Early diagnosis of pancreatic cancer is actually not difficult, but we did not do it right.
Written by | Tian Dongliang
Source | "Medical Community" public account
As the vice president of the Affiliated Cancer Hospital of Fudan University and the director of the Shanghai Institute of Pancreatic Tumors, Professor Yu Xiantao works in Xuhui Campus every Monday and Wednesday, works in Pudong Campus every Tuesday and Thursday, and decides where others are on Fridays depending on the specific work arrangement. He's been running between two places all year round, and he says he's home on both sides.
As the largest pancreatic cancer center in Asia, the Department of Pancreatic Surgery of Fudan Cancer Hospital has 70 beds in Xuhui Branch, and after the opening of Pudong Campus in 2019, the number of beds has increased by 80. Since 2014, when Shanghai conducted statistics on various hospitals, the annual number of pancreatic tumor surgeries in the Department of Pancreatic Surgery of Fudan University Affiliated Cancer Hospital has been ranked first in Shanghai.
"I also remember that the number of pancreatic tumor surgeries in 2014 was nearly 400, in 2020 it was 1488, and in 2021 it exceeded 2000 cases." Yu Xiantao explained that the number of surgeries has increased so rapidly, mainly after the opening of the Pudong campus, the number of beds has increased, and after a year of running-in, the amount of surgery has gone up rapidly.
Yu Xiantao believes that their annual surgical volume will have room to grow in the future, because there are many patients, and the number of doctors on their team who can stand alone is increasing every year.
But pancreatic cancer, known as the "king of cancer," is also one of the lowest 5-year survival rates of any tumor, less than 10 percent, and the incidence of pancreatic cancer is getting higher and higher. "Therefore, our efforts have not been able to meet the people's higher demand for life and health, and the level of diagnosis and treatment has not been improved by leaps and bounds, which is a big problem."
After seeing the problems in the clinical treatment of pancreatic cancer, Yu Xianli realized that changes must be made. He was the first generation of surgeons to awaken, and surgeons should not be superstitious about their own scalpel.
"Let patients live longer"
After 30 years of clinical work in pancreatic surgery, Yu Xiantao said that the progress of surgical technology in the past two or three decades has been dazzling.
When he was a resident, a pancreatic cancer surgery took seven or eight hours, and the trauma was also very large, and now it only takes two or three hours, and it is minimally invasive. "The surgery is done faster and faster, the better it is done, the more it is done, the more it is cured, the problem also arises, the operation is so good, why does the patient still not live long?"
As the earliest awakening generation of surgeons, Yu Xianli realized that the future development of pancreatic surgery should have new thinking, new ideas, and new strategies, and the goal of surgery is to provide long-term survival for patients, but surgery is no longer the only means, and the treatment of such serious and difficult diseases as pancreatic cancer should be from finding a doctor who prescribes a good operation to finding a professional team with the strongest comprehensive ability.
As a tumor with high surgical difficulty and malignancy in abdominal surgery, Yu Xiantao has always believed that the treatment progress of pancreatic cancer will replicate the development path of liver cancer. "It will form a large center of comprehensive treatment, which is well known all over the world. Because this disease is difficult to treat, it needs to invest a lot of resources to gather people in different professional directions to form a large platform. ”
Shanghai Pancreatic Research Institute is already such a platform, in the Affiliated Cancer Hospital of Fudan University, patients can hang up the number of "Yu Xianlin Multidisciplinary Clinic", in the multidisciplinary clinic, in addition to Yu Xianlin, there are 4 other doctors and two assistants in different professional directions for patients.
Yu Xianli called this form of outpatient MDT (multidisciplinary consultation) flying into the homes of ordinary people, "We call MDT easy to availability, regularization and normalization, patients can hang up our team number like hanging expert clinics, which is according to the law of disease and the law of discipline development, we continue to break through and innovate, in order to make the discipline have vitality." ”
Pancreatic surgery should be developed, and Yu Xianli said that there are two points that must be done. First of all, this discipline must be engaged in scientific research, because pancreatic cancer is difficult, it needs to have a breakthrough, and it is necessary to deepen the understanding of it. Second, surgical leadership, internal medicine assistance, although called pancreatic surgery, but also inseparable from internal medicine treatment, "only to do surgery patients must not live long, to achieve 4 modernization: surgical minimally invasive, tumor treatment precision, clinical research systematization, patient management of the whole process." ”
Minimally invasive surgical treatment has been achieved at present, but Yu Xiantao believes that precision is lacking in pancreatic cancer treatment, "Pancreatic cancer has not yet reached the era of precision and immunotherapy, we must take this step, which is my greatest wish and goal in the next 10 years, and it is also the direction of my efforts." ”
"And the whole process of patient management, the fight is the platform and system, not to fight which doctor's level is high, a doctor is excellent is useless, to fight the platform is excellent, the team strength is strong, now is not a doctor's surgery to do well, can bring the best benefits to patients in the era, we need sharpshooters, more need is an excellent team."
"Early diagnosis of pancreatic cancer is not difficult"
When it comes to pancreatic cancer, the king of cancer, Yu Xianmao uses the term "menacing" to describe it.
Pancreatic cancer, which was relatively rare in China before the 1990s, has slowly become more common, especially after 2000, and the incidence has gradually moved closer to Western developed countries. "The main reason is the Westernization of our diet and lifestyle, as well as the pressure of work."
According to the data, since 2014, pancreatic cancer has become the only malignant tumor with an increased mortality rate, and its mortality rate is expected to rise to the second place by 2030, second only to lung cancer. The incidence and mortality rate of pancreatic cancer in China are higher than the world average, especially in central cities and developed coastal areas.
However, the rate of improvement in the diagnosis and treatment level of pancreatic cancer in mainland China has not kept pace with the increase in its incidence and number of patients. Mainland pancreatic cancer has the characteristics of "three highs and four lows": high morbidity, high mortality, high recurrence and metastasis rate, low early diagnosis rate, low resection rate, low drug efficiency, and low 5-year survival rate.
Yu Xiantao also pointed out that the biggest problem with pancreatic cancer is that its early symptoms are very hidden, and its early diagnosis and detection rate is not high. "How to do better with early diagnosis and early treatment?" How to form a breakthrough? This is an urgent problem to be solved. Like lung cancer, before 2000, the median survival period of lung cancer was less than one year, what is the difference with pancreatic cancer? But by 2010, the median survival time for lung cancer was 4 years, a huge improvement, and we were still making small strides overall. ”
But in Yu Xiantao's view, the early diagnosis of pancreatic cancer is actually not difficult, but we did not do it right.
The early diagnosis rate of a disease can be rapidly improved, and Yu Xianli believes that two conditions must be met: first of all, there must be objective inspection methods, and the second examination methods should be convenient and easy to obtain. "I give two examples, with the B ultrasound, the early diagnosis rate of breast, thyroid and liver cancer has increased rapidly, and the detection rate of low-dose thin-layer spiral CT of the lungs on small lung nodules has suddenly increased the early diagnosis rate of lung cancer, so the significant improvement in the median survival of lung cancer is not only the reason for targeted drugs, but also a large number of early patients are detected."
Pancreatic cancer also has objective examination methods, Yu Xiantao said: "Specifically for the epigastric pancreas thin layer enhanced spiral CT, pancreatic cancer below 1 cm can be detected, if you do it once a year? But how many people would want to do it? ”
For the early diagnosis and early treatment of pancreatic cancer, Yu Xianli said that breakthroughs can be made from two points, professional researchers continue to conduct scientific research and seek breakthroughs in scientific research, while professional doctors do a good job in science popularization, so that non-specialist doctors and the people can understand the mysterious and important organ of the pancreas and understand pancreatic cancer. For the early diagnosis of pancreatic cancer, Yu Xianlin summed up a recipe:
Don't think of yourself as gastrointestinal disease because of the fullness and discomfort of the upper middle quadrant; don't think of yourself as diabetes because of the sudden increase in blood sugar after middle age; don't think of yourself as diabetes because of back pain, just think of being a disease of the orthopedic department of the lumbar muscle strain; don't think of hepatitis only because of yellow eyes, please think about this may be pancreatic cancer, especially the early symptoms of pancreatic head cancer, do an epigastric enhanced thin-layer spiral CT, let the pancreatic surgeon help you rule it out.
"After our patients finished the operation, they lived a very good life, thank you very much, I said don't thank me, I want to thank the first doctor who let you do CT, he thought of it, did it for you in time, let you check it out." And many patients are uncomfortable, just take some medicine, no longer do a gastroscope, take some medicine, and then do not do a colonoscopy, three months, half a year has passed, pancreatic cancer has long progressed, losing the opportunity for early diagnosis and treatment. ”
Source: Medical community
Editor-in-charge: Zheng Huaju
Proofreader: Zang Hengjia
Plate making: Xue Jiao