胰腺癌（胰腺）诊断与治疗

The doctor will examine the patient’s skin, tongue, and eyes to see if they are yellow, which is a sign of jaundice. Jaundice can be from a tumour in the head of the pancreas that is blocking the normal flow of a substance called bile, which is produced in the liver. However, many patients with pancreatic cancer do not have jaundice when the cancer is diagnosed. The doctor will also feel the abdomen for changes caused by the cancer, although the pancreas itself, which is located in the back of the upper abdomen, can rarely be felt. An abnormal buildup of fluid in the abdomen, called ascites, may be another sign of cancer. The doctor will also examine the abdomen to determine if the patient have pain in the upper portion of the abdomen just below the breastbone.

The doctor may take samples of blood to check for abnormal levels of bilirubin and other substances. Bilirubin is a chemical that may reach high levels in people with pancreatic cancer due to blockage of the common bile duct by a tumour. Carbohydrate antigen 19-9 (CA19-9) is a tumour marker. A tumour marker is a substance produced by a tumour that may be found at higher levels if cancer is present and can be measured in the blood. CA19-9 levels are often increased in people with pancreatic cancer, although some patients have normal CA19-9 levels. CA19-9 levels often become higher as the cancer grows or spreads.

A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer comThank you for your message. We will contact you shortly.bines these pictures into a detailed multi-dimensional scan (typically 3-dimensional or more) image that shows any abnormalities or tumours. A CT scan can be used to determine the size and location of the primary tumour and evaluate the possibility of spread to lymph nodes or other parts of the body.

A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

The doctor will put a thin, lighted tube called an endoscope through the mouth and stomach into the small intestine. Then, a smaller tube called a catheter is passed through the endoscope and into the bile ducts and pancreatic ducts. Dye is injected into the ducts, and the doctor takes x-rays that can show whether a duct is compressed or narrowed. Often, a plastic or metal stent can be placed across the obstructed bile duct during ERCP to help relieve any jaundice. Samples of the tissue can be taken during this procedure and can sometimes help confirm the diagnosis of cancer. The patient is lightly sedated during this procedure. ERCP is generally used to place bile duct stents and not commonly used for diagnosis.

An ultrasound uses sound waves to create a picture of the internal organs. There are 2 types of ultrasound devices:
A transabdominal ultrasound deviceis placed against the outside of the abdomen and is slowly moved around by the doctor to produce an image of the pancreas and surrounding structures.
An endoscopic ultrasound (EUS) device is a thin, lighted tube that is passed through the patient’s mouth and stomach and down into the small intestine. It is slowly moved around the area to take a picture of the pancreas.EUS is generally done under sedation, so the patient sleeps through the procedure. A biopsy may also be done at the same time as this procedure.

In this x-ray procedure, a thin needle is inserted through the skin and into the liver. A dye is injected through the needle, so the bile ducts show up on x-rays. By looking at the x-rays, the doctor can tell whether there is a blockage of the bile ducts.

An MRI uses magnetic fields to produce detailed images of the body. MRI can be used to measure the tumour’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye is usually injected into a patient’s vein.

This is the removal of a small amount of tissue for examination under a microscope. There are a couple of different ways to collect a tissue sample:
Fine needle aspiration (FNA): An FNA uses a thin needle that is inserted into the pancreas to suction out cells. This is typically done by EUS or through the skin, called percutaneously, guided by a CT scan.

This is used to collect a larger piece of tissue, which may be helpful for biomarker or genetic testing of the tumour.
Molecular or biomarker testing of the tumour: The doctor may recommend additional molecular tests to be performed on the tumour sample to identify specific mutations, genetic alterations, expression of certain proteins, and other molecular features unique to the tumour.

It is now recommended that all patients with a diagnosis of pancreatic cancer be considered for germline testing. This means testing a blood or saliva sample to look for mutations in a person’s DNA that may indicate a hereditary predisposition to cancer. If a patient is found to be a carrier for particular genetic mutations, this may help guide the treatment decisions if pancreatic cancer is diagnosed.