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Pankreascancer

Senast uppdaterad: Senast reviderad:
Sakkunnig:

DEFINITION:
Det finns en rad olika histologiska typer och adenokarcinom är absolut vanligast och utgör mer än 90 %.
FÖREKOMST:
Genomsnittet har varit 1 152 nya fall per år under de senaste 20 åren.
SYMTOM:
Är till en början vaga och ospecifika, gulsot, buksmärta, viktnedgång och illamående.
KLINISKA FYND:
Gulsot och smärta i övre delen av buken och/eller ryggen tillsammans med ofrivillig viktnedgång kan ge misstanke enligt standardiserat vårdförlopp (RCC). 
DIAGNOSTIK:
Akut (inom 24 timmar): ultraljud av lever, gallvägar och pankreas. Diagnosen ställs i regel med DT eller MR.
BEHANDLING:
Om tumören anses resektabel, är behandlingen kirurgisk.
  1. Kamisawa T, Wood LD, Itoi T, Takaori K. Pancreatic cancer. Lancet. 2016 Jul 2;388(10039):73-85. doi: 10.1016/S0140-6736(16)00141-0. pmid: 26830752. PubMed  
  2. Pankreascancer inklusive periampullär cancer, Nationellt vårdprogram, Regionala Cancercentrum i Samverkan (Oktober 2012/Mars 2014). www.cancercentrum.se  
  3. Silverman DT, Dunn JA, Hoover RN, et al. Cigarette smoking and pancreas cancer: a case-control study based on direct interviews. J Natl Cancer Inst. 1994; 86: 1510-6.
  4. Fryzek JP, Garabrant DH, Greenson JK, Schottenfeld D. A review of the epidemiology and pathology of pancreas cancer. Gastrointest Cancer 1997; 2: 99-110. PubMed  
  5. Hruban RH, Petersen GM, Ha PK, Kern SE. Genetics of pancreatic cancer: from genes to families. Surg Oncol Clin N Am 1998; 7: 1-23. PubMed  
  6. Schenk M, Schwartz AG, O'Neal E, et al. Garabrant familial risk of pancreatic cancer. J Natl Cancer Inst 2001; 93: 640-44. PubMed  
  7. Lowenfels AB, Maisonneuve P, DiMagno EP, Elitsur Y, Gates LK Jr, Perrault J, et al. Hereditary pancreatitis and the risk of pancreatic cancer. J Natl Cancer Inst 1997; 89: 442-6. PubMed  
  8. Michaud DS, Giovannucci E, Willett WC, Colditz GA, Stampfer MJ, Fuchs CS. Physical activity, obesity, height, and the risk of pancreatic cancer. JAMA 2001; 286: 921-9. PubMed  
  9. Ji BT, Chow WH, Gridley G, et al. Dietary factors and the risk of pancreatic cancer: a case-control study in Shanghai, China. Cancer Epidemiol Biomarkers Prev 1995; 4: 885-93. PubMed  
  10. Ben Q, Xu M, Ning X, et al. Diabetes mellitus and risk of pancreatic cancer. A meta-analysis of cohort studies. Eur J Cancer 2011; 47: 1928-37 PubMed  
  11. Liao W-C, Tu YK, Wu MS, et al. Blood glucose concentration and risk of pancreatic cancer: Systematic review and dose-response meta-analysis. BMJ 2015 Jan 3; 349:g7371. doi: 10.1136/bmj.g7371 DOI  
  12. Gapstur SM, Jacobs EJ, Deka A, et al. Association of alcohol intake with pancreatic cancer mortality in never smokers. Arch Intern Med 2011; 171: 444-51. PubMed  
  13. DiMagno EP. Pancreatic cancer: clinical presentation, pitfalls and early clues. Ann Oncol 1999; 10(suppl 4): 140-2.
  14. Nationellt vårdprogram: Pankreascancer inklusive periampullär cancer. Regionala Cancercentrum i Samverkan. Reviderad version 1.1 (2014-03-05). www.cancercentrum.se  
  15. Mortensen MB, Svolgaard B, Vyberg M. Diagnostik og udredning af cancer pancreatis. Ugeskr Læger 2010; 172: 1369. Ugeskrift for Læger  
  16. Montgomery RC, Hoffman JP, Riley LB, Rogatko A, Ridge JA, Eisenberg BL. Prediction of recurrence and survival by post-resection CA 19-9 values in patients with adenocarcinoma of the pancreas. Ann Surg Oncol 1997; 4: 551-6. PubMed  
  17. Louhimo J, Alfthan H, Stenman UH, Haglund C. Serum HCG beta and CA 72-4 are stronger prognostic factors than CEA, CA 19-9 and CA 242 in pancreatic cancer. Oncology 2004; 66: 126-31. PubMed  
  18. De La Cruz MS, Young AP, Ruffin MT, et al. Diagnosis and management of pancreatic cancer. Am Fam Physician. 2014 Apr 15;89(8):626-32. PMID: 24784121. PubMed  
  19. Nationellt vårdprogram gallblåse- och gallvägscancer, RCC (hämtad 2021-09-09) kunskapsbanken.cancercentrum.se  
  20. Jemal A, Clegg LX, Ward E, Ries LA, Wu X, Jamison PM, et al. Annual report to the nation on the status of cancer, 1975-2001, with a special feature regarding survival. Cancer 2004; 101: 3-27. PubMed  
  21. Povoski SP, Karpeh MS, Conlon KC, Blumgart LH, Brennan MF. Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy. Ann Surg 1999; 230: 131-42. PubMed  
  22. Sohn TA, Yeo CJ, Cameron JL, et al. Resected adenocarcinoma of the pancreas -- 616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 2000;4:567-579. PubMed  
  23. Van der Gaag NA, Rauws EA, Van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Eng J Med 2010; 362: 129-37. PubMed  
  24. Bergenfeldt M, Hansen CP, Mortensen MB. Kirurgisk behandling af cancer pancreatis. Ugeskr Læger 2010; 172: 1358. Ugeskrift for Læger  
  25. Dormann A, Meisner S, Verin N et al. Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 2004; 36: 543-50.
  26. Vilmann P. Palliativ behandling af malign obstruktion i distale dele af ventriklen eller duodenum: stor incision, lille incision eller ingen incision?. Ugeskr Læger 2005; 167: 3665. PubMed  
  27. Kristensen A, Vagnildhaug OM, Grønberg BH, et al. Does chemotherapy improve health-related quality of life in advanced pancreatic cancer? A systematic review. Crit Rev Oncol Hematol. 2016 Mar;99:286-98. pmid: 26819138. PubMed  
  28. Ladekarl M, Jensen BV, Pfeiffer P. Onkologisk behandling af patienter med pancreascancer. Ugeskr Læger 2010; 172: 1373. Ugeskrift for Læger  
  29. Yip D, Karapetis C, Strickland A et al. Chemotherapy and radiotherapy for inoperable advanced pancreatic cancer. Cochrane Database of Systematic Reviews 2006; 3: 1-75. The Cochrane Library  
  30. Polati E, Finco G, Gottin L, Bassi C, Pederzoli P, Ischia S. Prospective randomized double-blind trial of neurolytic coeliac plexus block in patients with pancreatric cancer. Br J Surg 1998; 85: 199-201. PubMed  
  31. Roldan GE, Gunderson LL, Nagorney DM, Martin JK, Ilstrup DM, Holbrook MA, et al. External beam versus intraoperative and external beam irradiation for locally advanced pancreatic cancer. Cancer 1988; 61: 1110-6. PubMed  
  32. Treatment of locally unresectable carcinoma of the pancreas: comparison of combined-modality therapy (chemotherapy plus radiotherapy) to chemotherapy alone. J Natl Cancer Inst 1988; 80: 751-5. PubMed  
  33. Ansari D, Tingstedt B, Andersson B et al. Pancreatic cancer: yesterday, today and tomorrow. Future Oncol. 2016 Aug;12(16):1929-46. Epub 2016 Jun 1.PMID: 27246628 PubMed  
  34. NORDCAN. Faktablad Cancerstatistik: www-dep.iarc.fr  
  35. Burcharth F, Olsen SD, Trillingsgaard J et al. Pancreaticoduodenectomy for periampullary cancer in patients more than 70 years of age. Hepato Gastroenterol 2001; 48: 1149-52. PubMed  
  • Josef Sayegh, specialist i allmänmedicin, Stockholm
  • Matthias Löhr, professor och överläkare, Gastrocentrum Kirurgi, Karolinska universitetssjukhuset