胰腺癌能早期發現嗎

美國國會參議院多數黨領袖哈里·瑞德在周一（2018-5-14）接受胰腺癌手術，各家媒體紛紛報道。

比較有代表性的新聞稿是這個：

https://edition.cnn.com/videos/politics/2018/05/14/harry-reid-pancreatic-cancer-surgery-nr.cnn

新聞稿裡面說，醫生說這是癌症的早期，預後會很好。網友們開始熱議：胰腺癌真的能早期發現嗎？有篩查之說么？要是有，包括什麼？

這段話是網友的提問：Harry Reid has pancreatic cancer. Apparently, 「His doctors caught the problem early during a routine screening」. What is a routine screen for pancreatic cancer? Or is this suggesting an alternative routine screen suggested pancreatic cancer? If so what screen would do that?

綜合新聞稿以及網友回復：

胰腺癌早期很難發現，一經發現基本都是晚期；

胰腺癌早期發現，需要很細心地發現早期癥狀，引起警覺；

胰腺癌早期發現也確實有很幸運的例子，是在檢查其他疾病中，誤打誤撞，偶然發現的。

以下是網友回復：

KidneysRABlackBox （Medical Student）

I"m sure senators have a very thorough physical, particularly at such an advanced age. If I had to guess, there might have been an anomaly with his labs/physical/history, like elevated A1C, elevated bilirubin levels, or changes in stool patterns and consistency, that would cause the physician to look deeper at underlying causes, leading to the pancreatic cancer discovery.

Raddagast

There was very little chance he was being screened for pancreatic cancer. Even for high risk populations, we don"t know what the best thing to do is for early detection. Medical writing of the lay population and press is consistently inaccurate; this cancer was not being looked for and was just incidentally found during some other reason for a doctor"s visit. They called this visit a "routine screening" probably to avoid detailing his other medical history. Maybe he just turned yellow from an obstructing lesion and he got surgery. You know, the routine kind of jaundice. Or routine 20 lb weight loss, fatigue, or migratory thrombophlebitis leading to workup.

There are a number of scenarios mentioned elsewhere in this thread. Another I can think of is being followed after incidental findings of IPMN (intraductal papillary mucinous neoplasm) or some other incidental abdominal finding. This could lead to more frequent attention to the area possibly on imaging leading to his diagnosis.

methestudy（Surgery ）

Those of us unfortunately familiar with pancreas surgery know 「surgery couldn』t have gone much better」 means horrible pancreatic leak forthcoming in next few days. If they caught it as early as they say then he probably had small ducts and a soft pancreas. High leak risk.

Hope he got neoadjuvant chemo.

iStayedAtaHolidayInn

There is no such thing as a routine pancreatic cancer screening.

NettletoothStreet Pharmacist

Well, this is just speculation, but for someone like Harry Reid who is not obese and not a typical T2D patient, if he suddenly had an elevated blood sugar and elevated hemoglobin A1C, it may trigger more investigation into why he suddenly has diabetes, as pancreatic cancer can cause diabetes. For someone like him, they may have done an ultrasound right off and some extra labwork, and followed up with a CT scan if there was any suggestive signs of pancreatic cancer.

Even in panc CA patients without a formal diagnosis of diabetes, the majority have some degree of insulin resistance/glucose intolerance if tested. Something about the CA impacts pancreatic function.

【人物介紹】

哈里·瑞德 (Harry Reid)，1939年12月2日出生於美國內華達州，是代表美國內華達州的聯邦參議員，屬民主黨。2014年11月13日，民主黨選舉哈里·里德為新一屆參議院少數黨領袖。哈里·瑞德是第110屆國會參議院多數黨領袖。

【背景知識】

胰腺癌的診斷與鑒別診斷

(一)胰腺癌的危險因素

包括吸煙、肥胖、酗酒、慢性胰腺炎等，接觸萘胺及苯類化合物者罹患胰腺癌的風險顯著增加。糖尿病是胰腺癌的危險因素之一，特別是老年、低體重指數、無糖尿病家族史的患者，新發2型糖尿病時應注意隨訪並警惕胰腺癌的可能。胰腺癌具有遺傳易感性，約10％的胰腺癌患者具有遺傳背景，患有遺傳性胰腺炎、Peutz-Jeghers綜合征、家族性惡性黑色素瘤及其他遺傳性腫瘤疾病的患者，患胰腺癌的風險顯著增加。

(二)診斷方法的選擇

胰腺癌的主要癥狀包括上腹不適、體重減輕、噁心、黃疸、脂肪瀉及疼痛等，均無特異性。對臨床上懷疑胰腺癌的患者和胰腺癌的高危人群，應首選無創性檢查手段進行篩查，如血清學腫瘤標誌物、超聲、胰腺CT或MRI等。腫瘤標誌物聯合檢測結果與影像學檢查結果相結合，可提高陽性率，有助於胰腺癌的診斷和鑒別診斷。

1．腫瘤相關抗原：CAl9-9可異常表達於多種肝膽胰疾病及惡性腫瘤患者，雖非腫瘤特異性，但血清CAl9-9的上升水平仍有助於胰腺癌與其他良性疾病的鑒別。作為腫瘤標誌物，CAl9-9診斷胰腺癌的靈敏度為79％～81％，特異度為82％～90％。CAl9-9水平的監測亦是判斷術後腫瘤複發、評估放化療效果的重要手段(Category 2B)。3％～7％的患者為Lewis抗原陰性血型結構，不表達CAl9-9，故此類胰腺癌患者檢測不至IJCAl9-9水平的異常。某些良|生疾病所致的膽道梗阻或膽管炎患者，亦可導致CAl9-9水平的升高，故在黃疸緩解後對CAl9-9的檢測更有意義，以其作為基線值也更為準確(Category 3)。其他腫瘤標誌物包括癌胚抗原、CA50及CA242等，聯合應用有助於提高診斷的靈敏度及特異度。

2．腹部超聲：作為篩查手段，可對梗阻部位、病變性質等做出初步評估。由於受胃腸道氣體的干擾和操作者技術及經驗水平的影響，靈敏度及特異度不高，診斷價值有限。

3．胰腺CT(pancreatic protocol CT)：是對疑有胰腺腫瘤患者的首選影像學檢查方法。針對胰腺腫瘤應設置特別掃描參數，對全腹部行對比劑增強掃描，包括薄層(

4．胰腺MRI(pancreatic protocol MRI)：與CT同等重要，參數要求同上。在排除及檢測肝轉移病灶方面，靈敏度及特異度優於CT。

5．內鏡超聲(endoscopic uhrasonography，EUS)：為CT及MRI的重要補充，可準確描述病灶有無累及周圍血管及是否有淋巴結轉移，在診斷門靜脈或腸系膜上靜脈是否受累方面，靈敏度及特異度優於對腸系膜上動脈的檢測。EUS的準確性受操作者技術及經驗水平的影響較大。

6．PET/CT：不可替代胰腺CT或MRI，作為補充，在排除及檢測遠處轉移方面具有優勢。對於原發病灶較大、疑有區域淋巴結轉移及CAl9-9顯著升高的患者，推薦應用。7．腹腔鏡探查：不建議常規應用。對於瘤體較大、疑有腹腔種植或遠處轉移的患者，可行腹腔鏡探查，以避免不必要的開腹探查。

附：胰腺癌診治流程圖

【朗讀】這是我根據新聞報道視頻，翻讀的朗讀練習音頻。

Harry Reid, his office just released a statement revealing that he has undergone surgery for pancreatic cancer and is now undergoing treatment.

He was tired of course a few years ago .

He"s been living in his home state of Nevada.

But this surgery took place not too far from here in Baltimore Johns Hopkins cancer center.

And according to his office they just released a statement saying that he"s out of surgery,he"s in good spirits and resting with his family.

Most importantly, the statement says that his doctors caught the problem early during a routine screening.

And that the surgeons are confident that the surgery was a success.

What does that tell you that doctors are saying that they"re confident the prognosis is good because they caught this early through routine screening.

That is the more unusual scenario but as soon as you point out that it can be very favorable if in fact before this cancer really had a chance to spread to the surrounding area spread to other organs , it was caught.

Sometimes people who have some sort of genetic history of this sort of cancer maybe undergoing screenings if there was another concern that they were looking for something else may happen to find this pancreatic cancer

they"re able to remove it before it is spreading this way that can be of a more favorable prognosis.

But the reason it is often caught so late is because there really aren"t any symptoms until the cancer started already spread.

That"s something they start to have back pain or some other symptoms ,they go to their doctor, problems at that point it is already pretty far along.

So he is 78 years old, it"s a it"s a big operation, no matter what, even if it"s caught early,I am sure the recovery is for a long time but if they"re confident that I know this team of Hopkins pretty well ,they"re confident they got it all out that fortune is pretty favorable for him.

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