病程和临终关怀期间，患者需要全面的症状控制。
