概述

胰腺癌始于胰腺组织(位于腹部胃下后方的一个器官)。胰腺会释放有助于消化的酶,并产生有助于控制血糖的激素。

胰腺会发生几种类型的增生,包括癌性和非癌性肿瘤。胰腺中最常见的癌症类型起源于将消化酶运出胰腺的导管细胞(胰腺导管腺癌)。

胰腺癌很少在早期阶段被发现,而在这个阶段最容易治愈。这是因为它往往在扩散到其他器官后才会出现症状。

根据癌症的程度选择胰腺癌的治疗方案。方案可能包括手术、化疗,放射疗法或其组合。

症状

在疾病进展到晚期之前,往往不会显现胰腺癌的体征和症状。这其中可能包括:

  • 腹痛辐射到背部
  • 食欲不振或者意外体重减轻
  • 皮肤和眼白发黄(黄疸)
  • 浅色大便
  • 尿色深
  • 皮肤瘙痒
  • 新患糖尿病或者已患糖尿病变得更难以控制
  • 血凝块
  • 疲劳

何时就诊

如果出现令您担忧的任何原因不明的症状,请就诊。许多其他疾病可能导致这些症状,因此医生可能检查您是否患有这些疾病以及胰腺癌。

病因

尚不清楚胰腺癌的病因。医生已确定可能增加罹患此类癌症风险的因素,包括抽烟和携带某些遗传性基因突变。

了解您的胰腺

您的胰腺长约 15 厘米,看起来像一颗放倒的梨子。胰腺释放(分泌)胰岛素等激素,帮助身体处理食物中摄入的糖分。它还产生消化液,帮助身体消化食物和吸收营养。

胰腺癌如何形成

当您的胰腺细胞出现 DNA 变化(突变)时,胰腺癌发生。细胞的 DNA 含有告诉细胞该做什么的指令。这些突变告诉细胞无控制地生长并在正常细胞本会死亡后继续存活。这些不断累积的细胞会形成肿瘤。如果不加治疗,胰腺癌细胞会扩散到附近的器官和血管,以及身体的远端部位。

大多数胰腺癌起源于胰腺导管内衬细胞。这种类型的癌症叫做胰腺腺癌或胰腺外分泌癌。癌可以较低频地在胰腺的产激素细胞或神经内分泌细胞中形成。这些类型的癌症叫做胰腺神经内分泌肿瘤、胰岛细胞瘤或胰腺内分泌癌。

风险因素

可能增加胰腺癌风险的因素包括:

  • 吸烟
  • 糖尿病
  • 胰腺慢性炎症(胰腺炎)
  • 有增加癌症风险的遗传综合征家族史,包括 BRCA2 基因突变、林奇综合征和家族性非典型痣恶性黑色素瘤综合征
  • 胰腺癌家族史
  • 肥胖症
  • 年龄较大,因为大多数人都是在 65 岁以后才被诊断出来

一项大型研究表明,同时具备抽烟、长期糖尿病和不良饮食等因素所以增加的胰腺癌风险,超过了其中任何一个单一因素带来的风险。

并发症

随着胰腺癌的进展,可能引起的并发症包括:

  • 体重减轻。多种因素可能导致胰腺癌患者体重减轻。可能因为癌症消耗身体的能量发生体重减轻。因癌症治疗或因肿瘤压迫胃部引起的恶心和呕吐可能导致患者进食困难。或者因为胰腺分泌的消化液过少,导致患者的身体难以处理食物中的营养。
  • 黄疸。胰腺癌阻塞肝脏胆管可导致黄疸。体征包括皮肤和眼睛发黄、尿色加深和粪色变浅。黄疸通常不伴腹痛。

    医生可能会建议将一根塑料或金属管(支架)放在胆管内撑起胆管以保持畅通。支架需要通过一种名为内镜下逆行胰胆管造影术(ERCP)的手术放置。在内镜下逆行胰胆管造影术期间,将内镜从咽喉插入,经胃到达小肠上段。通过内镜插入一条细径中空管(导管),由导管将染料注入胰腺和胆管内。最后拍摄胆管图像。

  • 疼痛。肿瘤增大可能压迫腹部神经,导致疼痛加剧。止痛药可能有助于缓解疼痛。治疗(例如放疗和化疗)可能有助于减慢肿瘤生长并起到一定的疼痛缓解作用。

    如果是重度病例,医生会建议将酒精注射入神经来控制腹部疼痛(腹腔神经丛阻滞术)。该手术会阻止神经向大脑发送疼痛信号。

  • 肠梗阻。胰腺癌生长进入或压迫小肠第一段(十二指肠),会阻止消化后的食物从胃进入小肠。

    医生可能会建议将在小肠内置管(支架),保持其畅通。有些病例通过手术放置临时进食管或将胃连至未被癌症阻塞的小肠低点,也可能有所帮助。

预防

您可以通过以下措施降低患胰腺癌的风险:

  • 戒烟。如果您抽烟,请尽量戒烟。与医生讨论戒烟策略,包括互助组、药物治疗和尼古丁替代疗法。如果您不抽烟,请勿开始抽烟。
  • 保持健康体重。如果您体重健康,请努力维持。如果您需要减轻体重,尽量缓慢、稳定地减轻体重 — 一周减去 1 到 2 磅(0.5 到 1 千克)。将日常锻炼与富含蔬菜、水果和全谷类的少量饮食相结合帮助减轻体重。
  • 健康饮食。富含色彩丰富的水果、蔬菜和全谷类食物的饮食有助于降低患癌症的风险。

如果您有胰腺癌家族病史,请考虑向遗传咨询师咨询。她/他可能和您一起查看您的家族病史,并确定基因检测是否有助于了解您患胰腺癌或其他癌症的风险。

在 Mayo Clinic 治疗

June 06, 2021
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