Space-occupying formation of the pancreas ICD 10. Malignant neoplasms of the pancreas - description

Inflammation of the pancreas is called pancreatitis. Most often, this disease is chronic.

This pathology can occur without any symptoms or develop against the background of other diseases of the abdominal cavity, so the diagnosis is not always made in a timely and correct manner. That is why you need to have an idea about this disease and, if you suspect pancreatitis, consult a doctor.

International classification of diseases

Modern medicine knows over forty classifiers of pancreatitis, this makes it difficult for doctors to communicate internationally on the topic of diagnosis and treatment. In order for specialists from different countries to freely exchange experience and understand each other well, the International Classification of Diseases (ICD) was adopted.

This classification is regularly reviewed under the guidance of the World Health Organization. Now the ICD-10 is in force, the number “10” means the tenth revision.

According to this classification of ICD - 10, pancreatitis occurs:

spicy (code K85);
chronic (code K86).

Mechanism of development of pancreatitis

The pancreas produces digestive enzymes and the hormonal substance insulin. These enzymes in the gland are in an inactive state, and begin to work only when they enter the duodenum.

But it happens that the outflow of enzymes from the pancreas is disrupted or the enzymes for some reason begin to activate before reaching the duodenum. That’s when enzyme substances begin to destroy the pancreas itself and digest its tissue. This releases toxins that can enter the circulatory system, spread throughout the body and harm internal organs.

Damaged gland tissue is replaced by other types of tissue, such as fat or scar tissue. Necrosis of a large area of this organ is also possible. As a result of such changes, the normal functioning of the pancreas is disrupted, the production of enzymes in the required quantity stops, and inflammatory processes begin. Complications of this pathology are diabetes mellitus and pancreatic cancer.

Causes of the disease

Pancreatitis begins for various reasons. In ICD-10 there is a different gradation of this pathology depending on the suspected causes. For example, drug-induced, alcoholic, purulent, hemorrhagic pancreatitis.

To successfully treat the pathology, it is necessary to find out the cause of the problem.

The causes of pancreatitis can be:

It is no coincidence that ICD-10 distinguishes between chronic and acute pancreatitis. These two types of the same pathology have their own characteristics, consequences and differ in treatment tactics.

In the acute form, digestive enzymes begin digestion already in the pancreas, the disease develops in a short time. Treatment is aimed at normalizing the functioning of the digestive organs.

The chronic form is characterized by changes in the structure of the gland that have already begun. The tissues of this organ lose their integrity and are replaced by another type of tissue. As a result of these pathological changes, the damaged organ cannot fully perform its basic functions.

This leads to irreversible consequences and affects all internal organs and systems of the human body. In the future, there is a lack of enzymes produced, the pancreas will atrophy and diabetes will begin.

The chronic form is often caused by advanced acute pancreatitis. Also, prerequisites may include malnutrition, consumption of fatty foods, alcohol, chronic diseases of other internal organs and the harmful effects of medications.

Treatment of the chronic stage of pathology comes down to maintaining the normal functioning of the body. They also strive to reduce the impact of harmful effects on the body to prevent attacks of the disease and deterioration of well-being.

It is impossible to cure the chronic form, you can only reduce the number of attacks of exacerbation of the disease. But even this brings relief to the life of a sick person.

Symptoms of the disease

The clinical picture of the manifestation of pathology is different for all stages. The main symptom is a fairly strong, unexpected girdling pain. It often begins on the left side and can become stronger if the patient lies on his back. This pain is sometimes mistaken for pain in the heart or kidney, since it is felt more in the upper abdomen.

Digestive disorders are always observed. This, as a rule, is vomiting mixed with bile, diarrhea with particles of undigested food, hiccups, and flatulence. The temperature rises, and the pressure can be both low and high. The patient's condition sharply worsens, shortness of breath and increased sweating appear.

These symptoms are pronounced and are often signs of the acute stage. You need to know them, because even during the chronic form, acute attacks can occur. But the manifestations of the chronic phase are more diffuse and extended over time.

For several years, a person may feel discomfort in the upper abdomen, more often after eating, especially when eating fatty, fried and spicy foods. It is difficult for a damaged pancreas to digest everything at once, which is why such pain occurs.

If a person adheres to proper nutrition, and even more so a separate diet, then the manifestations of pancreatitis will occur much later. Poor digestion over a long period of time should serve as a signal. A person tends not to notice obvious symptoms, but any disease must be treated in a timely manner.

With a chronic disease, acute attacks may sometimes occur, but the person will associate this with overeating or drinking alcohol. The chronic stage is dangerous because the process of destruction of the pancreas is already underway, but the person does not know about it and does not take any measures. But it is very important to identify the disease on time; diagnosis helps with this.

Diagnostic examination and tests required

If you suspect chronic pancreatitis, you should consult a doctor. A gastroenterologist deals with such pathologies.

Urine, feces and blood tests are required, including a biochemical blood test. The abdominal organs are examined using ultrasound and radiography. The pancreas is checked using computed tomography, gastroscopy and functional tests are performed.

Main directions in the treatment of the disease

In case of exacerbation of a chronic disease, treatment will be similar to that prescribed for the acute stage; hospitalization is almost always recommended. Treatment must be carried out under medical supervision, as there is a danger to life.

For mild chronic symptoms, treatment will be aimed at lifestyle adjustments.

For life you will need to follow a certain diet and take medications that will compensate for the lack of enzymes in the body. It is useful to visit sanatoriums that offer comprehensive treatment with the use of medicinal mineral waters.

Treatment must be outlined and planned by a doctor. Even when choosing mineral water, it is necessary to consult a specialist, since it is a medicinal product and has contraindications.

The chronic stage of the disease is dangerous because even with proper treatment, insulin levels still decrease over time, and this will lead to diabetes mellitus. That is why patients with chronic inflammation of the pancreas should periodically seek advice from an endocrinologist. This will help keep your sugar levels under control and identify the disease at an early stage, which will help with successful treatment.

Possible ways of prevention

Chronic pancreatitis (ICD - 10) is a complex disease with difficult treatment. Code 10 means that this pathology has an alcoholic or infectious etiology.

Prevention in these cases will include stopping the consumption of alcoholic beverages and timely treatment of infections in the body. Such measures for chronic pancreatitis will help reduce exacerbations.

Pancreatic necrosis is a destructive disease of the pancreas that occurs against the background of incompletely cured pancreatitis.

The danger lies in the development of multiple organ failure. In 1% of cases, the disease acts as the cause of an acute abdomen. Pancreatic necrosis is diagnosed in 70% of cases in young people. It can be either an independent disease or act as a complication.

Definition and disease code according to ICD-10

With the disease, the death of organ cells is noted due to a strong inflammatory process.

During the development of the disease, defense mechanisms are disrupted. The pancreas begins to digest itself. With this disease, there is a high probability of disruption of the functioning of other organs or systems.

Photo of pancreatic necrosis of the pancreas

The disease code according to ICD-10 is K86.8.1. Pancreatic necrosis develops in three stages:

At the first stage, bacterial toxins are formed. However, blood tests do not always show the presence of pathogenic microflora.
In the second stage, an abscess appears. It affects neighboring organs. This stage occurs in the absence of treatment.
The third stage - purulent processes are formed in the organ itself and in the retroperitoneal tissue. At this stage, there is a high probability of death.

Reasons for development

One of the main reasons is an unbalanced diet and occasional alcohol consumption. Studies have shown that alcoholism does not cause this serious illness, but in most cases it begins with an episode of drinking.

People with more often develop pancreatitis, which is rarely complicated by necrosis of the pancreas.

The underlying cause of the disease is a violation of local defense mechanisms. Too much food and drink leads to increased secretion and increased flow. As a result, the outflow of pancreatic juice is disrupted. This provoking factor is called obstructive.

The reflex factor includes the reflux of bile from the duodenum into the pancreas. This activates proenzymes. Usually in this case, the cause is surgical complications, blunt, and various endoscopic manipulations.

The risk group includes the following groups of patients:

abnormalities of the pancreas,
diseases of the digestive tract.

Classification

There are two main groups of the disease:

Total.
Infected.

Total

Refers to a severe degree of the disease. It affects up to 100% of the retroperitoneal tissue. The patient's condition constantly worsens over 1-3 days, even with therapy. In addition to progressive necrosis, signs of the onset of multiple organ failure and pancreatogenic shock are added.

A blood test reveals an increase in leukocytes and pancreatic enzymes. The death of gland cells occurs without the possibility of recovery.

Infected

Develops in 40-70% of patients with TOP. Microflora enters the zone of changes from the large intestine. The disease is suspected if health continues to deteriorate 7 days after the start of TOP.

The peak of the disease occurs on days 10-14. The necrotic lesion moves beyond the organ to the omentum and other organs.

Gradually, tissue breakdown products and sepsis lead to poisoning of the entire body, as well as systemic inflammation. The patient goes into shock, which ends in death.

Kinds

The following types are distinguished:

fatty,
hemorrhagic,
mixed.

Fatty

As the disease develops, metabolic processes and the normal functioning of pancreatic cells fail. There may be a sharp drop in blood pressure.

The disease is characterized by the rapid formation of an inflammatory infiltrate. If the disease is recurrent in nature, then such a focus may appear later. This form is formed with the participation of lipase.

This type of disease progresses slowly. Peripancreatic tissues are gradually involved in the inflammatory process. Patients with this form show fluctuations in alpha-amylase, but changes in its amount do not play a role in the pathological process itself.

Hemorrhagic

With this form, an irreversible process of cell death occurs. The form occurs during acute pancreatitis or develops during exacerbation of the chronic form.

The disease necessarily affects the secretory part of the pancreas. Its cells produce cells that are part of pancreatic juice.

The hemorrhagic form develops due to the aggressive effects of trypsin and some other enzymes that break down protein molecules.

The cause of the development of the disease may be a complex humoral process of regulation and production of digestive enzymes.

Mixed

This form is characterized by signs of several types of necrosis. Under the influence of negative factors, a sharp stimulation of the production of pancreatic juice begins. The ducts can no longer cope with the load, so the juice begins to concentrate.

Young people and middle-aged people are more prone to the disease. The mixed type does not appear at first. When symptoms appear, we are talking about the active phase.

Symptoms

Pancreatic necrosis has a pronounced clinical picture, so it is difficult to confuse it with another pathology. Symptoms include:

Pain. It arises in the left side of the abdomen and radiates to the shoulder, back, groin and chest. The patient cannot describe the localization of sensations. The intensity of the pain depends on the severity of the disease.
Nausea and vomiting. Immediately after the pain, vomiting appears, which is not associated with food intake. It doesn't bring relief. In addition to bile, the vomit contains blood clots.
Dehydration. Since vomiting is very difficult to stop, it causes dehydration. The skin and mucous membranes become dry, diuresis decreases.
Bloating. Since the pancreas ceases to function, the processes of rotting and fermentation intensify in the intestines. This leads to increased gas formation and bloating.
Intoxication. Bacterial toxins circulating in the bloodstream lead to an increase in body temperature. General weakness appears, heartbeat increases.
Paleness of the skin. At the first stage, vasoactive substances appear in the blood, which is manifested by redness of the dermis. When intoxicated, the skin turns pale, gray or jaundiced.

Complications

Pancreatic necrosis is complicated not only by purulent processes, but also by disturbances in the functioning of other organs. The incidence of infectious complications occurs in every third patient.

The likelihood of their occurrence depends on the area of the lesion. The most life-threatening are the first three weeks of illness.

Complications include:

peritonitis,
ulcers,
fistulas

Diagnostics

Initially, the diagnosis is made based on the patient's complaints. Laboratory research methods are prescribed, which reveal:

Increase in liver enzymes.
Increase in C-reactive protein.
Calcitonin in the blood.
Increased blood sugar.
The amount of elastase, amylastase, and trypsin in the urine increases significantly.

The survey allows you to identify indirect signs of inflammation. Fistulas are visualized using a contrast agent. Additionally carried out:

Ultrasonography. It indicates the presence of stones, enlargement and changes in the structure of the gland, and foci of necrosis are identified.
allows for a more detailed assessment of pathological changes.

In the most difficult cases, laparoscopy is performed. This is the most accurate way to make a diagnosis and assess the condition of the organ and surrounding tissues.

During the diagnostic process, studies are carried out regarding intestinal obstruction and acute inflammatory diseases.

Treatment

Treatment is carried out using:

medicines,
surgical impact,
diets.

During illness, any physical activity is prohibited, and therapeutic fasting is prescribed. Parenteral nutrition is prescribed using nutrients.

Medicines

Taking medications is necessary to reduce pain and eliminate the cause that led to the disease. It is necessary to prescribe medications to restore water balance.

To relieve pain, antispasmodic drugs and non-narcotic analgesics are administered. In extreme cases, it is allowed to take narcotic painkillers.

To reduce the secretory activity of the pancreatic gland, antienzyme agents and proton pump inhibitors are administered. If not, choleretic drugs are prescribed to unload the ducts.

For aseptic necrosis and to suppress pathogenic microflora in infected cases, antibiotics are prescribed. Typically, cephalosporins with fluoroquinolones are used in combination with metronidazole.

Operations

The most effective treatment method is surgery. It allows you to remove inflammatory hemorrhagic exudate, stop bleeding and drain the retroperitoneal space.

Such treatment is possible after the acute process has stopped and the patient’s condition has stabilized.

Emergency surgical intervention is indicated for total or subtotal necrosis, as well as for the development of purulent peritonitis. If the infected destructive process affects the gland, laparotomy surgery is used, providing good access to other organs.

Often it is necessary to remove neighboring organs: gallbladder, spleen. Doctors note that sometimes repeated surgical treatment is required if the gland continues to deteriorate.

Diet for pancreatic necrosis: sample menu

In case of exacerbation of the disease, fasting is prescribed before and after surgery. To prevent exhaustion of the body, artificial nutrition is introduced. Nutrients enter directly into the blood, bypassing the gastrointestinal tract. After this, you must adhere to diet No. 5 for a week.

Immediately after the operation, you are allowed to drink tea, mineral water and rosehip decoction. If the condition is stable, after a week, foods low in calories, salt and fat are gradually introduced. Products are steamed or boiled. At the same time, they are thoroughly crushed and wiped.

As for fruits, soft varieties of apples and pears are allowed. You can eat no more than 10 grams per day. butter. You can start your morning with an omelet, but you should cook it only with protein. Crackers and cookies are allowed.

To maintain the required amount of calcium, you are allowed to eat a small amount of cottage cheese and drink low-fat milk.

Soups with mushroom, fish and meat broth are contraindicated. You will have to give up bread and other flour products. You can't drink grape juice, coffee or cocoa. Meat, fatty fish, grapes, bananas, dates and figs are strictly prohibited.

Forecast

The chance of recovery after pancreatic necrosis is great, but it depends on age, the number of complications and the severity of the disease. Death occurs in 40-70% of cases.

Most often, death is associated with late seeking medical help. If necrosis affects a large part of the gland, then there is a high probability of an unfavorable outcome. With survival, a person becomes disabled.

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2007 (Order No. 764)

Other specified diseases of the pancreas (K86.8)

general information

Short description

Chronic pancreatitisis an inflammatory-destructive process in the pancreas, characterized by focal necrosis in combination with diffuse or segmental fibrosis, the development of functional failure and progression after the cessation of exposure to etiological factors.

Protocol code: N-T-027 "Chronic pancreatitis and other diseases of the pancreas"
For therapeutic hospitals

ICD-10 code(s):

K86 Other diseases of the pancreas

K86.0 Chronic pancreatitis of alcoholic etiology

K86.1 Other chronic pancreatitis

K86.2 Pancreatic cyst

K86.3 Pancreatic pseudocyst

K86.8 Other specified diseases of the pancreas

Classification

Classification of chronic pancreatitis(Marseille-Rome, 1988)

1. Chronic calcific.

2. Chronic obstructive.

3. Chronic parenchymal-fibrous (inflammatory).

Clinical and morphological classification of chronic pancreatitis(Kuznetsov V.V., Golofeevsky V.Yu. 2000)

Etiology	Clinical characteristics	Morphological options	Predominant morphological changes	Outcomes
Alcoholic	A. Clinical options: painful; dyspeptic; latent; combined B. Change in function: violation of exocrine function; endocrine dysfunction B. Degrees of severity: mild; average; heavy D. Current phase: exacerbation; remission D. Complications: early, late	Parenchymatous	Swelling and inflammation Necrosis Dystrophy Lipomatosis	Fibrosis Cysts Calcinosis Malignancy
Biliary dependent
Gastroduodenal pathology		Fibrous- sclerotic	Fibrosis Parenchyma atrophy Parenchyma dystrophy
Drug
Infectious		Pseudotumorous (hyperplastic)	Hypertrophy parenchyma Hyperplasia parenchyma
Idiopathic
Ischemic and others

Severity of chronic pancreatitis

Mild degree characterized by the absence of signs of external and intrasecretory insufficiency. Clinical signs (pain, dyspepsia) are moderate. It is possible to increase the activity of pancreatic enzymes in the blood and urine. Exacerbations - 1-3 times a year.

Moderate degree characterized by distinct clinical and laboratory abnormalities, the presence of exocrine and intrasecretory functions of the pancreas, and concomitant lesions of other digestive organs. Possible weight loss. Exacerbations - 4-5 times a year.

Severe degree characterized by pronounced clinical and laboratory manifestations, persistent “pancreatic” and pancreatogenic diarrhea, protein deficiency, polyhypovitaminosis, progressive exhaustion, and natural damage to other organs and systems. Exacerbations - 6-7 times a year and more often.

Risk factors and groups

Alcohol;

Cholelithiasis;

Metabolic disorders (metabolic and hormonal disorders);

Hereditary chronic pancreatitis;

Autoimmune pancreatitis associated with primary sclerosing cholangitis, primary biliary cirrhosis and Sjogren's syndrome;

Operations, injuries of the pancreas;

Viral infections;

Acute circulatory disorders in the pancreas;

Allergic reactions, toxic effects (uremia during kidney transplantation), deficiency of antioxidants in food;

Hyperparathyroidism is an increase in calcium in the blood.

Diagnostics

Diagnostic criteria

Complaints and anamnesis:
- pain;
- belching of air or eaten food;
- nausea;
- vomit;

Loss of appetite;
- bloating;
- weight loss.

Physical examination

Recurrent abdominal pain syndrome (usually in the area of the anterior abdominal wall with irradiation to the back, occurring after heavy fatty, spicy food, or drinking alcohol);

Loss of body weight (due to poor absorption and malnutrition due to pain);

Insufficiency of exocrine function (steatorrhea, polyfecal matter);

Insufficiency of intrasecretory function (impaired glucose tolerance, diabetes mellitus);

Chronic fibrous-indurative pancreatitis is characterized by intermittent jaundice.

Instrumental studies

Plain X-ray of the abdominal cavity: pancreatic calcifications with a characteristic localization near the second lumbar vertebra;

Ultrasound signs: an increase in echogenic density, uneven contours and changes in size; in some patients there is a decrease in the gland, the presence of calcifications, cysts, deformation, expansion of the main duct of the gland (the study is considered complete if the Wirsung duct is visualized). If a tumor of the gland is suspected, ultrasound is supplemented by CT;

Computed tomography: foci of calcification, necrosis, the presence of cysts and pseudocysts of the pancreas. For gland carcinomas, diagnostic efficiency is close to 85%, especially with repeated studies;

ERCP-combined X-ray endoscopic examination of the deformation of the duct, has an irregular clear-shaped appearance, the presence of stones and strictures of the main duct and its lateral branches. Indications for ERCP are suspicion of pancreatic carcinoma, pseudotumor forms of CP, persistent pain syndrome, weight loss. The “gold” standard for identifying strictures of the main duct and dilatation of its side branches.

Indications for consultation with specialists: depending on concomitant pathology.

List of main diagnostic measures:

1. Amylase in urine and blood.

2. General blood test.

3. Determination of C-reactive protein.

4. Determination of ALT or AST.

5. Determination of total bilirubin and fractions.

6. Determination of alkaline phosphatase.

7. GGTP (gamma-glutamyl transpeptidase).

8. Blood lipase.

9. Blood glucose, sugar curve.

10. Coprogram.

11. Ultrasound of the pancreas, gall bladder.

12. Consultation with a gastroenterologist.

List of additional diagnostic measures:

1. General urine test.

2. Blood calcium.

3. Coagulogram.

4. Blood glucose with load.

5. Determination of total protein and fractions.

6. Elastase activity in blood serum and feces.

7. Plain X-ray of the abdominal cavity (if indicated).

8. Computed tomography of the abdominal organs (if indicated).

9. Laparoscopy with pancreatic biopsy (if indicated).

10. Consultation with an endocrinologist, surgeon (if indicated).

Laboratory diagnostics

Laboratory research

Hyperamylasemia (studied in the first three days of exacerbation, constant - occurs only in the cystic form of pancreatitis), amylasuria, leukocytosis with a shift in the leukocyte formula to the left.
With obstruction of the biliary tract - increased levels of alkaline phosphatase, ALT and bilirubin.
Serum C-reactive protein concentration is a reliable indicator of the severity of pancreatitis.
A significant increase (threefold) in ALT or AST speaks in favor of a biliary etiology of pancreatitis.

Differential diagnosis

Differential diagnosis
Exclusion of syndrome-related diseases is a necessary stage in the diagnosis of CP.

Syndrome-related diseases include gastroduodenal ulcers, diseases of the small intestine, lesions of the lower thoracic spine with radicular syndrome, as well as carcinoma of the stomach, pancreas, kidney, and transverse colon.

Evidence in favor of HP is:
- typical “pancreatogenic” late or early pain that occurs after drinking alcohol and/or eating errors;
- symptoms of exocrine pancreatic insufficiency (polyfecalia, steatorrhea, weight loss, relatively easy correction of diarrhea with enzyme preparations);
- positive amylase test at the beginning of an exacerbation of the disease;
- characteristic changes in the structure of the gland and its ducts according to ultrasound, CT, ERCP.

In recognizing CP, changes in the postbulbar part of the duodenum and the major duodenal papilla, determined by endoscopy and measuring duodenal pressure, are important.

Treatment abroad

Get treatment in Korea, Israel, Germany, USA

Get advice on medical tourism

Treatment

Treatment Goals: ensuring remission.

Non-drug treatment: Diet No. 5.

Drug treatment

For severe exacerbation of CP, emergency care includes:

1. Reducing the functional activity of the pancreas to a minimum: hunger, aspiration of stomach contents through a nasogastric tube, use of H2 blockers (ranitidine 150-300 mg or famotidine 40-80 mg/day intravenously, etc.) or proton pump inhibitors (omeprazole 40-80 mg/day, pantoprazole 80 mg/day, rabeprazole 40 mg/day).

2. Suppression of pancreatic secretion of enzymes (H2-blockers, proton pump inhibitors, anticholinergic blockers, glucagon, calcitonin, 5-fluorouracil, somatostatin and its analogue octreotide 100 mcg 3 times a day).

3. Removal of inflammatory mediators from the blood circulation (infusion therapy with saline solutions).

4. Pain relief includes the administration of analgesics and antispasmodics.

5. To combat infectious complications or the threat of their development, the prescription of cephalosporin antibiotics or synthetic penicillins in standard doses is indicated.

Planned conservative treatment includes the following activities:

1. Small meals low in fat and fiber (for diarrhea), stop drinking alcohol in any form.

Ineffectiveness of outpatient treatment;
- occurrence of complications.

Prevention

Primary prevention
- stopping alcohol consumption;
- maintaining a healthy lifestyle;
- timely treatment of diseases of the biliary system.

Information

Sources and literature

Protocols for diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 764 of December 28, 2007)
1. 1. Chronic pancreatitis. EBM Guidelines. 4.3.2005 2. Clinical recommendations based on evidence-based medicine: Trans. from English / Ed. Yu.L. Shevchenko, I.N. Denisova, V.I. Kulakova, R.M. Khaitova. - 2nd ed., rev. -M.: GEOTAR-MED, 2002. - 1248 p.: ill. 3. Treatment of pancreatic exocrine dysfunction. EBM guidelines.2005. 4. Pancreatic unsufficiency. EBM guidelines. 2004. 5. S.P.L. Travis, Gastroenterology: translated from English - M: medical lit. 2002 - 640 s 6. A.V. Okhlobystin, V.T. Ivashkin Algorithms for the management of patients with acute and chronic pancreatitis. 7. Karlsson Sven, Ahren B.O. Scand G Gastroenterol, 1992, No. 27, p.27: 161-5 8. Classification of diseases of internal organs and methods of therapeutic research. A guide for medical universities and practicing doctors. (Edited by Golofeevsky V.Yu. - St. Petersburg Publishing House “Faliant” 296 pp. 2006
2. The choice of medications and their dosage must be discussed with a specialist. Only a doctor can prescribe the right medicine and its dosage, taking into account the disease and condition of the patient’s body.
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Published: February 4, 2015 at 11:25 am

A malignant neoplasm that develops in the pancreas is called a cancerous tumor. The main signs of oncology are severe pain in the abdomen (in the upper part) and back pain, sudden weight loss, anorexia, weakness and jaundice. The patient may feel thirsty, experience frequent urination, diarrhea and vomiting. For every 100,000 people, 8 to 10 suffer from this disease.

Pancreatic cancer classification system

Pancreatic cancer is classified according to the international TNM system. Each letter has its own definition, for example: the size of a malignant neoplasm (malignant neoplasm) and its location - T; formation of metastases in lymph nodes – N; metastases present in organs located next to the affected organ – M.

Let's consider the classification of pancreatic tumors, according to the abbreviation:

TX: It is not possible to assess the condition of the original tumor.
T0: There are no signs of cancer.
Tis: Initial signs of the disease are observed, but the formation does not grow further.
T1: The tumor is located only in the pancreas, it does not spread beyond it. The size is small - approximately 2 cm or less.
T2: Located in the pancreas, a malignant neoplasm does not spread beyond its boundaries. The size of cancer is 2 cm in diameter and above.
T3: The neoplasm in the gland goes beyond its limit, without penetrating into the circulatory system located near the organ.
T4: Category in which surgery no longer helps. A cancerous formation in the pancreas has spread beyond its boundaries and affects the arteries and veins located near the organ.

NX: The status of the lymph nodes located near the pancreas cannot be assessed.
N0: There are no signs of cancer in the lymph nodes near the gland.
N1: The cancer has spread to the lymphatic system, near the affected organ.

MX: Detection of metastases is not possible.
M0: There is a tumor, but no metastases.
M1: Metastases have been detected that have spread to other organs. As a rule, their growth occurs in organs located near the affected organ: stomach, liver, intestines and lungs.

Despite the existence of a classification, there is insufficient information regarding the need for surgical intervention, as well as predicting the effect of therapy.

Pancreatic cancer - ICD 10 codes

The appearance of a tumor in the pancreas, ICD code 10 – C25;
Formation of cancer in the head – code C25.0;
Neoplasm of a malignant nature of the organ body – C25.1;
The appearance of a neoplasm of the tail of the pancreas, ICD code 10 - C25.2;
Cancer formation in the pancreatic ducts – C25.3;
Islet cell cancer – C25.4;
In the remaining parts of the organ, cancer is detected, ICD 10 code is C25.7;
Pancreas, affected in more than one of the above locations - C25.8.

zhkt.guru

Pancreatic cancer treatment

Treatment of pancreatic cancer is one of the most difficult areas in oncology. This situation is associated with many reasons, primarily with the predominantly elderly age of patients and the presence of concomitant pathologies. It is also important to note the difficulty of diagnosing a tumor with this location. Thus, patients are referred at late stages, when the tumor is considered inoperable, growing into vital anatomical structures and spreading metastases to distant organs.

ICD-10 in this reference book indicates all subtypes of the oncological process with one or another localization. Pancreatic cancer urolithiasis helps the doctor to accurately identify the location of the tumor in the organ and make the right decision on therapeutic measures.

Pancreatic cancer ICD 10 is designated by the following code:

C25.0 Malignant neoplasm of the head of the pancreas:

C25.1 Bodies.
C25.2 Tail.
C25.3 Ducts.
C25.9 Unspecified.

Principles of therapy

The main method of treatment for gland cancer remains unchanged - surgery. Whether it will be radical or palliative depends on the type of tumor, its stage and location.

Radical and palliative treatment

There are two main principles in the treatment of cancer patients:

Radical treatment, its essence is the complete removal of all malignant cells, which allows for a complete recovery in the future. In this case, it is important not to allow a single cancer cell to remain in the body, otherwise a relapse of the disease will occur. For these purposes, radical surgery is used to remove part or all of the pancreas, regional lymph nodes, gallbladder and its ducts, part of the stomach, duodenum, and possibly the spleen. After surgery, radiation or chemotherapy may be prescribed to make sure that no atypical cells remain;
palliative measures are taken when the tumor is considered inoperable. As a rule, in the case of its germination into blood vessels, veins and other organs, as well as as a result of metastasis. In fact, it is a treatment for stage 4 and often stage 3 pancreatic cancer. The goal of palliative treatment is to prolong the patient’s life and improve its quality by partially relieving symptoms.

Therapy for resectable tumors

Unfortunately, at the stage when the tumor is considered operable, it is detected extremely rarely. In many cases, even when the operation begins and it is believed that the formation is resectable, nuances are identified that do not allow it to be completely removed. As a result, the operation turns from radical to palliative.

For radical therapy, the following operations for pancreatic cancer may be offered:

Surgery is the only effective treatment method

pancreaticoduodenectomy or Whipple procedure. This resection is used when the head of the organ is affected. In this case, the head and part of the body of the gland, the gallbladder, its ducts, part of the small and duodenal intestines and the antrum of the stomach are removed. The Whipple procedure is a complex surgical procedure with a high mortality rate of approximately 10-15% of cases. Five-year survival rate, despite the radical method, still remains low at 5-8%;
distal pancreatectomy is performed if the tumor is localized in the tail or body of the pancreas. The tail and body of the organ are removed, leaving only the head. Such an intervention is performed extremely rarely, since a tumor in the tail is almost always detected in an advanced stage. The average life expectancy for distal pancreatectomy is 10 months;
A total pancreatectomy is performed if the entire organ or its head and body are affected. This type of surgery is characterized by complete removal of the gland, duodenum, spleen, antrum of the stomach, gallbladder and regional lymph nodes. Pancreatic cancer often progresses after surgery despite the radical nature of the procedure. This type of intervention is rarely performed due to disappointing results; the Whipple procedure is more often used.

Therapy for locally advanced cancer

In this case, surgery can only be performed as a palliative measure. To reduce the severity of pain in pancreatic cancer, eliminate bleeding or stenosis. If such symptoms are not observed or are not so pronounced, the operation may not be performed, so as not to once again put stress on an already weakened body.

In this case, chemotherapy is used for pancreatic cancer. Most often, anticancer drugs for gland damage are administered intravenously - these are Gemcitabine and 5-fluorouracil (5-FU). Radiation therapy may also be offered. These methods are not able to remove all cancer cells and lead to only partial regression of the tumor process.

Metastatic cancer and its therapy

Resection of the head of the pancreas

Pancreatic cancer treatment in this case is also palliative. Metastases from the main tumor spread far beyond the gland, affecting other structures and organs. Surgical intervention can be carried out only to reduce the tumor and, accordingly, intoxication in the body, as well as in cases of compression and stenosis of other organs.

Most often, chemotherapy is used in palliative measures, Gemcitabine is administered. Pancreatic cancer prognosis for existing metastases is negative, the average life expectancy of such patients is six months.

Other palliative methods

Additionally, in the treatment of inoperable patients the following is used:

bile duct stents, they can help improve appetite, prevent severe weight loss and reduce itching;
pancreatic cancer ASD 2 is a drug that, according to scientist Dorogov, can defeat even advanced stages of cancer. It was not recognized by official medicine, but in case of hopelessness, patients are ready for various experiments;
antidepressants and narcotic substances such as morphine, which help relieve pain and the psychological state of the patient.

How long do patients with this diagnosis live with pancreatic cancer? The issue is ambiguous; with early detection, a positive outcome is possible, but no more than 10% of patients achieve it. As a rule, the life expectancy of such patients does not exceed one year.

Video: surgical treatment of pancreatic cancer. Robot-assisted and laparoscopic surgery

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Pancreatic cancer: classification, survival prognosis, diagnosis

Tumors and malignancies of the pancreas are widespread throughout the world. Up to 200 thousand newly diagnosed malignant neoplasms of the pancreas are registered annually. This prevalence attracts the attention of surgeons and oncologists around the world.

Types of tumors

Morphologically, pancreatic cancer develops from epithelial, hematopoietic and lymphoid tissue. In 95% of patients, the tumor develops from epithelial tissue. It can be represented by adenocarcinoma, adenoma and cystadenoma. Adenoma and cystadenoma are benign tumors. They are distinguished by long development and progression, absence of symptoms and a favorable prognosis.

This article will discuss malignant neoplasms (cancer) of the pancreas. ICD-10 code – P.25.

Malignant neoplasms of glandular tissue

Glandular tissue is a type of epithelial tissue. Therefore, cancer that develops from glandular cells belongs to the category of epithelial tumors. And the malignant growth itself is called “adenocarcinoma”. This is the most frequently detected type of neoplasm - up to 95% of all malignant tumors. In the pancreas, adenocarcinoma can develop:

From the epithelium of the excretory ducts.
From acini cells (actually glandular cells).

In addition, the following malignant tumors develop from glandular tissue: cystadenocarcinoma, acinar cell and squamous cell carcinoma. They are detected in only 5% of all patients.

Classification of stages of adenocarcinoma development

The Russian Federation has adopted an international staged classification of pancreatic cancer based on the TMN classification:

Stage 1 – The tumor node is located within the organ, does not exceed 2 cm in size. There are no metastases to regional lymph nodes. There are no distant metastases to organs. There are no symptoms at this stage. The prognosis is favorable.
Stage 2 – the tumor grows into the duodenum, bile duct and surrounding tissue. There are no metastases to regional lymph nodes. There are no distant metastases to organs. The patient begins to be bothered by early symptoms. The prognosis is favorable.
Stage 3 - the tumor grows into the duodenum, bile duct and surrounding tissue. There is a single metastasis to one regional lymph node. There are no distant metastases to organs. Early symptoms are observed, the prognosis is doubtful.
Stage 4A - implies tumor growth into surrounding tissues and organs with disruption of their function. There may be single or multiple metastases to regional lymph nodes. There are no distant metastases to organs. The expressed symptoms are concerning, the prognosis is doubtful.
Stage 4B - assigned to all patients who have foci of distant metastasis to organs and tissues. The severe symptoms are troubling. The prognosis is unfavorable.

Localization of the tumor in the pancreas

Anatomically, the malignant process of the pancreas is localized:

The most common pathology is in the head (up to 70% of cases).
In the body and tail of the organ it is in second place in terms of prevalence (up to 24%).
The uncinate process is the rarest pathology (up to 6% of cases).

Reasons for the development of adenocarcinoma

A pathogenetically significant etiological factor has not yet been identified, nor has the mechanism of transformation of healthy cells into cancer cells. There are hypothetical assumptions classified as predisposing factors that contribute to the development of malignant cells.

Predisposing factors, the effect of which has now been proven in scientific experiments:

Smoking. It has been proven that the chemical compounds contained in tobacco have a carcinogenic effect not only on the lungs, but also on the pancreas. The risk of developing a tumor in smokers is 2-3 times higher than in non-smokers.
Obesity and overweight worsen the course and prognosis.
Many years of work at industrial enterprises related to the chemical industry.
A history of long-term chronic pancreatitis in combination with type 1 diabetes mellitus. The symptoms of these diseases mask the symptoms of cancer for a long time. In addition, pancreatitis worsens the prognosis.
Burdened heredity - the presence of malignant tumors in close relatives. It has been proven that family history worsens the prognosis.

Early symptoms and signs

As with any tumor, there are no specific symptoms and manifestations of pancreatic cancer. This poses a challenge for early diagnosis. In the first stages of development, cancer can be suspected only during a routine medical examination based on a number of nonspecific symptoms. Without confirmation by laboratory and instrumental examination methods, the diagnosis cannot exist.

The first symptoms of pancreatic cancer:

Pain with primary localization in the upper abdomen in the epigastrium.
Symptoms of weight loss to the point of complete exhaustion.
Dyspeptic symptoms: loss of appetite, diarrhea, nausea, vomiting.
Jaundice staining of the sclera, mucous membranes and skin.
Palpable enlarged gallbladder.
Ascites.
Palpable space-occupying lesion in the area of the pancreas.
Frequent urination.

Even with a combination of several symptoms, one cannot speak with complete confidence about the presence of a malignant process. They are not specific and are present in other pathologies. If they are available, the doctor has the right to prescribe additional instrumental examination methods to the patient for early detection of the tumor and verification of the diagnosis.

One of the main reasons for the development of symptoms of pancreatitis is alcohol. A modern natural anti-alcohol complex shows good results in the fight against psychological dependence and the consequences of excessive consumption of alcoholic beverages:

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Clinical manifestations of pancreatic cancer in late stages

Patients seek medical help on their own in the later stages, when symptoms begin to bother them. As a rule, these are abdominal pains of an uncertain nature.

Important! The location of the most severe pain helps in topical differential diagnosis. With cancer of the head of the pancreas, pain is localized in the epigastric region or in the right hypochondrium. In case of cancer of the body and tail, the glands encircle the upper abdomen or are localized in the epigastrium and in the left hypochondrium with irradiation to the lower back and back.

In addition to pain, symptoms and manifestations of pancreatic cancer in the later stages may include:

Unmotivated cachexia.
Saffron staining of sclera, mucous membranes and skin. Jaundice staining is caused by compression of the bile ducts and, as a result, a violation of the outflow of bile. Excess bilirubin circulates in the blood, giving a yellow tint.
Vomiting food eaten the day before; gastrointestinal bleeding; bloating, rotten belching. These symptoms are observed only in the later stages of cancer, when the tumor begins to invade the stomach and duodenum, interfering with the evacuation of food.
Multiple thrombosis of superficial and deep veins.
Splenomegaly, ascites.

Laboratory diagnostics and detection of tumor markers

In the early stages of development, only one laboratory test can confirm cancer: a blood test for the presence of tumor markers. For the pancreas, these are carcinoembionic (CEA) and carbonic anhydrate (CA-19-9 antigens).

At later stages, in addition to this analysis, the following is carried out:

General clinical blood test, which reveals a decrease in hemoglobin and red blood cells, an increase in the erythrocyte sedimentation rate.
Biochemical analysis - disturbance of the protein composition of the blood, increase in alkaline phosphatase and gammaglutamyl transpeptidase.
General urine analysis - increased glucose, appearance of diastase (pancreatic amylase).

Instrumental methods for diagnosing cancer

Ultrasound methods

They are performed primarily on all patients with suspected cancer. They are considered the most informative and are available in almost every clinic.

Ultrasound examination of the abdominal organs. It is carried out through the skin of the anterior abdominal wall. A direct sign of a tumor is the presence of a single volumetric formation or a heterogeneous cavity with a clear line between this formation and normal parenchyma. The head and body of the gland are best visualized, so tumors of this location are easier to diagnose in the early stages than tumors of the tail. Using ultrasound, you can detect a tumor from 1-2 cm. The ultrasound method allows you to assess the prevalence of the cancer process and the presence of metastases in the abdominal organs. Cancer germination is said to occur when there is germination of malignant cells into adjacent blood vessels and lymph nodes.
Duplex scanning of pancreatic vessels. It is carried out in real time with simultaneous contrasting. Allows you to evaluate blood flow and the degree of vascularization of the tumor formation and parenchyma, the relationship of organ structures relative to each other. This study is performed on patients whose ultrasound showed signs of cancer cell growth in the blood vessels and aorta.
Endoscopic ultrasound examination. A type of conventional transcutaneous ultrasound, only here an additional endoscopic sensor is used. This sensor is inserted through the esophagus and stomach into the lumen of the duodenum, where signals are received. The good thing about this method is that it allows you to diagnose tumors with a diameter of 5 mm or more, which cannot be detected with a regular ultrasound. In addition, the doctor evaluates the condition of adjacent organs and vessels for metastasis.

Computed tomography in spiral mode

This is the gold standard for diagnosis. The study is most effective with intravenous contrast enhancement of the pattern. At the same time, the cancerous formation selectively accumulates contrast, which makes it possible to assess the size, localization and prevalence of the pathology. Using CT, the condition of regional lymph nodes, the ductal system, blood vessels and adjacent organs is assessed. CT is a highly sensitive method. Metastases, if present, are detected in 99% of cases.

Magnetic resonance imaging

Used as an alternative to CT. However, MRI has a drawback - it is difficult to differentiate a malignant neoplasm from an inflammatory focus. MRI is often performed to better visualize the ducts.

Percutaneous aspiration biopsy under ultrasound guidance

An invasive diagnostic method that allows you to remove material from the affected area for histological examination. The method is important for determining the morphology of the tumor and the final decision about its benignity or malignancy. Based on the results of the biopsy, the question of the advisability of chemoradiotherapy is decided.

Laparoscopy

An invasive method of the latest generation, allowing oncologists to assess with their own eyes the condition of the pancreas, its ducts and adjacent organs in real time. The conclusion about the presence of cancer is given right there in the operating room. If present, the extent, location and metastasis are assessed.

Principles and directions of treatment

Directions of therapeutic effects on the tumor process:

Surgical (radical and palliative).
Radiation or chemotherapy.
Combined.
Symptomatic.

The type of treatment is selected individually. The patient’s age, the presence of concomitant somatic pathology, the morphology of cancer and its prevalence are taken into account. Symptoms of suspected complications and location are also assessed. However, none of these criteria is an absolute indication for resection. Indications and contraindications for surgery and treatment tactics are selected individually by the doctor.

Surgery

The operation for radical removal of the pancreas is carried out strictly according to indications.

Absolute contraindications to radical surgery:

Metastatic screenings to the liver and peritoneum.
Metastatic screenings to lymph nodes that cannot be removed.
Germination of venous vessels by metastases throughout the entire thickness of the wall with its deformation.
Involvement of large branches of the aorta (celiac trunk, superior mesenteric and hepatic arteries) in the cancer process.
Severe concomitant somatic pathology.

Surgical treatment involves one of three types of surgery: pancreaticoduodenectomy, total pancreaticduodenectomy, or excision of the distal parts of the gland.

During pancreatoduodenal resection, the head and uncinate process with part of the stomach, common bile duct and duodenum are excised.

Excision of the distal sections involves the removal of one of the parts of the gland (head, body, tail, process) with part of the bile duct, duodenum and stomach.

With total pancreaticduodenectomy, the pancreas is completely resected with all adjacent lymph nodes, tissue, vessels, and ligaments. This operation is performed extremely rarely, since the patient ends up with absolute enzyme and hormonal deficiency.

As for palliative surgery, it is performed for most patients. Patients with symptoms of obstructive jaundice, intestinal obstruction and impaired food evacuation are especially in need of palliative surgery. In this case, preference is given to the usual laparotomy, during which the patency of the bile ducts or gastrointestinal tract is restored by creating a stoma. The surgeon also assesses the condition of the organ, the degree of damage and the extent of the cancer process.

Surgical treatment is especially indicated in late stages of cancer. The survival prognosis increases 5-7 times. The average prognosis for survival after surgery is up to 2 years.

Radiation therapy

It is performed before or after surgery or to relieve pain. Radiotherapy is also indicated for the treatment of tumors in the early stages, when there are small areas of damage. Therapy is carried out in courses of 5 weeks with fixed doses of radiation. During treatment, nausea, vomiting, and weakness may occur, but after completion of the course the side effects go away on their own. Radiation therapy improves the prognosis of the disease and relieves painful pain symptoms.

Chemotherapy

Treatment is carried out with special chemotherapy drugs that can kill cancer cells or slow down their growth. Nowadays it is preferable to use combinations of several drugs to achieve results more quickly. Chemotherapy is carried out in courses. During treatment, the patient experiences nausea and vomiting, baldness, and ulceration of the mucous membranes. Upon completion of the course, these side effects disappear. Chemotherapy also improves disease prognosis and survival.

Symptomatic treatment is carried out for patients with an inoperable tumor, when none of the above methods is able to completely eliminate the cancer. This improves the quality of life, eliminates symptoms, and improves the prognosis of the disease in general.

Predictions: How long can you live?

Survival rates vary widely and depend on the stage of the disease, so even the attending doctor cannot give an accurate prognosis. The average life expectancy for pancreatic cancer is as follows:

After radical surgical treatment, the average survival rate is 1 to 2.5 years. About 20% of patients live more than 5 years.
After palliative surgery, chemotherapy and radiation therapy, if the patient refuses surgery, the life prognosis is up to 1 year. On average 6-8 months.

Useful video: How to detect pancreatic cancer