Upper abdominal pain is considered as a common stomach disease. How to judge pancreatic cancer?

Pancreatic cancer is a kind of cancer that is difficult to find in the early stage. The main reason is that the pancreas is concealed and there are no obvious symptoms in the early stage.

As can be seen from the above picture, the pancreas belongs to the retroperitoneal organ, which is located behind the stomach, surrounded by the duodenum and connected with the transverse mesocolon below. The tail of the pancreas is the spleen, surrounded and covered by other organs.

Therefore, pancreatic diseases, especially cancer, are difficult to find early and are often mistaken for other organ diseases in the upper abdomen, such as stomach or hepatobiliary diseases. Pancreatitis is easy to find, mainly because of obvious pain. After hospital treatment, the diagnosis was made by CT and blood amylase.

Another factor that pancreatic cancer is difficult to find is that it is more difficult to find pancreatic problems with economical and simple ultrasound examination. The main reason is that the pancreas is hidden behind the gastrointestinal tract and contains a lot of gas, which is not easy to be observed by ultrasound.

Pancreatic cancer, the most common site is the pancreatic head, which is surrounded by duodenum. This includes the lower end of the common bile duct and the same opening of the pancreatic duct. Tumors can easily lead to common bile duct obstruction and cause jaundice in patients. In addition, the pain of pancreatic cancer is also special, with persistent back pain, which is more obvious than ordinary stomach pain. It may be relieved when taking drugs to treat ulcers.

It is found that the relatively effective examination method for pancreatic cancer is abdominal enhanced CT or magnetic resonance imaging. It was found that the pancreas occupied a space, and the mass was enhanced after enhanced scanning. CT-guided fine needle aspiration biopsy can confirm the pathological diagnosis. For the treatment of pancreatic cancer, if it is in the middle and early stage, radical surgery is needed, and the trauma of general surgery is relatively large; If the tumor is relatively advanced, surgery is generally not considered, and local control of chemotherapy or radiotherapy is needed to give symptomatic treatment for different symptoms to relieve pain.

Upper abdominal pain is considered as a common stomach disease, but it was finally diagnosed as pancreatic cancer. This is actually not surprising. Most symptoms are not specific, that is, not one symptom corresponds to a disease. Many diseases may have the same or similar symptoms, and the same disease may have many symptoms. Judging the condition by symptoms is unreliable and can only be used as a possible clue, which needs further examination and confirmation. For example, epigastric pain may appear in many diseases. Although it is mostly caused by stomach diseases, it is not only stomach diseases that have epigastric pain. In addition to stomach diseases, liver diseases, gallbladder diseases, pancreatic diseases, and even heart diseases, epigastric pain may occur. Moreover, gastropathy is not just gastritis, it may be gastric ulcer or gastric cancer, and it cannot be taken for granted that it is gastritis.

So if you have epigastric pain, you should further check what causes it. Of course, we can start with the most common stomach diseases, such as gastroscopy. If the stomach disease is ruled out, or the so-called gastritis and gastric ulcer are found, but the treatment according to this disease is ineffective, then we must think that it may be other diseases and need further examination.

As far as pancreatic cancer is concerned, there may also be epigastric pain. As far as symptoms are concerned, it is impossible to judge whether it is caused by pancreatic cancer. However, we must find a tendency from the symptoms. Pancreatic diseases (not only pancreatic cancer, but also pancreatitis, etc. ) there may be low back pain, but not necessarily. Finally, further examination is needed through imaging examination. If a space occupying lesion is found, it needs biopsy or surgical diagnosis.

There is such a patient in the outpatient clinic who often socializes outside for work reasons. Recently, I always feel pain and discomfort in my upper abdomen. I thought it was just general gastritis, so I took some medicine to treat my stomach trouble. After taking the medicine for a few days, the symptoms have not changed obviously, and there is a trend of aggravation. Go to the hospital for examination at once. The gastroenterologist gave him a gastroscope and found no abnormality, so he asked the patient to do a whole abdominal enhanced CT. The results showed that there was a tumor in the body and tail of the pancreas, and at the same time,

Patients with epigastric pain are very common in outpatient department of gastroenterology. Most people think it's just a stomachache. People think that stomachache is inaccurate, and they can't point out the exact position of the stomach. In fact, besides the stomach, there are other organs in the upper abdomen, such as the duodenum connecting the stomach, liver, gallbladder, pancreas and spleen. Because the visceral nerves cross each other in the abdominal cavity, besides the diseases of the stomach itself, it may also be caused by other organs, especially pancreatic diseases.

From the position of physiological anatomy, the stomach is hidden in the middle of the upper abdomen like a long strip of pancreas, behind the stomach. It is precisely because of the same body surface projection that both of them often have symptoms of upper abdominal pain and discomfort, a series of upper digestive tract symptoms, such as upper abdominal pain, belching, abdominal distension and so on. And there will be systemic symptoms such as weight loss. Because of the hidden position of pancreas and the influence of intestinal gas in abdominal cavity, the sensitivity of abdominal color Doppler ultrasound in detecting pancreatic diseases is not enough. If a definite diagnosis is needed, abdominal enhanced CT should be performed as soon as possible, and MRI should be performed if conditions permit.

It can be seen that epigastric pain is not only a disease of the stomach, but also a further diagnosis should be made in time when conventional drugs are ineffective, especially pancreatic diseases.

Answer: Ren Xiangyu, Master of Medicine.

Welcome to pay attention to the life call order and get more useful health knowledge. The upper abdomen is divided into left, middle and right areas according to the nine-point method of abdominal body surface position. The occurrence of pain symptoms is related to the pathological changes of organs in the region, and sometimes the pathological changes of organs outside the abdomen can also cause abdominal pain symptoms. Because the positions of the stomach, duodenum, liver, gallbladder, pancreas and other organs in the upper abdomen are close to each other and are related to each other, in general, when there are pain symptoms in the upper abdomen, the lesions of the stomach, duodenum, pancreas, liver, gallbladder and other organs should be considered first.

Anatomically speaking, the pancreas and stomach are in the upper left and middle upper part of the abdominal cavity, and the pancreas is in the lower back of the stomach. Therefore, the symptoms of pain in the upper left and middle upper abdomen in daily life are considered as stomach diseases, which is also the reason why pancreatic diseases such as pancreatitis and pancreatic cancer are mistaken for stomach diseases.

Clinically, there is such a diagnosis idea: adults have persistent upper abdominal pain for a long time, and gastroscopy can't explain the cause of abdominal pain, or the discomfort caused by primary stomach disease has not improved after taking relevant drugs for treating stomach diseases. To be alert to the possibility of pancreatic lesions, it is necessary to carry out laboratory tests such as hematuria amylase, blood sugar, glucose tolerance test and tumor markers in time, as well as related abdominal ct, magnetic resonance imaging, cholangiopancreatography and endoscopic ultrasound.

Finally, let's talk about the symptoms and characteristics of pancreatic cancer and the causes of these symptoms, so that everyone can understand. The most common symptoms of pancreatic cancer are epigastric pain, fullness and discomfort, jaundice, loss of appetite and emaciation.

1. Upper abdominal pain and discomfort: usually the earliest symptom. In the early stage, the pancreatic duct was obstructed, expanded, twisted and pressured by the mass, which showed discomfort in the upper abdomen, or dull pain, dull pain and swelling pain, and the position was deeper or slightly to the left. In the middle and late stage of pancreatic cancer, the tumor invaded the celiac plexus, resulting in persistent severe abdominal pain, which radiated to the back and waist, making people unable to lie flat. Sitting in a curled posture, the pain symptoms are slightly relieved, but it will seriously affect their normal sleep and diet.

2. Jaundice: Jaundice is characterized by progressive aggravation, which is caused by cancer compression or infiltration of the common bile duct. The occurrence of jaundice is related to the location of pancreatic tumor. The closer the tumor is to the common bile duct, the earlier the jaundice symptoms appear. The more severe the biliary obstruction, the deeper the jaundice. At the same time, the urine is dark yellow, and the stool is clay-colored, accompanied by itchy skin and sometimes bleeding tendency. At this time, the sclera and skin are obviously yellow, and the liver and gallbladder are swollen.

3. Gastrointestinal symptoms: such as loss of appetite, abdominal distension, indigestion, diarrhea or constipation. Some patients will feel sick and vomit. When cancer invades the duodenum, there will be symptoms related to upper gastrointestinal obstruction or gastrointestinal bleeding.

4. emaciation and fatigue: pancreatic cancer can cause progressive emaciation, fatigue and weight loss due to factors such as diet reduction, indigestion, lack of sleep and cancer consumption, and obvious cachexia and tumor metastasis can occur in the late stage.

5. Other symptoms: Pancreatic head cancer can lead to biliary obstruction, usually without biliary tract infection. If accompanied by biliary tract infection, it may be related to the existence of cholelithiasis. Some patients will have mild diabetes, as well as mental and neurological disorders such as depression, anxiety and personality mania, among which depression is the most common. These two symptoms are also a clue to distinguish chronic stomach diseases, hepatobiliary diseases and pancreatic cancer.

Thanks for reading!

First of all, epigastric pain is a symptom of many diseases. Most abdominal organs can cause pain, but this symptom can also easily lead to misdiagnosis and missed diagnosis. Upper abdominal pain is not necessarily a simple stomach disease.

Next, I will analyze the disease of upper abdominal pain for everyone. The upper abdomen refers to the line above the 12 rib arch and below the diaphragm on both sides. The main organs are stomach, duodenum, pancreas, liver and gallbladder. Therefore, the pathological changes of these organs will cause upper abdominal pain.

1, stomach diseases, mainly acute and chronic gastritis, gastric ulcer, gastric cancer, gastric perforation and other diseases, the pain of these diseases is mostly in the left upper abdomen and middle abdomen, mainly dull pain, dull pain, but also accompanied by some symptoms of the stomach. There are nausea and vomiting, belching, belching, acid reflux, loss of appetite and so on. , mainly used for gastroscopy.

2, pancreatitis, pancreatic cancer, such diseases are mainly pancreatic lesions. Pancreatitis is mainly pain in the middle and upper abdomen, and the pain is persistent colic, mainly radiation pain in the back, accompanied by blood pressure drop, pallor, shock and diarrhea, mainly caused by drinking or overeating, and relieved by bending over and sitting sideways. Pancreatic cancer is a malignant tumor, and the main pain is mainly based on the site of cancer. The pain is in the left upper abdomen, right upper abdomen, middle abdomen, possibly in the right lower abdomen and umbilicus, and even total abdominal pain, accompanied by mud stool, nausea and vomiting, dyspepsia and progressive jaundice. The main examination is CT.

3. Cholecystitis, gallstones, hepatitis and liver cancer. These are hepatobiliary diseases, mainly pain in the upper right abdomen and lower right abdomen, with dull pain or colic, but accompanied by nausea, jaundice and radiation pain in the right shoulder and back.

Therefore, there are many diseases that cause epigastric pain, but the diagnosis should be made according to the specific pathogenic factors, accompanying symptoms and auxiliary examination. Pancreatic cancer has also been analyzed above, mainly with pain, and the accompanying symptoms are also obvious.

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Unfortunately, the treatment effect of advanced pancreatic cancer is very poor. Pancreatic cancer is called the king of cancer. Most patients died within half a year after diagnosis, and the 5-year survival rate was only 5% to 10%. Why the prognosis of pancreatic cancer is so poor, besides the high degree of malignancy of pancreatic cancer itself, there is also a very important reason, that is, when most pancreatic cancers are discovered, they are already in the advanced stage of cancer. Because early pancreatic cancer is not uncomfortable, even if symptoms appear, it is difficult to distinguish it from other diseases.

The pancreas is located on the deep surface of our abdominal cavity, behind the peritoneum, and in front of it is the stomach, intestine and thick belly. Therefore, even if it is uncomfortable, it is difficult to be found, and it is often regarded as stomach pain, indigestion and other diseases, which leads to delayed diagnosis.

Therefore, we emphasize the screening of pancreatic cancer. The following people are at high risk of pancreatic cancer, who have long-term drinking, long-term smoking, obesity and diabetes, have chronic pancreatitis in the past, have pancreatic cancer patients in their families and have recurrent biliary pancreatitis. For these people, it is necessary to start screening from the age of 40. Because the pancreas is too deep and there is intestinal obstruction in front, it can't be seen clearly with color Doppler ultrasound. If you want to check pancreatic cancer, it is recommended to choose.

In short, don't wait until you are sick to see a doctor. At this time, pancreatic cancer is often in the middle and late stages, and the therapeutic effect should be greatly reduced.

The final judgment of western medicine on diseases still depends on pathology. Pathological biopsy is the gold standard.

There are gastritis, gastric ulcer, gastric cancer, pancreatic cancer, cholecystitis, myocardial infarction, early appendicitis, post-cholecystectomy syndrome, liver abscess and other diseases.

Usually, patients with pancreatic cancer may have symptoms such as epigastric discomfort, weight loss, jaundice and steatorrhea, but sometimes they may have no symptoms. Generally speaking, for patients suspected of pancreatic cancer, it is important to choose non-invasive examination methods such as serological tumor markers (such as CA 199), such as abdominal color Doppler ultrasound. Of course, pancreatic CT and MRI have a higher judgment on the diagnosis of pancreatic cancer. If further clarification is needed, percutaneous biopsy can be guided by CT; Brush ERCP pancreatic juice cells; Endoscopic ultrasound-guided fine needle aspiration biopsy confirmed the pathological type of the tumor.

The incidence of pancreatic cancer is hidden and there are no typical symptoms in the early stage. Abdominal distension and abdominal pain are very similar to gastritis and gastric ulcer. According to common sense, no one will doubt pancreatic cancer and delay treatment.

The pancreas is located in the left upper abdomen and retroperitoneal organs, and the stomach is in front. If the pancreatic tumor is enlarged and the capsule is tense, there will be dull pain. Because it overlaps with the stomach, it is difficult to distinguish between stomachache and pancreatic pain.

The digestive juice secreted by the pancreas has effects on protein, fat and sugar. If a tumor occurs, its function will be damaged, the patient's digestive function will be poor, and abdominal distension will occur. If the tumor oppresses the digestive tract, there will be discomfort such as nausea, loss of appetite and abdominal distension, which is not easy to distinguish from stomach diseases.

There is no clear screening opinion for pancreatic cancer. Generally, middle-aged and elderly people aged 50-60 have intractable anorexia, indigestion, emaciation, epigastric pain, back pain, etc. The simplest thing is to do a B-ultrasound. Is there a tumor in the pancreas? Is the biliary tract dilated? If you suspect that there is something wrong with the pancreas, further examination of ct and MRI of the pancreas can be found in most cases.

About 60%-70% of pancreatic cancer occurs in the head of the pancreas. The tumor will compress part of the common bile duct in the pancreas, and bile cannot be discharged smoothly. Painless jaundice is a typical symptom, but it is often in the late stage.

Tumor marker CA 19-9 is a relatively sensitive index of pancreatic cancer, and about 80% of patients are abnormally elevated. In clinic, CA50 and CA242 are often used in combination to improve the sensitivity, but the specificity is not high, which has auxiliary diagnostic significance.

It is not easy to obtain pathological specimens of pancreatic cancer. Duodenal endoscopic biopsy is the most commonly used method to diagnose pancreatic head cancer, but the success rate is not high and it is inconvenient. Clinically, pancreatic cancer is often diagnosed by imaging examination and tumor markers.

I'm Dr. @ Liu Yongyi, thank you for reading!

Thanks for asking.

Upper abdominal pain is a common clinical symptom, and pancreatic cancer should consider the following characteristics:

1. Weight loss: Progressive emaciation is an important manifestation. Patients with pancreatic cancer will have obvious emaciation, especially the tumor at the tail of the pancreas, and emaciation is even earlier than any other symptoms.

2. The upper-middle abdominal pain involves the back, and the forward position is slightly relieved: the pancreas is located in the deep abdominal cavity, which is an extraperitoneal organ with hidden clinical symptoms, and abdominal pain has its own characteristics.

3. Jaundice: The most common part of pancreatic cancer is the pancreatic head, and most of the common bile duct runs in the pancreatic head. Once the tumor compresses the common bile duct, progressive jaundice will occur.

4. Ascites: Especially in men, in the case of upper abdominal pain with ascites, it is necessary to pay attention to exclude pancreatic cancer.

When the diagnosis of pancreatic cancer is suspected, it is necessary to improve the whole abdominal CT enhancement and MRCP, scan with PET-CT if necessary, and puncture under ultrasound endoscope to obtain tumor tissue if chemotherapy is needed. In addition, the serum CA 199 of some patients with pancreatic cancer will increase significantly, and the diagnosis of pancreatic cancer by B-ultrasound is insensitive and easy to be missed.

I hope my answer will satisfy you.

Once discovered, cancer is very common in China. On the one hand, the early symptoms of many cancers are not obvious, on the other hand, patients have not paid enough attention to them. Upper abdominal pain can be caused by many diseases, including not only common gastritis and gastric ulcer, but also hepatobiliary and pancreatic diseases and intestinal diseases. Here are some suggestions to help you find early cancer!

How to find cancer early? Whether pancreatic cancer or other tumors, the early symptoms are not obvious. If you want to find the high-risk group that needs early diagnosis. High-risk groups include: the elderly; Have a family genetic history, that is, their parents and relatives have a history of cancer; Bad living habits and occupational contact history, that is, smoking and drinking, often staying up late, eating irregularly and unhealthy, and working in chemicals such as dyes; If you are a high-risk group, on the one hand, you must pay attention to uncomfortable places (especially recurrent old and bad diseases) and see a doctor as soon as possible; On the other hand, for the annual physical examination, the work unit has better arrangements, and those who have not made arrangements have to have physical examinations at their own expense. Health is always the first.