World Pancreatic Cancer Day丨Faced with the “King of Cancer”, can we only surrender?

The third Thursday of November is World Pancreatic Cancer Day.

Facing pancreatic cancer, known as the "king of cancer",

Is there really nothing we can do?

Pancreatic cancer is difficult to diagnose in its early stages. Once diagnosed, most patients are already in the advanced stage. Surgical cure rates are low, treatment options are limited, and prognosis is extremely poor. Therefore, pancreatic cancer is known as the "king of cancer." In recent years, the incidence of pancreatic cancer has been rising year by year, and patients are becoming younger and younger, but the public's understanding and awareness of the disease still needs to be deepened.

It is "hidden"

To understand pancreatic cancer, we must first know where the pancreas is. The pancreas is an important organ hidden deep in the left upper abdomen of the human body. It is closely adjacent to the liver, gallbladder, intestines, stomach and other organs, and is backed by complex blood vessels and nerve tissues. According to the anatomical location, the pancreas is divided into the head, neck, body and tail.

The pancreas is the second largest digestive gland in the human body after the liver, and has both endocrine and exocrine functions: the exocrine glands secrete pancreatic juice, which is rich in digestive enzymes to help digest food; the endocrine glands secrete endocrine hormones, mainly insulin, to maintain blood sugar homeostasis.

Not all tumors that grow on the pancreas are called pancreatic cancer. The pancreatic cancer we often refer to is the canceration of the pancreatic ductal epithelial cells, that is, pancreatic ductal adenocarcinoma, which accounts for 95% of all pancreatic cancer pathological types. In addition, pancreatic neuroendocrine tumors are also a type of pancreatic malignant tumor, but they often show the biological behavior of inert tumors, grow and develop relatively slowly, and are far less malignant than pancreatic ductal adenocarcinoma. This also explains why Apple founder Steve Jobs, who suffered from pancreatic neuroendocrine tumors, was able to "live with the tumor" for 8 years.

Why is it so difficult to detect it early?

The cause of pancreatic cancer is still unknown. Studies have shown that the main risk factors for pancreatic cancer include smoking, obesity, diabetes, chronic pancreatitis, excessive drinking, and long-term exposure to harmful chemicals. In addition, pancreatic cancer has a genetic susceptibility. People with family hereditary diseases or relatives with tumors will also have a significantly increased risk of pancreatic cancer. These high-risk groups should change their lifestyles, eat a healthy diet, exercise appropriately, pay special attention to abnormal changes in the body, identify them early, and actively diagnose and treat them.

The anatomical location of the pancreas is hidden, and the detection rate of small pancreatic tumors by ordinary B-ultrasound is low, so it is difficult to detect pancreatic cancer in the early stage through routine physical examinations. In addition, pancreatic cancer basically does not cause obvious pain in the early stage. It is only in the late stage that the growing tumor compresses the peripheral nerves and causes cancer pain, which will arouse vigilance. For this reason, the pancreas is also called the most cunning organ that is best at hiding and camouflaging.

Early diagnosis is the key to improving the survival rate of pancreatic cancer patients. Currently, the diagnosis of pancreatic cancer is mainly based on upper abdominal enhanced CT. In CT images, lesions as small as 2 mm can be seen clearly.

So, are there any early warning signs for pancreatic cancer? Please keep the following four points in mind:

If you feel fullness and discomfort in the upper abdomen, don’t just think about having a gastroscopy or colonoscopy;

When blood sugar rises after middle age, don’t just think about diabetes;

Don’t just treat back pain as lumbar muscle strain or disc herniation;

If your eyes turn yellow, don't just think of hepatitis.

If you experience the above symptoms and discomfort, you should go for a pancreatic enhanced CT scan in time.

Surgery determines survival

The treatment of pancreatic cancer is mainly a comprehensive treatment with surgery as the main method. Pancreatic surgery is known as the "crown jewel" of surgery. It is difficult, risky and extremely challenging. Surgical resection is the only hope for pancreatic cancer patients to achieve long-term survival, but since most of them are already in the advanced stage when diagnosed, the current surgical resection rate is less than 20%. Studies have shown that patients who undergo radical surgical resection have significantly longer survival time.

The choice of surgical method should be determined based on the patient's general condition, tumor location, volume, vascular invasion, infiltration of surrounding organs, etc. Open or minimally invasive surgery is feasible. For patients who are temporarily unable to undergo surgical resection or have recurrence and metastasis, drug treatment is required, including chemotherapy, targeted therapy, immunotherapy, etc. Active participation in clinical trials of new drugs can also benefit patients.

Is pancreatic cancer hereditary?

"Doctor, my father has pancreatic cancer. Will it be passed on to me?" In fact, the possibility of pancreatic cancer being inherited is low. Only 5% to 10% of pancreatic cancer patients have a family history and an obvious genetic tendency.

Familial pancreatic cancer means that at least two first-degree relatives in the family have pancreatic cancer. In a pancreatic cancer family, as the number of first-degree relatives with pancreatic cancer increases, the risk of pancreatic cancer also increases significantly. If one first-degree relative has pancreatic cancer, the risk of pancreatic cancer is 4.6 times that of the average person; if two first-degree relatives have pancreatic cancer, the risk of pancreatic cancer will reach 6.4 times that of the average person; if three or more first-degree relatives have pancreatic cancer, the risk will reach 32 times.

For familial pancreatic cancer screening, 40 years old is generally considered to be the appropriate age to start screening, or 10 years earlier than the age of the earliest pancreatic cancer patient in the family. Usually, screening is done once a year. If uncertain solid lesions or nonspecific pancreatic duct stenosis are found, the screening time should be shortened to 3 to 12 months, or even to within 3 months, and extra-pancreatic tumors should be screened annually.

With the advancement of medical technology, the gratifying progress in drug research and development, the increasing richness of treatment methods and programs, the participation of multidisciplinary comprehensive diagnosis and treatment, and individualized comprehensive treatment have brought more hope and benefits to pancreatic cancer patients. In short, pancreatic cancer is not invincible, and giving up is the biggest cognitive misunderstanding.

Author: Yu Xianjun, Director of Shanghai Pancreatic Tumor Research Institute and Professor of Pancreatic Surgery at the Affiliated Cancer Hospital of Fudan University

Text compiled by Wei Miaoyan, Department of Comprehensive Treatment of Pancreatic Tumors, Fudan University Cancer Hospital

Image production: Wang Junke

Video Editing: Park Chin-young

Planning: Tan Jia

Editor: Wang Jianying

Source: Healthy China