pancreatic cancer

膵癌

WordNet

1. type genus of the family Cancridae (同)genus Cancer
2. the fourth sign of the zodiac; the sun is in this sign from about June 21 to July 22 (同)Cancer the Crab, Crab
3. (astrology) a person who is born while the sun is in Cancer (同)Crab
4. a small zodiacal constellation in the northern hemisphere; between Leo and Gemini
5. any malignant growth or tumor caused by abnormal and uncontrolled cell division; it may spread to other parts of the body through the lymphatic system or the blood stream (同)malignant neoplastic disease
6. of or involving the pancreas; "pancreatic cancer"

PrepTutorEJDIC

1. 〈U〉〈C〉『がん』 / 〈U〉〈C〉害悪 / 《Cancer》(星座の)カニ座
2. 膵臓の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/02/26 13:33:08」(JST)

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Pancreatic cancer
Classification and external resources
ICD-10	C25
ICD-9	157.0-157.9
OMIM	260350
DiseasesDB	9510
MedlinePlus	000236
eMedicine	med/1712
MeSH	D010190

Pancreatic cancer is a malignant neoplasm originating from transformed cells arising in tissues forming the pancreas. The most common type of pancreatic cancer, accounting for 95% of these tumors, is adenocarcinoma (tumors exhibiting glandular architecture on light microscopy) arising within the exocrine component of the pancreas. A minority arise from islet cells, and are classified as neuroendocrine tumors. The signs and symptoms that eventually lead to the diagnosis depend on the location, the size, and the tissue type of the tumor, and may include abdominal pain, lower back pain, and jaundice (if the tumor compresses the bile duct).

Pancreatic cancer is the fourth most common cause of cancer-related deaths in the United States and the eighth worldwide. Pancreatic cancer has an extremely poor prognosis: for all stages combined, the 1- and 5-year relative survival rates are 25% and 6%, respectively; for local disease the 5-year survival is approximately 20% while the median survival for locally advanced and for metastatic disease, which collectively represent over 80% of individuals, is about 10 and 6 months respectively.

Signs and symptoms

Early pancreatic cancer often does not cause symptoms, and the later symptoms are usually nonspecific and varied. Therefore, pancreatic cancer is often not diagnosed until it is advanced. Common symptoms include:

• Pain in the upper abdomen that typically radiates to the back (seen in carcinoma of the body or tail of the pancreas)
• Loss of appetite (anorexia) or nausea and vomiting
• Significant weight loss (cachexia)
• Painless jaundice (yellow tint to whites of eyes (sclera) or yellowish skin in serious cases, possibly in combination with darkened urine) when a cancer of the head of the pancreas (75% of cases) obstructs the common bile duct as it runs through the pancreas. This may also cause pale-colored stool and steatorrhea. The jaundice may be associated with itching as the salt from excess bile can cause skin irritation.
• Trousseau sign, in which blood clots form spontaneously in the portal blood vessels, the deep veins of the extremities, or the superficial veins anywhere on the body, may be associated with pancreatic cancer.
• Diabetes mellitus, or elevated blood sugar levels. Many patients with pancreatic cancer develop diabetes months to even years before they are diagnosed with pancreatic cancer, suggesting new onset diabetes in an elderly individual may be an early warning sign of pancreatic cancer.
• Clinical depression has been reported in association with pancreatic cancer, sometimes presenting before the cancer is diagnosed. However, the mechanism for this association is not known.
• Symptoms of pancreatic cancer metastasis. Typically, pancreatic cancer first metastasizes to regional lymph nodes, and later to the liver or to the peritoneal cavity and, rarely, to the lungs; it rarely metastasizes to bone or brain.

Risk factors

Risk factors for pancreatic cancer may include:

• Family history: 5–10% of pancreatic cancer patients have a family history of pancreatic cancer. The genes have not been identified. Pancreatic cancer has been associated with the following syndromes: autosomal recessive ataxia-telangiectasia and autosomal dominantly inherited mutations in the BRCA2 gene and PALB2 gene, Peutz-Jeghers syndrome due to mutations in the STK11 tumor suppressor gene, hereditary non-polyposis colon cancer (Lynch syndrome), familial adenomatous polyposis, and the familial atypical multiple mole melanoma-pancreatic cancer syndrome (FAMMM-PC) due to mutations in the CDKN2A tumor suppressor gene. There may also be a history of familial pancreatitis.
• Age. The risk of developing pancreatic cancer increases with age. Most cases occur after age 60, while cases before age 40 are uncommon.
• Smoking. Cigarette smoking has a risk ratio of 1.74 with regard to pancreatic cancer; a decade of nonsmoking after heavy smoking is associated with a risk ratio of 1.2.
• Diets low in vegetables and fruits.
• Diets high in red meat. Processed meat consumption is positively associated with pancreatic cancer risk, and red meat consumption was associated with an increased risk of pancreatic cancer in men.
• Diets high in sugar-sweetened drinks (soft drinks). In particular, the common soft drink sweetener fructose has been linked to growth of pancreatic cancer cells.
• Obesity
• Diabetes mellitus is both risk factor for pancreatic cancer, and, as noted earlier, new onset diabetes can be an early sign of the disease.
• Chronic pancreatitis has been linked, but is not known to be causal. The risk of pancreatic cancer in individuals with familial pancreatitis is particularly high.
• Helicobacter pylori infection
• Gingivitis or periodontal disease
• Partial gastrectomy

Alcohol

It is controversial whether alcohol consumption is a risk factor for pancreatic cancer. Overall, the association is consistently weak and the majority of studies have found no association. Although drinking alcohol excessively is a major cause of chronic pancreatitis, which in turn predisposes to pancreatic cancer, chronic pancreatitis associated with alcohol consumption is less frequently a precursor for pancreatic cancer than other types of chronic pancreatitis.

Some studies suggest a relationship, the risk increasing with increasing amount of alcohol intake. The risk is greatest in heavy drinkers, mostly on the order of four or more drinks per day. There appears to be no increased risk for people consuming up to 30g of alcohol a day, which is approximately 2 alcoholic beverages/day, so most people who take alcohol do so at a level that "is probably not a risk factor for pancreatic cancer". A pooled analysis concluded, "Our findings are consistent with a modest increase in risk of pancreatic cancer with consumption of 30 or more grams of alcohol per day".

Several studies caution that their findings could be due to confounding factors. Even if a link exists, it "could be due to the contents of some alcoholic beverages" other than the alcohol itself. One Dutch study even found that drinkers of white wine had lower risk.

Diagnosis

Axial CT image with i.v. contrast. Macrocystic adenocarcinoma of the pancreatic head.

Most patients with pancreatic cancer experience pain, weight loss, or jaundice.

Pain is present in 80% to 85% of patients with locally advanced or advanced metastatic disease. The pain is usually felt in the upper abdomen as a dull ache that radiates straight through to the back. It may be intermittent and made worse by eating. Weight loss can be profound; it can be associated with anorexia, early satiety, diarrhoea, or steatorrhea. Jaundice is often accompanied by pruritus and dark urine. Painful jaundice is present in approximately one-half of patients with locally unresectable disease, while painless jaundice is present in approximately one-half of patients with a potentially resectable and curable lesion.

The initial presentation varies according to location of the cancer. Malignancies in the pancreatic body or tail usually present with pain and weight loss, while those in the head of the gland typically present with steatorrhea, weight loss, and jaundice. The recent onset of atypical diabetes mellitus, a history of recent but unexplained thrombophlebitis (Trousseau sign), or a previous attack of pancreatitis are sometimes noted. Courvoisier sign defines the presence of jaundice and a painlessly distended gallbladder as strongly indicative of pancreatic cancer, and may be used to distinguish pancreatic cancer from gallstones. Tiredness, irritability and difficulty eating because of pain also exist. Pancreatic cancer is often discovered during the course of the evaluation of aforementioned symptoms.

Liver function tests can show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, γ-glutamyl transpeptidase and alkaline phosphatase levels). CA19-9 (carbohydrate antigen 19.9) is a tumor marker that is frequently elevated in pancreatic cancer. However, it lacks sensitivity and specificity. When a cutoff above 37 U/mL is used, this marker has a sensitivity of 77% and specificity of 87% in discerning benign from malignant disease. CA 19-9 might be normal early in the course, and could be elevated because of benign causes of biliary obstruction. Imaging studies, such as computed tomography (CT scan) and endoscopic ultrasound (EUS) can be used to identify the location and form of the cancer. The definitive diagnosis is made by an endoscopic needle biopsy or surgical excision of the radiologically suspicious tissue. Endoscopic ultrasound is often used to visually guide the needle biopsy procedure. Nonetheless, pancreatic cancer is usually staged using a CT scan. In fact, a histologic diagnosis is not usually required for resection of the tumor, rather histologic analysis helps determine which chemotherapeutic regimen to start.

Pathophysiology

Micrograph of pancreatic ductal adenocarcinoma (the most common type of pancreatic cancer). H&E stain.

The development of pancreatic cancer may involve the over-expression of oncogenes, inactivation of tumor suppressor genes or the deregulation of various signaling proteins. Mutations leading to carcinoma may be accelerated by genetic or environmental factors and other risk factors already described. Specific mutations vary among and even within the cyto-histologic categories discussed below.

Exocrine pancreas cancers

Micrographs of normal pancreas, pancreatic intraepithelial neoplasia (precursors to pancreatic carcinoma) and pancreatic carcinoma. H&E stain.

The most common form of pancreatic cancer (ductal adenocarcinoma) is typically characterized by moderately to poorly differentiated glandular structures on microscopic examination. Pancreatic cancer has an immunohistochemical profile that is similar to hepatobiliary cancers (e.g. cholangiocarcinoma) and some stomach cancers; thus, it may not always be possible to be certain that a tumour found in the pancreas arose from it.

Cross section of a human liver, taken at autopsy examination, showing multiple large pale tumor deposits. The tumor is an adenocarcinoma derived from a primary lesion in the body of the pancreas.

Pancreatic carcinoma is thought to arise from progressive tissue changes. Three types of precancerous lesion are recognised: pancreatic intraepithelial neoplasia – a microscopic lesions of the pancreas, intraductal papillary mucinous neoplasms and mucinous cystic neoplasms both of which are macroscopic lesions. The cellular origin of these lesions is debated.

The second most common type of exocrine pancreas cancer is mucinous. The prognosis is slightly better.

Other exocrine cancers include adenosquamous carcinomas, signet ring cell carcinomas, hepatoid carcinomas, colloid carcinomas, undifferentiated carcinomas, and undifferentiated carcinomas with osteoclast-like giant cells.

Pancreatic cystic neoplasms

Pancreatic cystic neoplasms are a broad group of pancreas tumors that have varying malignant potential.

Pancreatic neuroendocrine tumors

Main article: Neuroendocrine tumor

Endocrine pancreatic tumors have been variously called islet cell tumors, pancreas endocrine tumors (PETs), and pancreatic neuroendocrine tumors (PNETs). The annual clinically recognized incidence is low, about five per one million person-years. However, autopsy studies incidentally identify PETs in up to 1.5% most of which would remain inert and asymptomatic.

The majority of PNETs are usually categorized as benign but the definition of malignancy in pancreas endocrine tumors has been ambiguous. A small subset of endocrine pancreatic tumors are incontrovertible pancreatic endocrine cancers, that make up about 1% of pancreas cancers. Low- to intermediate-grade neuroendocrine carcinomas of the pancreas may be called islet cell tumors. Some sources have also termed these pancreatic carcinoid, a practice that has sometimes been strongly condemned.^{[citation needed]} Definitional migration has caused some complexity of PNET classification, which has adversely affected what is known about the epidemiology and natural history of these tumors. It is probable that some of these tumors have been included in ICD-O-3 histology classifications 8240–8245, in that they were labeled pancreatic carcinoid tumours but most islet cell carcinomas have been coded as ICD-O-3 system 8150–8155.

The more aggressive endocrine pancreatic cancers are known as pancreatic neuroendocrine carcinomas (PNEC). Similarly, there has likely been a degree of admixture of PNEC and extrapulmonary small cell carcinoma.^{[citation needed]}

Prevention

According to the American Cancer Society, there are no established guidelines for preventing pancreatic cancer, although cigarette smoking has been reported as responsible for 20–30% of pancreatic cancers.

The ACS recommends keeping a healthy weight, and increasing consumption of fruits, vegetables, and whole grains, while decreasing red meat intake, although there is no consistent evidence this will prevent or reduce pancreatic cancer specifically. In 2006, a large prospective cohort study of over 80,000 subjects failed to prove a definite association. The evidence in support of this lies mostly in small case-control studies.

A long-term study found that people who consumed in the range of 300 to 449 international units (IU) of vitamin D daily had a 43% lower risk of pancreatic cancer than those who took less than 150 IU per day; 150 IU is appreciably less than what was then, or is now, recommended. The World Health Organization (WHO) International Agency for Research on Cancer (IARC), concluded that there were insufficient studies in pancreatic cancer, and while it found evidence for an inverse association between vitamin D and colorectal cancer to be persuasive, it found evidence for a causal link to be limited, and also found that randomized controlled trials (RCTs) were inconclusive. Taking too much vitamin D may be harmful. Poor general diet, obesity, and relative physical inactivity can be risk factors in some cancers, so the role of vitamin D itself is not certain.

B vitamins, such as B₁₂, B₆, and folate, can reduce the risk of pancreatic cancer when consumed in food, but not when ingested in vitamin tablet form.

Screening

People who may have a high risk of pancreatic cancer due to a family history can be followed, but there is no consensus on what constitutes optimal monitoring. Several small studies have shown promising preliminary results for new biomarkers, but further validation on a larger scale is needed. People with pancreatic cancer themselves, or family members, may wish to participate in the activities at a research facility, or identify a pancreas tumor registry.

Treatment

Exocrine pancreas cancer

Surgery

Treatment of pancreatic cancer depends on the stage of the cancer. Although only localized cancer is considered suitable for surgery with curative intent at present, only ~20% of cases present with localised disease at diagnosis. Surgery can also be performed for palliation, if the malignancy is invading or compressing the duodenum or colon. In such cases, bypass surgery might overcome the obstruction and improve quality of life but is not intended as a cure.

The Whipple procedure is the most common attempted curative surgical treatment for cancers involving the head of the pancreas. This procedure involves removing the pancreatic head and the curve of the duodenum together (pancreato-duodenectomy), making a bypass for food from stomach to jejunum (gastro-jejunostomy) and attaching a loop of jejunum to the cystic duct to drain bile (cholecysto-jejunostomy). It can be performed only if the patient is likely to survive major surgery and if the cancer is localized without invading local structures or metastasizing. It can, therefore, be performed in only the minority of cases.

Cancers of the tail of the pancreas can be resected using a procedure known as a distal pancreatectomy. Recently, localized cancers of the pancreas have been resected using minimally invasive (laparoscopic) approaches.

After surgery, adjuvant chemotherapy with gemcitabine has been shown in several large randomized studies to significantly increase the 5-year survival (from approximately 10 to 20%), and should be offered if the patient is fit after surgery (Oettle et al. JAMA 2007, Neoptolemos et al. NEJM 2004, Oettle et al. ASCO proc 2007).

Radiation

Principles of radiation therapy in pancreas adenocarcinoma are reviewed extensively in guidelines by the National Comprehensive Cancer Network. Radiation can be considered in several situations. One situation is the addition of radiation therapy after potentially curative surgery. Groups in the US have been more apt to use adjuvant radiation therapy than groups in Europe.

Chemotherapy

In patients not suitable for resection with curative intent, palliative chemotherapy may be used to improve quality of life and gain a modest survival benefit. Gemcitabine was approved by the United States Food and Drug Administration in 1998, after a clinical trial reported improvements in quality of life and a 5-week improvement in median survival duration in patients with advanced pancreatic cancer. This marked the first FDA approval of a chemotherapy drug primarily for a nonsurvival clinical trial endpoint. Gemcitabine is administered intravenously on a weekly basis.

A Canadian-led Phase III randomised controlled trial, reported in 2005, involved 569 patients with advanced pancreatic cancer, led the US FDA in 2005 to license erlotinib (Tarceva) in combination with gemcitabine as a palliative regimen for pancreatic cancer. This trial compared the outcome of gemcitabine/erlotinib to gemcitabine/placebo, and demonstrated improved survival rates, improved tumor response and improved progression-free survival rates. Other trials are now investigating the effect of the above combination in the adjuvant (post surgery) and neoadjuvant (pre-surgery) settings.

Addition of oxaliplatin to Gemcitabine (Gem/Ox) was shown to confer benefit in small trials, but is not yet standard therapy.

Pancreatic neuroendocrine tumors

Main article: Neuroendocrine tumor

The majority of these tumors are histologically benign. Treatment of pancreatic endocrine tumors, including the less common malignant tumors, may include:

• Watchful waiting: incidentally identified small tumors, for example on a computed tomography (CT) scan performed for other purposes, may conceptually not always need intervention, but criteria for watchful waiting are unclear.

• Surgery: tumors within the pancreas only (localized tumors), or with limited metastases, may be removed. For localized tumors, the surgical procedure is much less extensive than the types of surgery used to treat pancreatic adenocarcinoma.

• Hormone therapy: if the tumor is not amenable to surgical removal and is causing symptoms by secreting functional hormones, a synthetic hormone analog medication, octreotide, may lessen the symptoms, and sometimes also slows tumor growth.

• Radiation therapy: occasionally used if there is pain due to anatomic extension, such as metastasis to bone.

• Radiolabeled hormone: some PNETs absorb a hormone called norepinephrine and these may respond to nuclear medicine medication, radiolabeled MIBG therapy (or, experamentally, other hormones), given intravenously.

• Radiofrequency ablation (RFA), cryoablation, hepatic artery embolization

• Chemotherapy and targeted medication for PNETs receive Wikipedia discussion in the relevant section of that article.

Prognosis

Age-standardized death from pancreatic cancer per 100,000 inhabitants in 2004.

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Exocrine pancreatic cancer (adenocarcinoma and less common variants) typically has a poor prognosis, partly because the cancer usually causes no symptoms early on, leading to locally advanced or metastatic disease at time of diagnosis.

Pancreatic cancer may occasionally result in diabetes. Insulin production is hampered, and it has been suggested the cancer can also prompt the onset of diabetes and vice versa. It can be associated with pain, fatigue, weight loss, jaundice, and weakness. Additional symptoms are discussed above.

For pancreatic cancer:

• For all stages combined, the 1-year relative survival rate is 25%, and the 5-year survival is estimated as less than 5% to 6%.
• For local disease, the 5-year survival is approximately 20%.
• For locally advanced and for metastatic disease, which collectively represent over 80% to 85-90% of individuals, the median survival is about 10 and 6 months, respectively. Without active treatment, metastatic pancreatic cancer has a median survival of 3–5 months; complete remission is rare.

Outcomes with pancreatic endocrine tumors, many of which are benign and completely without clinical symptoms, are much better, as are outcomes with symptomatic benign tumors; even with actual pancreatic endocrine cancers, outcomes are rather better, but variable.

In 2010, an estimated 43,000 people in the US were diagnosed with pancreas cancer and almost 37,000 died from the disease; pancreatic cancer has one of the highest fatality rates of all cancers, and is the fourth-highest cancer killer among both men and women worldwide. Although it accounts for only 2.5% of new cases, pancreatic cancer is responsible for 6% of cancer deaths each year.

See also

• Category:Deaths from pancreatic cancer
• Category:Pancreatic cancer survivors
• Gastrointestinal cancer
• Pancreatic Cancer Action (organisation in the UK)
• Lustgarten Foundation for Pancreatic Cancer Research (organization in the US)

References

External links

• Pancreatic cancer at the Open Directory Project

UpToDate Contents

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• 1. 膵外分泌癌の臨床症状、診断、および病期分類 clinical manifestations diagnosis and staging of exocrine pancreatic cancer
• 2. 膵臓癌の治療プロトコル treatment protocols for pancreatic cancer
• 3. 進行性膵外分泌癌に対する化学療法 chemotherapy for advanced exocrine pancreatic cancer
• 4. 膵外分泌癌の疫学および危険因子 epidemiology and risk factors for exocrine pancreatic cancer
• 5. 限局進行性および切除可能境界膵外分泌癌のマネージメント management of locally advanced and borderline resectable exocrine pancreatic cancer

English Journal

• PKM2 gene regulates the behavior of pancreatic cancer cells via mitogen-activated protein kinase pathways.

• Feng J1, Ma T2, Ge Z3, Lin J4, Ding W2, Chen H5, Zhu W2, Zhou S1, Tan Y4.
• Molecular medicine reports.Mol Med Rep.2015 Mar;11(3):2111-7. doi: 10.3892/mmr.2014.2990. Epub 2014 Nov 20.
• The aim of the current study was to investigate the effect of the PKM2 gene on the proliferation, invasion, migration and apoptosis of Panc‑1 and Sw1990 pancreatic cancer cells via its interaction with the mitogen‑activated protein kinases (MAPKs) signaling pathways. The expression levels of PKM
• PMID 25411978

• Identification of bile biomarkers of biliary tract cancer through a liquid chromatography/mass spectrometry-based metabolomic method.

• Xu X1, Cheng S1, Ding C1, Lv Z1, Chen D2, Wu J1, Zheng S1.
• Molecular medicine reports.Mol Med Rep.2015 Mar;11(3):2191-8. doi: 10.3892/mmr.2014.2973. Epub 2014 Nov 18.
• The incidence and mortality rate of biliary tract cancer have been increasing worldwide; however, its diagnosis and prognosis have not improved in recent years. A novel approach, termed 'metabolomics', may have the potential to be developed as an effective diagnostic tool. The present study prospect
• PMID 25405977

• Measuring the societal burden of cancer: The cost of lost productivity due to premature cancer-related mortality in Europe.

• Hanly P1, Soerjomataram I, Sharp L.
• International journal of cancer. Journal international du cancer.Int J Cancer.2015 Feb 15;136(4):E136-45. doi: 10.1002/ijc.29105. Epub 2014 Sep 4.
• Every cancer-related death in someone of working age represents an economic loss to society. To inform priorities for cancer control, we estimated costs of lost productivity due to premature cancer-related mortality across Europe, for all cancers and by site, gender, region and country. Cancer death
• PMID 25066804

Japanese Journal

• Stromal Palladin Expression Is an Independent Prognostic Factor in Pancreatic Ductal Adenocarcinoma

• PLoS ONE 11(3), e0152523, 2016-03-29
• NAID 120005757988

• 受賞論文の要旨 第68回広島医学会総会 ポスター優秀賞 分枝型膵管内乳頭状粘液性腫瘍(IPMN)の経過観察中に膵癌を発症した1例

• 広島医学 69(3), 222-228, 2016-03
• NAID 40020813595

• 膵がん薬物療法の今後の展望 (特集 消化器がん(消化管・肝胆膵がん)の新展開)

• 腫瘍内科 = Clinical oncology 17(2), 192-198, 2016-02
• NAID 40020799219

Related Links

• Pancreatic cancer - Mayo Clinic

Pancreatic cancer — Comprehensive overview covers symptoms and treatment of cancer of the pancreas. ... Mayo Clinic in Minnesota has been recognized as the best Gastroenterology & GI Surgery hospital in the nation for 2015 ...

• Pancreatic Cancer—Patient Version - National Cancer Institute

Information about pancreatic cancer treatment, clinical trials, research, and other topics from the National Cancer Institute. ... The pancreas lies behind the stomach and in front of the spine. There are two kinds of cells in the ...

Related Pictures

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★リンクテーブル★

リンク元	「膵癌」「pancreas cancer」「膵がん」「cancer of the pancreas」「pancreatic neoplasm」
拡張検索	「exocrine pancreatic cancer」「pancreatic cancer cell」
関連記事	「pancreatic」「cancer」

「膵癌」

　　[★]

英

pancreatic cancer (M), carcinoma of pancreas

同

膵臓癌

関

膵腫瘍

[show details]

膵癌 : 約 313,000 件
膵臓癌 : 約 494,000 件

疫学

危険因子

ガイドラインより

• 1． 家族歴　：膵癌，遺伝性膵癌症候群 　　　　：13倍
• 2． 合併疾患：糖尿病，慢性膵炎，遺伝性膵炎 　：DMでは2.1倍
• 3． 嗜好　　：喫煙 　　　　　　　　　　　　　：喫煙では2倍

HIM.587

• 喫煙、肥満、非遺伝性の慢性膵炎
• (はっきりしない)環境因子：食事、コーヒー、アルコール飲酒、胃部分切除の既往、胆嚢摘出術、ヘリコバクターピロリ
• 糖尿病との関連が示されたが、原因か結果かは明らかでない。

QB.B-336

• 慢性膵炎、糖尿病、膵石症

生存率

• 死亡数と罹患数はほぼ同数であり、予後が不良である。
• 部位別がんの5年生存率は膵癌が最も低く、7.7％であった(国立がん研究センターがん対策情報センター)
• 生存期間中央値は14.7カ月、切除例で21.0カ月、非切除例では8.2カ月。5年生存率は全症例、切除例がそれぞれ13.0%と18.8%、非切除例の3年生存率は3.1%(2001～2007年の膵癌全症例)。
• 腫瘍径10 mm以下では5年生存率が80.4%、10～20 mmで50.0%、20mmを超えると20%以下となる。

主要な組織型

• 外分泌腫瘍のなかの浸潤性膵管癌が80%以上を占める。
• 多い組織型は以下の通り：

腺房細胞

(腺癌)腺房細胞癌

膵管上皮細胞

(腺癌)膵管内腫瘍・・・膵管癌

管状腺癌　→　最も多い

乳頭腺癌

腺扁平上皮癌

粘液癌

膵管上皮細胞由来

(嚢胞腺癌)漿液性嚢胞腺癌

(嚢胞腺癌)粘液性嚢胞腺癌

粘液産生膵癌

発生部位

• 膵頭部　→　過半数を占める

• 膵体部
• 膵尾部

症状

• 膵癌診断時には無症状のことが多い。
• 腹痛(40%)、黄疸(15%)、食欲不振、腰背痛、全身倦怠感、体重減少

• 腹痛は膵体尾部癌で多い (QB.B-342 SSUR.633)　→　黄疸を示さず、切除不能の進行癌となってから上腹部痛や背部痛を訴えるからであろう

• 膵頭部：胆管並びに膵胆管膨大部閉塞→胆汁色素うっ滞、胆嚢拡大、黄疸
• 膵頚、膵体：門脈、下大静脈の閉塞 (N.295)

検査

• 血液検査：腫瘍マーカー：CEA、CA19-9、SLX、DUPAN-2、SPan-1、CA-50。経過観察に用いる。早期発見には役立たない。
• 超音波検査：不均一な低エコー。主膵管拡張、胆管拡張。
• CT：膵管の狭窄、尾部膵管の拡張。単純で不正な低吸収像、造影で造影効果のない腫瘤影。近接臓器、リンパ節、血管への浸潤が分かる。

[show details]

膵体部癌

十二指腸から離れており、膵頭部癌とは言い難い。

• MRI：T1低信号、T2高信号

• MRCP

• 超音波内視鏡：
• ERCP
• 動脈造影：腫瘍濃染はみられない。診断、手術適応の決定に用いられる。動脈・静脈に浸潤していれば手術適応はなくなる　←　造影CTで代用できるから今はやられないのでは？

治療

治療のmodality：手術療法、化学療法、放射線療法

治療法の選択：切除可能例では手術療法、手術不能例で遠隔転移が無い場合は化学療法±放射線療法、遠隔転移がある場合には化学療法を行う。

• 手術療法：

膵頭部癌で黄疸症状のある場合にはPTCDで減黄したのちに手術(QB.B-345)

• 根治手術：

• 膵頭十二指腸切除術、幽門輪温存膵頭十二指腸切除術
• 膵体尾部切除術

• 膵体尾部癌の根治術では脾合併膵体尾部切除術が行われる(QB.B-345)、らしいが。

• 膵尾部切除術
• 膵全摘術：悪性膵管内乳頭粘液性腫瘍、多発膵島細胞腫瘍などで生存期間の延長が見込める場合。(SSUR.637)

• 姑息手術

• 化学療法

• 放射線療法

病期分類

• TNM分類

http://www.kuhp.kyoto-u.ac.jp/~pancreas/pancreas_rule.html

• 浸潤などを含めた記載方法

http://www.kuhp.kyoto-u.ac.jp/~pathology/templates/pancreas1.html

http://ncc.ctr-info.com/?action=common_download_main&upload_id=481

http://www.nsknet.or.jp/~nagasato/pcstage.html

参考

• 1. 日本癌治療学会 - がん診療ガイドライン - 膵癌

http://www.jsco-cpg.jp/item/11/

• 2. Minds 膵癌　(参考1)と同じ

http://minds.jcqhc.or.jp/stc/0037/1/0037_G0000244_GL.html

国試

• 102D039

「pancreas cancer」

　　[★]

膵癌、膵臓癌、膵がん、膵臓がん

関

cancer of the pancreas、pancreatic cancer、pancreatic carcinoma、pancreatic neoplasm

「膵がん」

　　[★]

英

pancreatic cancer、pancreatic carcinoma、pancreas cancer、cancer of the pancreas

関

膵癌、膵臓癌、膵臓がん、膵腫瘍

「cancer of the pancreas」

　　[★]

膵癌、膵臓癌、膵がん、膵臓がん

関

pancreas cancer、pancreatic cancer、pancreatic carcinoma、pancreatic neoplasm

「pancreatic neoplasm」

　　[★]

膵腫瘍、膵新生物

関

cancer of the pancreas、pancreas cancer、pancreatic cancer、pancreatic tumor

「exocrine pancreatic cancer」

　　[★]

• 外分泌膵癌, EPC

[show details]

外分泌膵癌 : 10 件
外分泌膵臓癌 : 11 件

関

外分泌腫瘍

「pancreatic cancer cell」

　　[★]

• 膵癌細胞、膵臓癌細胞、膵がん細胞

「pancreatic」

　　[★]

• adj.

• 膵臓の、膵性の、膵の

関

pancreas、pancreata

　 　

「cancer」

　　[★]

同

癌腫

関

tumor