胰腺癌及其最最新进展

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1、胰腺癌PancreaticCarcinoma姚建伟胰腺是个很有意思的腺体，它既是一个外分泌器官，又是一个内分泌器官。从体积上来说，执行外分泌功能的结构在胰腺中占的比例比较大，分泌出含有多种消化酶的胰液，胰液通过胰腺导管流入肠道，帮助消化食物。由于消化道是与外界相通的，所以称为外分泌。这部分如果发生炎症，将会使强大的消化酶进入腹腔，造成胰腺炎；这个部分的细胞发生癌变，就是我们平常所讲的胰腺癌。2006EstimatedUSCancerCases**Excludesbasalandsquamouscellskincancersandinsitucarcinomasexceptur

2、inarybladder.Source:AmericanCancerSociety,2006.Men720,280Women679,51031%Breast12%Lung&bronchus11%Colon&rectum6%Uterinecorpus4%Non-Hodgkinlymphoma4%Melanomaofskin3%Thyroid3%Ovary2%Urinarybladder2%Pancreas22%AllOtherSitesProstate33%Lung&bronchus13%Colon&rectum10%Urinarybladder6%Melanomaofs

3、kin5%Non-Hodgkin4%lymphomaKidney3%Oralcavity3%Leukemia3%Pancreas2%AllOtherSites18%2006EstimatedUSCancerDeaths*ONS=Othernervoussystem.Source:AmericanCancerSociety,2006.Men291,270Women273,56026%Lung&bronchus15%Breast10%Colon&rectum6%Pancreas6%Ovary4%Leukemia3%Non-Hodgkinlymphoma3%Uterineco

4、rpus2%Multiplemyeloma2%Brain/ONS23%AllothersitesLung&bronchus31%Colon&rectum10%Prostate9%Pancreas6%Leukemia4%Liver&intrahepatic4%bileductEsophagus4%Non-Hodgkin3%lymphomaUrinarybladder3%Kidney3%Allothersites23%流行病学占全部恶性肿瘤的1-2%死亡率/发病率=0.99近年我国城市发病率大幅度上升，死亡率上升到第5位。多发生在50岁以上，2/3患者>65岁，近年年轻患者明显

5、增加趋势男女比1.6-1.9：1Five-yearRelativeSurvival(%)*duringThreeTimePeriodsByCancerSite*5-yearrelativesurvivalratesbasedonfollowupofpatientsthrough2002.†Recentchangesinclassificationofovariancancerhaveaffected1995-2001survivalrates.Source:Surveillance,Epidemiology,andEndResultsProgram,1975-2002,Div

6、isionofCancerControlandPopulationSciences,NationalCancerInstitute,2005.Site1974-19761983-19851995-2001Allsites505365Breast(female)757888Colon505864Leukemia344148Lungandbronchus121415Melanoma808592Non-Hodgkinlymphoma475460Ovary374145Pancreas335Prostate6775100Rectum495565Urinarybladder737882†

7、病因学吸烟机制：烟草有害成分经胆管排泌，刺激胰管上皮，最终导致癌变。烟草中致癌物入血后经胰腺排泌，烟草中尼古丁促进体内儿茶酚胺释放，导致血液中胆固醇水平明显升高。饮酒因素：酒精>持续刺激胰腺细胞分泌活性>胰腺慢性炎症>>胰腺损害酒精致癌物质（亚硝胺）致癌慢性胰腺炎、既往胃部手术、放射线照射、以及糖尿病饮食因素：低纤维、高肉类、高脂肪遗传病理TumorsofthePancreas–UsuallyExocrineHeadNeck/BodyTail60-70%5-10%10-15%20%Diffusetumo