Pancreatic Cancer (췌장암)

소개

췌장암의 역학, 임상양상, 진단, 치료, 예후에 관하여 최근에 출판된 해리슨 17판을 바탕으로 정리하고 관련 논문내용을 첨부하였습니다.

목차

I. Incidence & Etiology

II. Clinical Features
1) Histologic types
2) Location
3) Symptoms

III. Diagnostic Procedures
• Difficulty in Diagnosing
• Imaging & Histologic
• Clinical
• Screening

IV. Treatment
1) Complete surgical resection
2) If surgically Unresectable

Ⅴ. Prognosis

Ⅵ. References

본문내용

III. Diagnostic Procedures
• Difficulty in Diagnosing
i) nonspecificity of initial symptoms
ii) poor sensitivity of both serologic assays & noninvasive techniques
• Imaging & Histologic confirmation 이 필요. (esp. 조직학적 확진은 필수)
- R/O islet cell tumor or lymphoma from ductal carcinoma
• Clinical suspicion : 환자가 모호하고 지속적인 복통을 호소한다.
• Screening (다음의 경우 spiral CT를 사용한 screening 고려)
i) 35 in patients with hereditary pancreatitis
ii) 10 years before the age of the youngest diagnosis of pancreatic cancer in those with a significant family history

1) Abdominal US
Obstructive jaundice 환자의 initial screening에 유용하다. CT보다는 민감도가 떨어진다.
2) Abdominal CT scan
- Sensitivity >80%, false negative 5~10%(염증성 종괴), false positive 5~10%
- 저음영의 종괴, 췌장의 국소적 비후, 췌장의 모양 변형
- 흔히 복강내로 전이되므로 liver, retroperitoneal LN, pelvis도 관찰
3) ERCP with EUS
- clarification of ambiguous CT or US finding
- stenosis or obstruction of pancreatic duct or bile duct
4) (Radiologic) Staging Criteria
(표로 정리)

참고자료

· 1) Harrisons Principles of Internal Medicine, 17th ed. p586~589
· 2) A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer.N Engl J Med. 2004 Mar 18;350(12):1200-10.