胰腺癌讲课幻灯原版课件

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1、胰腺癌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，近年年轻患者明显增加趋势男女比1.6-1.9：12006EstimatedUSCancerCases**Excludesbasalandsquamouscellskincancersandinsitucarcinomasexcepturinarybladder.Source:AmericanCancerSociety,2006.Men720,280Women679

2、,51031%Breast12%Lung&bronchus11%Colon&rectum6%Uterinecorpus4%Non-Hodgkinlymphoma4%Melanomaofskin3%Thyroid3%Ovary2%Urinarybladder2%Pancreas22%AllOtherSitesProstate33%Lung&bronchus13%Colon&rectum10%Urinarybladder6%Melanomaofskin5%Non-Hodgkin4%lymphomaKidney3%Ora

3、lcavity3%Leukemia3%Pancreas2%AllOtherSites18%2006EstimatedUSCancerDeaths*ONS=Othernervoussystem.Source:AmericanCancerSociety,2006.Men291,270Women273,56026%Lung&bronchus15%Breast10%Colon&rectum6%Pancreas6%Ovary4%Leukemia3%Non-Hodgkinlymphoma3%Uterinecorpus2%M

4、ultiplemyeloma2%Brain/ONS23%AllothersitesLung&bronchus31%Colon&rectum10%Prostate9%Pancreas6%Leukemia4%Liver&intrahepatic4%bileductEsophagus4%Non-Hodgkin3%lymphomaUrinarybladder3%Kidney3%Allothersites23%Five-yearRelativeSurvival(%)*duringThreeTimePeriodsByCance

5、rSite*5-yearrelativesurvivalratesbasedonfollowupofpatientsthrough2002.†Recentchangesinclassificationofovariancancerhaveaffected1995-2001survivalrates.Source:Surveillance,Epidemiology,andEndResultsProgram,1975-2002,DivisionofCancerControlandPopulationSciences,Na

6、tionalCancerInstitute,2005.Site1974-19761983-19851995-2001Allsites505365Breast(female)757888Colon505864Leukemia344148Lungandbronchus121415Melanoma808592Non-Hodgkinlymphoma475460Ovary374145Pancreas335Prostate6775100Rectum495565Urinarybladder737882†病因学吸烟慢性胰腺炎、既往胃

7、部手术、放射线照射、以及糖尿病饮食因素：低纤维、高肉类、高脂肪遗传诊断和诊断流程临床表现腹痛:胰头癌多见腹部不适及隐痛；胰体尾癌常出现上腹部及腰背部显著疼痛黄疸：胰头癌的突出表现消化道症状：食欲下降，腹胀或腹泻，恶心，呕吐或黑便消耗：乏力，消瘦，呈恶液质状态其它：腹水深而不规则的肿块血糖升高血栓性静脉炎远处转移的表现肿瘤扩散途径局部侵润：胰头癌中，肿瘤对胰周的侵犯通常通过神经鞘进行，主要累及腹膜后脂肪组织，之后会侵及腹膜后静脉和神经。晚期可直接蔓延到邻近的器官、腹膜；胰体尾癌侵犯更为广泛淋巴道转移血行转移：肝转移最常

8、见实验室及影像学检查CA19-9:良恶性胰腺疾病的鉴别诊断，术后复发监测和预后的指标B超腹部CT或MRI:与慢性胰腺炎鉴别病理学诊断US、CT引导的细针穿刺活检组织活检结果提示大约10％临床确诊病例为良性病变穿刺诊断注意事项：禁食、术后给予止血及生长抑素腹腔镜及术中活检组织胰液及十二指肠引流液细胞学检查腹腔冲洗液及腹水细胞学检查诊断流程图上腹痛