Karcinom Pankreatu
Incidence a epidemiologie Incidence vyšší u mužů Věk-7.dekáda Přežití-vysoká úmrtnost počet přeživších v 5 letech cca 3% (1-2) Většinou adenokarcinom medián přežití 9-12měsíců
Etiologie, rizikové faktory,příznaky Kouření Anorexia,weight loss,abdominal dyscomfort,pain,tromboflebitis -vague signs Jaundice-painless-near the intrapancreatic bileduct Nausea,vomiting
Diagnostika UZ CT PET MR EUS ERCP-zároveń léčba Ca 19 9
Pathologie Adenocarcinoma-from exocrine gland most cases Metastatic spread- lymphonodes- regional liver
Staging and prognosis According local spread,nodal status,distant metastases-TNM system
Treatment Resectable disease-surgery-high volume medical centers better Determination of resecability -carefull examination-to exclude metastatic disease Surgical palliation-jaundice, gastric obstruction Bypass billiary obstruction
Radiation therapy After radical resection-high risk of locoreg.recurrence Preoperative Postoperative In combination with chemotherapy palliative
Chemotherapy 5-FU historically Gemcitabine-standard –palliative,adjuvant Anti EGFR