Thomas Jefferson University, Philadelphia, PA, USA.
University of Michigan School of Medicine, Ann Arbor, MI, USA.
Am Fam Physician. 2014 Apr 15;89(8):626-32.
Pancreatic cancer remains the fourth leading cause of cancer-related deaths in the United States. Risk factors include family history, smoking, chronic pancreatitis, obesity, diabetes mellitus, heavy alcohol use, and possible dietary factors. Because more than two-thirds of adenocarcinomas occur in the head of the pancreas, abdominal pain, jaundice, pruritus, dark urine, and acholic stools may be presenting symptoms. In symptomatic patients, the serum tumor marker cancer antigen 19-9 can be used to confirm the diagnosis and to predict prognosis and recurrence after resection. Pancreas protocol computed tomography is considered standard for the diagnosis and staging of pancreatic cancer. Although surgical resection is the only potentially curative treatment for pancreatic ductal adenocarcinomas, less than 20% of surgical candidates survive five years. The decision on resectability requires multidisciplinary consultation. Pancreatic resections should be performed at institutions that complete at least 15 of the surgeries annually. Postoperatively, use of gemcitabine or fluorouracil/leucovorin as adjuvant chemotherapy improves overall survival by several months. However, more than 80% of patients present with disease that is not surgically resectable. For patients with locally advanced or metastatic disease, chemoradiotherapy with gemcitabine or irinotecan provides clinical benefit and modest survival improvement. Palliation should address pain control, biliary and gastric outlet obstruction, malnutrition, thromboembolic disease, and depression.
在美国，胰腺癌仍然是癌症相关死亡的第四大主要原因。危险因素包括家族史、吸烟、慢性胰腺炎、肥胖、糖尿病、大量饮酒以及可能的饮食因素。由于超过三分之二的腺癌发生在胰头，因此腹痛、黄疸、瘙痒、深色尿液和陶土色粪便可能是其首发症状。在有症状的患者中，血清肿瘤标志物癌抗原 19-9 可用于确认诊断，并预测切除后的预后和复发情况。胰腺方案 CT 被认为是诊断和分期胰腺癌的标准方法。尽管手术切除是治疗胰腺导管腺癌唯一有潜在治愈可能的方法，但不到 20%的手术候选者能存活五年。可切除性的决定需要多学科会诊。胰腺切除术应在每年至少完成 15 例手术的机构进行。术后，使用吉西他滨或氟尿嘧啶/亚叶酸作为辅助化疗可使总生存期延长数月。然而，超过 80%的患者就诊时疾病已无法手术切除。对于局部晚期或转移性疾病的患者，吉西他滨或伊立替康联合化疗可提供临床获益和适度的生存改善。姑息治疗应解决疼痛控制、胆道和胃出口梗阻、营养不良、血栓栓塞性疾病和抑郁问题。
