Once discovered, it is already in the advanced stage, and the survival rate is extremely low! Why is pancreatic cancer so scary?

Recently, Wu Zunyou, chief epidemiologist at the Chinese Center for Disease Control and Prevention, passed away from pancreatic cancer at the age of 60. While we are mourning and grieving, we also feel deeply the danger of pancreatic cancer.

Pancreatic cancer is known as the "king of cancers". It has a very low survival rate and poor prognosis, which seriously threatens public health. In recent decades, with the development of economic level and society, the incidence of pancreatic cancer in China has shown an increasing trend year by year. The incidence rate in men is higher than that in women, with a male-to-female ratio of about 1.5 to 2:1.

To change the current pessimistic situation, of course, it requires the unremitting efforts of medical staff, but as ordinary people, we must also take the initiative to strengthen the study of relevant medical knowledge and improve our understanding of pancreatic cancer, so as to better prevent and control pancreatic cancer.

Is a tumor growing in the pancreas pancreatic cancer?

When it comes to pancreatic cancer, we must understand that not all tumors that grow in the pancreas are pancreatic cancer.

Pancreatic cancer, as the name suggests, is a malignant tumor (cancer) that occurs in the pancreas. Many people would assume that all tumors that grow in the pancreas are pancreatic cancer. But in fact, regardless of whether tumors are benign or malignant, even malignant tumors that occur in the pancreas are not necessarily pancreatic cancer.

Pancreatic cancer refers to a malignant tumor that originates from the pancreatic ductal epithelium. There is another type of primary pancreatic tumor, neuroendocrine tumor, which originates from pancreatic multipotent neuroendocrine stem cells. The former Apple CEO Steve Jobs did not have pancreatic cancer, but a pancreatic neuroendocrine tumor. The two are very different in terms of biological characteristics ("temperament"), treatment and prognosis, and should never be confused.

Why is pancreatic cancer the “king of cancers”?

There are so many types of cancer, why is pancreatic cancer called the "king of cancer"? There are three main reasons:

1

High malignancy, low survival rate

Pancreatic cancer is a highly malignant tumor that is dangerous, highly invasive, progresses rapidly, and easily spreads and metastasizes. The effects of various existing treatments are very unsatisfactory. The surgical resection rate is low, the postoperative recurrence rate or metastasis rate is high, and the overall 5-year survival rate is less than 15%, and in the late stage it is even less than 5%. The overall survival period of patients after diagnosis is very short. The median survival time of pancreatic cancer patients who do not receive any treatment is often only about 4 to 6 months, and most patients die within 1 year after diagnosis.

2

Insidious onset, difficult to detect early

Pancreatic cancer is terrible, in addition to its high malignancy and strong invasiveness, another important reason is that it is difficult to detect early. Early diagnosis and early treatment are the key to improving survival rate and prognosis, but the pancreas is located behind the peritoneum, hidden deep inside, and surrounded by many other organs and tissues, making it difficult to be detected by common examination methods. There are often no specific clinical manifestations in the early stage, and most patients are already in the middle and late stages when diagnosed.

3

Advanced stage, difficult to treat, poor prognosis

There are few cases of pancreatic cancer in the early stage, and the treatment methods for late stage are very limited, and the treatment effect is not good. Although the diagnosis and treatment level of pancreatic cancer has improved in recent years, it is still far from ideal overall.

Which group of people are prone to pancreatic cancer?

Like most cancers, the exact cause of pancreatic cancer has not been fully understood so far, but epidemiological surveys have found some risk factors associated with the incidence of pancreatic cancer, including smoking.

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When it comes to smoking, many people only think of it as being related to lung cancer. In fact, smoking is related to many cancers. Smoking also plays a very important role in the development of pancreatic cancer. Some scholars believe that smoking causes 20% to 30% of pancreatic cancer, and quitting smoking can reduce the risk of pancreatic cancer. It should be pointed out that passive smoking also increases the risk of pancreatic cancer.

In addition to long-term smoking, other possible risk factors for pancreatic cancer include: excessive drinking, high-fat and high-protein diet, excessive body mass index (obesity), excessive coffee drinking, environmental pollution, genetic susceptibility factors (family history), history of chronic pancreatitis, history of cholecystectomy, occupational factors, etc.

Age is also a natural high-risk factor for most malignant tumors. Most pancreatic cancers occur after the age of 40, especially after the age of 55. In addition, the incidence of pancreatic cancer in people with diabetes seems to be higher than that in the general population, but there is no clear conclusion on whether there is a clear correlation between the two.

How to prevent pancreatic cancer?

To prevent a disease, we must first know the cause of its occurrence. However, since the exact cause is unknown, there is no effective preventive measure for pancreatic cancer. However, some measures can be taken to reduce the risk of pancreatic cancer as much as possible, such as quitting smoking, staying away from secondhand smoke, controlling alcohol consumption, eating a light, easily digestible, low-fat diet, avoiding high-fat and high-calorie diets, exercising regularly, promoting outdoor aerobic activities, controlling weight, and avoiding overweight and obesity.

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In addition, some benign lesions of the pancreas, such as pancreatic duct stones, intraductal mucinous papilloma and cystic adenoma, should be diagnosed and treated by a doctor in a timely manner; chronic pancreatitis and diabetes should also be diagnosed, treated and monitored in a timely manner.

How to detect pancreatic cancer as early as possible?

Before the cause of the disease is fully understood, the above-mentioned "prevention" measures can only reduce the risk to a certain extent. At present, early detection, early diagnosis and early treatment are particularly important. However, as mentioned earlier, pancreatic cancer has no specific manifestations in the early stage, and early detection and diagnosis of pancreatic cancer is very difficult because it is located deep behind the peritoneum.

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However, it does not mean that we can do nothing and just leave it to fate. As long as we pay attention to it, we can still do our best to detect and diagnose it early and then treat it early. So how can we do it?

①On the one hand, high-risk groups should take the initiative to undergo screening.

For people at high risk of pancreatic cancer, especially those with a family history and those with existing pancreatic lesions, it is recommended to draw blood once a year to check for tumor markers such as CA199, CA125, and CEA, combined with abdominal CT or MRI examinations, and sometimes ultrasound examinations can also be considered. If abnormalities are found, regular follow-up examinations or further examinations should be performed to confirm the diagnosis.

High-risk groups refer to: people over 40 years old (especially over 50 years old), those with a family history of pancreatic cancer or confirmed to carry a pancreatic cancer susceptibility gene, those with recent onset of diabetes without a family history of the disease, long-term smokers and drinkers, those with a high-fat and high-protein diet, patients with recurrent chronic pancreatitis, especially chronic pancreatitis with pancreatic duct stones, main pancreatic duct mucinous papilloma, mucinous cystic adenoma, solid pseudopapillary tumor, etc., who have elevated serum CA199.

②On the other hand, do not miss any "clues" and seek medical attention in time if you find any abnormalities.

Are there any signs that we might have pancreatic cancer? As mentioned before, pancreatic cancer has an insidious onset, and early symptoms are not obvious and specific. The first symptoms depend on the location and extent of the tumor. For example, early pancreatic head cancer may show signs of obstructive jaundice, while early pancreatic body and tail tumors generally do not show signs of jaundice.

Some early symptoms of pancreatic cancer are often easily confused with common gastrointestinal diseases. We need to be vigilant and improve our ability to identify them. Possible clinical manifestations include:

Upper abdominal discomfort or dull pain is a common initial symptom; gastrointestinal symptoms (anorexia, nausea, bloating and other indigestion symptoms, diarrhea, especially steatorrhea, etc.); jaundice, which may be accompanied by skin itching, dark tea-colored urine and clay-like stools; most pancreatic cancer patients may experience emaciation, fatigue, weight loss, etc. in the early stages; some patients may have low fever or abnormal blood sugar.

In general, for pancreatic cancer, which has an extremely low survival rate, the earlier it is discovered, the greater the chance of survival. Early identification and diagnosis of pancreatic cancer requires not only the patient's own attention, but also the first-time doctor's vigilance to minimize missed diagnoses and misdiagnoses.

Author: Pan Zhanhe, deputy chief physician and master's supervisor at Xiamen University Zhongshan Hospital

Reviewer: Tang Qin, Director and Researcher of the Science Popularization Department of the Chinese Medical Association