Adenocarcinoma of the pancreas

Adenocarcinoma of the pancreas is the most common histological form of malignant neoplasms of this organ of the paracrine system of the body.

Adenocarcinoma accounts for up to eight clinical cases out of ten diagnosed oncological pancreatic lesions.

In this disease, tumors are formed from the cells of the mucosa of the pancreas or from the epithelium of its excretory ducts. According to medical statistics, most often pancreatic adenocarcinoma occurs against a background of chronic pancreatitis in men of the older age group who have bad habits.

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Causes of pancreatic adenocarcinoma

Malignant neoplasms are a consequence of damage to the genome of healthy cells, which begin to mutate and aggressively multiply. But why this happens, is for certain unknown. And since the causes of pancreatic adenocarcinoma are unknown to science today, oncologists are left to enumerate the hypothetical risk factors of this fatal pathology, revealed on the basis of a statistical analysis of the case histories.

So, the pathogenesis of pancreatic adenocarcinoma, as well as other varieties of cancer of this gland, is associated with genetic oncology, chronic pancreatitis, diabetes, cirrhosis, and the consequences of removing part of the stomach in its pathologies. Also, smoking and alcohol abuse, poor nutrition (acute and fatty foods, excess of preservatives), obesity, and, of course, a sedentary lifestyle that worsens the whole process of metabolism can play a negative role. Specialists note a carcinogenic effect on the pancreas naphthylamine, benzidine, benzopyrene, asbestos, acetylaminofluorene and other chemicals.

But whatever the adenocarcinoma of the pancreas is caused, it is a mild knot of irregular shape. Its size can be up to 10 cm or more in diameter. Proliferation of tumor cells is characterized by high activity. In this case, the epithelial tissue of the stroma of the gland is rapidly replaced by fibrous tissue.

This pathological process can capture the entire pancreas and go beyond it, hitting neighboring organs. A mutant cell with lymph or blood spreads far from the original neoplasm, causing metastases in the duodenum, gall bladder, stomach, spleen, lymph nodes and peritoneal tissues.

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Symptoms of pancreatic adenocarcinoma

Specific symptoms of pancreatic adenocarcinoma are largely determined by its location and growth rate.

In almost half of cases, the tumor appears in the gland's head, and then the adenocarcinoma of the pancreas head is diagnosed. In the exocrine part of the organ, that is, in the part where pancreatic juice is produced with digestive enzymes, ductal pancreatic adenocarcinoma develops. And two-thirds of these adenocarcinomas are also localized in the gland's head.

Moderately differentiated pancreatic adenocarcinoma is characterized by the presence of a fairly dense node with fuzzy boundaries, consisting of ductal and glandular structures and small cysts. In the process of pathological mitosis, alpha, beta and delta cells of pancreatic islet tissue (Langerhans islets) can be involved, where biosynthesis of hormones takes place: insulin, glucagon, c-peptide, somatostatin, etc.

With small tumor sizes, the symptoms of pancreatic adenocarcinoma may not be felt. And this is the main reason for late seeking medical help. Growing up, the tumor nodes begin to squeeze the ducts of the organ, which leads to a deterioration in the outflow of bile and pancreatic juice, and even to a complete overlapping of the ducts.

Then the symptoms begin to manifest in the form:

• nausea, eructation, diarrhea (with particles of undigested food);
• loss of appetite and a significant decrease in body weight;
• severe pain in the epigastric region, which radiates into the back;
• yellowing of the skin and sclera, itching of the skin (mechanical jaundice due to squeezing of the bile duct);
• increased gallbladder;
• increased spleen;
• the presence of an admixture of blood in the urine and feces (because of the rupture of the enlarged veins of the esophagus and stomach).

Both at the beginning of the disease, and at later stages (with the decomposition of the tumor), the body temperature can rise. Most patients have anemia and an increase in the white blood cell count (leukocytosis).

Diagnosis of pancreatic adenocarcinoma

Oncologists do not hide that in the early stages of the disease the diagnosis of adenocarcinoma of the pancreas is very problematic, since its symptoms are similar to pancreatitis.

The list of diagnostic methods used includes:

• general blood analysis;
• biochemical blood test (for residual protein, sugar, urea, bilirubin, alkaline phosphase, amylase and transaminases, oncomarkers, antigens CA19-9, DuPan, Spanl, CA125, TAG72);
• Analysis of urine;
• endoscopic retrograde cholangopancreatography;
• contrast X-ray diodoscopy;
• ultrasound (ultrasound);
• computed tomography (CT) with contrast;
• biopsy and histological examination of tissue samples.

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Treatment of pancreatic adenocarcinoma

Malignant pancreatic tumors have little or no response to chemotherapy with the help of cytotoxic drugs, therefore treatment of pancreatic adenocarcinoma is carried out mainly surgically.

Carried out at an adenocarcinoma of a head of a pancreas radical operation (a pancreatoduodenal resection) assumes a full excision of a head of a gland, a duodenal gut and a cholic bubble, and also a part of the common bile duct and even a stomach. With this operation, the permeability of the gastrointestinal tract is restored by forming anastomosis between the organs - the anastomosis. The number of deaths of such surgical interventions is at least 15%, and the survival rate for five years is no more than 10%.

Pancreatectomy (complete removal of the pancreas) is resorted to in rare cases, because its absence leads to an extremely complex form of diabetes mellitus.

Most often, surgical treatment is palliative, and operations are performed to eliminate duct obstruction and to remove mechanical jaundice.

As a palliative measure (facilitating the condition of patients) a combination of chemotherapy and radiation is used. In particular, chemotherapy with the Gemzar antimetabolite drug (Gemcitabine), which is administered by intravenous infusions (1000 mg / m2 once a week for seven weeks), results in the arrest of adenocarcinoma growth.

Also, treatment of adenocarcinoma of the pancreas is performed to relieve pain. Depending on their intensity, doctors recommend taking such drugs as Paracetamol, No-shpa, Spazgan or Ketanov (Ketorolac). Ketanov is administered intramuscularly or taken internally. Orally administer one tablet (10 mg) 2-3 times a day. But this drug has side effects that may manifest as drowsiness, headache, increased sweating, nausea, abdominal pain, diarrhea, or constipation.

In addition, in order to compensate for the deficiency of pancreatic juice enzymes, digestive enzyme preparations are prescribed: Pancreatin, Penzital, Creon, Pancitrat, Panzinorm, Enzistal, etc.

Prophylaxis of pancreatic adenocarcinoma

As such, prophylaxis of adenocarcinoma of the pancreas is considered unlikely, because in the early stages (which occur asymptomatically) no one is asking about the examination.

And when the pancreatic head adenocarcinoma or ductal adenocarcinoma of the pancreas is diagnosed, the disease is usually already incurable.

Of course, it is necessary to lead a healthy lifestyle, maintain a diet for pancreatic cancer and treat chronic pancreatitis, cirrhosis and diabetes.

Prognosis of pancreatic adenocarcinoma

The prognosis of adenocarcinoma of the pancreas, to put it mildly, is unfavorable. This type of pancreatic tumor gives multiple metastases throughout the body, and very quickly. According to oncologists, the maximum life expectancy (from the moment of appearance of obvious symptoms of the disease) does not exceed 1.5 years. And only two patients and a hundred with a diagnosis of pancreatic adenocarcinoma live up to five years. At the same time, after a radical operation, up to 27% of patients continue to live for five years. And in comparison with the unoperated patients, the life expectancy after repeated surgery for recurrence of adenocarcinoma of the pancreas increases threefold.