胰腺癌诊治指南（Guidelines for the diagnosis and treatment of pancreatic cancer）.doc

胰腺癌诊治指南（Guidelines for the diagnosis and treatment of pancreatic cancer） Guidelines for the diagnosis and treatment of pancreatic cancer Shanghai Tumor Hospital Combined therapy group of liver, gallbladder and pancreas 1 、 diagnosis and diagnosis process Medical history and physical examination First of all, a detailed history should be asked, including family history, diet history, chronic pancreatitis, diabetes history, etc.. For obstructive jaundice, unexplained weight loss (more than normal weight 10%), unexplained abdominal pain or back pain, the recent emergence of unexplained indigestion and gastrointestinal tract, diabetes and normal routine emergency without a family history of obesity and diabetes, sudden unexplained diarrhea, spontaneous onset of pancreatitis performance should be alert to the possibility of pancreatic cancer. laboratory examination Detection of serum tumor markers CA19-9 and CA242, CA19-9 is more sensitive in the diagnosis of pancreatic cancer, and the specificity of CA242 is better than CA19-9. The items must be checked: CEA, CA19-9, CA50, CA242. Special inspection B ultrasound is the first non-invasive examination for pancreatic cancer. The ultrasound found abnormal or unclear display should be CT or MRI to check further, can further display the location and size of the pancreatic mass and density as well as there is no pancreatic duct and (or) local bile duct dilatation, lesion invasion, lymph node metastasis and is associated with liver metastasis. For CT/MRI diagnostics, ERCP can be considered explicitly. Pathological diagnosis Mainly include (1) fine needle aspiration biopsy guided by US and CT; (2) EUS; (3) laparoscopic and intraoperative biopsy; (4) the pancreatic and duodenal drainage; (5) peritoneal lavage fluid and ascites. Pathological diagnosis is necessary before and after chemoradiotherapy for resectable pancreatic cancer Diagnostic flow chart Diagnostic flow chart Upper abdominal pain, jaundice, weight loss B ultrasonic e