Exocrine Pancreatic Cancer

ISBN-13: 9783642711800 / Angielski / Miękka / 2011 / 214 str.

Hughes Baumel; Bernard Deixonne; H. Sarles

Opis

For a long time, approximately since Oberlin and Guerin described the multifocal origin of pancreatic cancers and precancerous pancreatic lesions, no important study dealing with the entire subject of pancreatic cancer has been published in France and probably in the international literature. For some decades the knowl edge acquired 40years or more ago was not improved appreciably, though the fre quency ofthe disease started to increase in occidental countries. This has recently changed, and the progress ofthe medical sciences has spread to the pancreas. Although the surgical or medical prognosis of the most frequent form of pancreatic cancer, exocrine adenocarcinoma, remains very bad, recent studies have shown the multiplicityofits pathological forms, some being less severe so that curative surgery is possible. New experimental models, particularly in the hamster, and the use of carcinogenic drugs allow experimental studies on lesions similar to those in man. Oncologic immunology is still at its beginnings but shows promise for diagnosis and treatment. Though modem techniques of imaging sonography, aspirative cytology, CT scan, endoscopic catheterism, arteriography, and maybe in the future nuclear magnetic resonance - have not yet significantly in fluenced prognosis, they have made the diagnosis easierand more precocious. Yet in a diseasethat diffuses so rapidly to deep lymph nodes, it has not been proved whether early diagnosis can improve prognosis."

Spis treści

1 Epidemiology.- 1.1 Frequency.- 1.2 Descriptive Epidemiology.- 1.2.1 Incidence by Age and Sex.- 1.2.2 Geographical, Racial, and Social Variations.- 1.3 Causal Epidemiology.- 1.3.1 Chronic Pancreatitis.- 1.3.2 Diabetes Mellitus.- 1.3.3 Dietary Habits.- 1.3.4 Chemical and/or Industrial Agents.- 2 Pathological Anatomy.- 2.1 Macroscopic Study.- 2.1.1 Macroscopic Morphology.- 2.1.2 Intraglandular Localization.- 2.2 Microscopic Study.- 2.2.1 Histological Types.- 2.2.2 Epineoplastic Pancreatitis.- 2.2.3 Pancreatic Cytology.- 2.2.4 Duct Hyperplasia-Cancer Relationship.- 2.3 Extraglandular Extension.- 2.3.1 Spreading by Contiguity.- 2.3.2 Spreading via the Venous Network.- 2.3.3 Spreading via Lymphatic Effluents.- 2.4 Classification of the Stages of Development.- 2.4.1 TNM Classification.- 2.4.2 Hermreck’s Classification.- 2.4.3 Cubilla’s Classification.- 2.4.4 A New Proposal.- 3 Clinical Features.- 3.1 Classical Types.- 3.1.1 Painful.- 3.1.2 Jaundiced.- 3.1.3 Cachectic.- 3.1.4 Tumor.- 3.2 False Types.- 3.2.1 Rheumatological.- 3.2.2 Gastrointestinal.- 3.2.3 Psychic.- 3.2.4 Febrile.- 3.2.5 Endocrine.- 3.2.6 Blood-Vascular.- 3.3 Metastatic Types.- 3.3.1 Pleural Effusion.- 3.3.2 Steatonecrosis.- 4 Biological Examinations.- 4.1 Standard Biology.- 4.2 Pancreatic Function Tests.- 4.3 Tumor Markers.- 4.3.1 Serological Markers.- 4.3.2 Antitumor Immunity.- 5 Morphological Examinations.- 5.1 Conventional Roentgenograms.- 5.1.1 Abdominal Plain Films.- 5.1.2 Upper Gastrointestinal Tract.- 5.2 Ultrasonography and Computerized Tomography.- 5.2.1 Ultrasonography (US).- 5.2.2 Computerized Tomography (CT).- 5.2.3 Value and Limitations of Ultrasonography and Computerized Tomography in Diagnosis of Pancreatic Cancer.- 5.3 Exploration of Bile Ducts and Wirsung’s Duct.- 5.3.1 Cholangiography.- 5.3.2 Endoscopic Retrograde Cholangiopancreatography (ERCP).- 5.3.3 Value and Limitations of Cholangiography and ERCP in Diagnosis of Pancreatic Cancer.- 5.4 Angiography.- 5.5 Laparoscopy.- 5.6 Percutaneous Needle Biopsy.- 5.6.1 Method.- 5.6.2 Diagnostic Accuracy.- 5.7 Magnetic Resonance.- 5.8 Morphological Diagnosis of the Principal Varieties of Pancreatic Tumors.- 5.8.1 Adenocarcinoma.- 5.8.2 Cystadenocarcinoma.- 5.9 Radiological Invasion Workup.- 6 Present Strategies for Diagnosis.- 6.1 Early Diagnosis.- 6.2 Presenting Symptoms.- 6.3 Further Investigations.- 6.4 Pretherapeutic Appraisal.- 6.5 Exploratory Laparotomy.- 6.6 Diagnostic Steps.- 6.7 Conclusion.- 7 Therapeutic Management.- 7.1 Pancreatectomies.- 7.1.1 Anatomical Basis for Surgery.- 7.1.2 Surgical Approaches.- 7.1.3 Techniques.- 7.1.4 Advantages and Disadvantages.- 7.2 Symptomatic Treatment.- 7.2.1 Surgical Biliary Bypass.- 7.2.2 Nonsurgical Biliary Drainage (External and Internal).- 7.2.3 Digestive Diversion.- 7.2.4 Analgesia.- 7.3 Chemotherapy and Radiation Therapy.- 7.3.1 Chemotherapy.- 7.3.2 External Beam Irradiation.- 7.3.3 Internal Radiation Therapy.- 7.3.4 Combined Radiation Therapy and Chemotherapy.- 8 Results of Therapy.- 8.1 Pancreatic Resection Versus Palliative Bypass.- 8.2 Results in Relation to Extent of Resection.- 8.2.1 Rate of Resectability.- 8.2.2 Percentage of Cures.- 8.2.3 Operative Mortality and Morbidity.- 8.3 Symptomatic and Adjuvant Therapies.- 9 Present Treatment Strategies.- 9.1 The Various Patient Groups.- 9.1.1 Operability.- 9.1.2 Resectability.- 9.1.3 Curability.- 9.2 Exploratory Laparotomy.- 9.2.1 Pancreatic Biopsy.- 9.2.2 Abdominal Metastases.- 9.2.3 Invasion of Adjacent Vessels.- 9.2.4 Lymph Node Involvement.- 9.3 Curative Strategies.- 9.3.1 Pancreatectomies.- 9.3.2 The Problem of Jaundice.- 9.3.3 Localization and Stage of Development.- 9.3.4 Adjuvant Treatments.- 9.4 Palliative Strategies.- 9.4.1 Palliative Surgery.- 9.4.2 Adjuvant Therapies.- 9.5 Inoperable Patients.- 9.5.1 Jaundice.- 9.5.2 Nutrition.- 9.5.3 Pain.- 9.5.4 Radiation Therapy and Chemotherapy.- 9.6 Conclusion.- 10 Intensive Care.- 10.1 Nutritional Deficiency and Support.- 10.1.1 Nutritional Deficiency.- 10.1.2 Nutritional Support.- 10.2 Pain.- 10.2.1 ChronicPain.- 10.2.2 Postoperative Pain.- 10.3 Organic Predisposition.- 10.3.1 Age.- 10.3.2 Respiratory Function.- 11 Treated Patients.- 11.1 Prognostic Factors.- 11.1.1 General Factors.- 11.1.2 Oncological Factors.- 11.1.3 Therapeutic Factors.- 11.2 Quality of Survival.- 11.2.1 After Resection.- 11.2.2 After Palliative Treatment.- 11.2.3 Inoperable Patients.- 11.3 Follow-up.- 12 Conclusion.- 13 Subject lndex.