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Treatment and Prognosis of Pancreatic Cancers

cancer therapy




The average life expectancy for patients with unresectable pancreatic cancers is less than one year. 



5-フルオロウラシル ... 抗癌剤  5-fluorouracil;

エルロチニブ ... ゲムシタビンと併用して膵臓癌治療に用いる  erlotinib;

経皮的な  percutaneous;

ゲムシタビン ... 癌・腫瘍のDNA 合成を阻害する代謝拮抗物質  gemcitabine;

十二指腸の  duodenal;

膵臓癌  pancreatic cancer;

腺癌  adenocarcinoma;

胆管ドレナージ  biliary drainage;

超音波内視鏡  endoscopic ultrasonography;

遠位胃切除(幽門側胃切除)  distal gastrectomy;

拡大リンパ節郭清(切除)  extended lymphadenectomy;

上腸間膜動脈  superior mesenteric artery;

内臓神経切除術  splanchnicectomy;

乳頭部周囲腺癌  periampullary adenocarcinoma;

腹腔動脈  celiac artery (axis);

平均余命  average life expectancy;

補助療法 ... 薬物の作用を増強する物質による治療法  adjuvant therapy;

門脈  portal vein;

膵十二指腸切除術  pancreaticoduodenectomy;

膵頭部腫瘍  pancreatic head tumor;

膵嚢胞性腫瘍  pancreatic cystic neoplasm



Credit: Surgical knife, Feather



Patients with primary pancreatic adenocarcinomas rather than metastases are most commonly treated by resectional surgery.



The patients should undergo the resectional surgery in highly experienced medical settings.  Outcomes of resectional surgeries depend on surgeons' skills and experiences.



If patients who receive treatment with preoperative biliary drainage due to obstructive jaundice caused by pancreatic head tumor undergo resectional surgery, they are at increased risk of complications.



When patients have periampullary adenocarcinoma, they most commonly undergo pancreaticoduodenectomy.  If they receive distal gastrectomy and extended lymphadenectomy, they are not expected to have better outcomes.



If there is a fat layer around the celiac and superior mesenteric arteries and if the mesenteric and portal veins are not invaded, the pancreatic cancers may be resected.  



After resection has been successful, adjuvant therapy is performed with for example 5-fluorouracil and folinic acid or gemcitabine.



After resectional surgery is successful, when the patients receive adjuvant therapy, their 5-year survival rates approach about 20%.



Surgery can also relieve symptoms caused by pancreatic cancers. 



If surgical exploration that patients undergo reveal that they do not have resectable tumors, they may undergo a biliary or gastric bypass surgery to alleviate their symptoms.



Both biliary and duodenal stents may be used instead of invasive surgery.   



In addition, splanchnicectomy can be used with endoscopic ultrasonography or percutaneously to achieve long-lasting pain relief.



If pancreatic cancers that patients have contacted have locally advanced and unresectable, they need to be treated with a combination of chemotherapy and radiation therapy, and then additional chemotherapy.



For most common chemotherapy, 5-fluorouracil is intravenously and continuously administered.  As alternative chemotherapy drug, gemcitabine may be used. 



The average life expectancy for patients who have unresectable pancreatic cancers is 10 to 12 months.



The average life expectancy for patients who have unresectable pancreatic cancers is 10 to 12 months.



Erlotinib, which is an oral cancer drug, is expected to additionally prolong their survival time. 



If patients have locally advanced or metastatic pancreatic cancers, treatment for alleviating pain and for preventing local complications needs to be adequately performed.



Biliary obstruction can be cured surgically or with a plastic or flexible metal stent.



Patients with a pancreatic cystic neoplasm should undergo resectional surgery.



The long-term survival rate for patients who had resection of pancreatic cystic neoplasms exceeds 70%