Cancer of the biliary tract and major duodenal papilla

Cancer of the biliary tract and major duodenal papillaGallbladder cancer usually occurs over the age of 50 years, more often in women. The morphological structure is adenocarcinoma various differential programme with infiltrative growth, rarely (less than 15%) - ploskokletochnyi cancer. The tumor gradually affects the whole bubble extends to the liver, the gallbladder and the common bile duct, adjacent organs (stomach, duodenum, colon). Metastases gallbladder cancer found in the liver, regional lymph nodes, peritoneum, ovaries, pleura. The disease is diagnosed late (70-90% neoperabelny by the time of diagnosis). Early gallbladder cancer is incidental finding during cholecystectomy about cholelithiasis or cholecystitis. A careful analysis of the clinical symptoms, supplemented by a survey, promote timely diagnosis of this disease. The earliest symptom is pain in the right upper quadrant, epigastric region with irradiation in the back. Typical night increased pain. Compared with the previous period in patients with cholecystitis, cholelithiasis possible to detect the change in the character of pain (constant, intensive). Have nausea, vomiting, loss of body weight. When the blockage of the bile ducts, develops hydrops and empyema of the gall bladder, jaundice, enlargement of the proximal ducts and cholangitis, secondary to liver cirrhosis. Bilirubin reaches high numbers, increased levels of alkaline phosphatase, transaminase. Palpation is determined by the increased dense liver, sometimes that is palpable enlarged gall bladder. In the absence of blockade of the choledochus during intravenous holographie find the so-called disabled gallbladder. The precise diagnosis by sonography and computed x-ray tomography. Radical surgery that can be performed rarely, includes, in addition to cholecystectomy, resection of the right lobe of the liver, sometimes pancreatoduodenectomy. Cancer of the extrahepatic bile duct is more likely to occur at the age of 60-70 years. In half of the cases affected the common bile duct. The tumor is an adenocarcinoma of the various differentiation with infiltrative growth. A tumor is growing along the ducts, involves the hepatic vein and artery, portal vein, pancreas, duodenum. Metastases are formed in the regional lymph nodes and liver. Clinical symptoms and methods of diagnosis are the same as in cancer of the gallbladder. It is very informative percutaneous perhepatic cholangiography, help identify the level and location of the tumor. The diagnosis is confirmed during surgery, but a biopsy is often difficult. Radical operation cannot be performed rarely, mainly in cancer destapling division of the common bile duct. At the same time produce pancreatoduodenectomy. Cancer of the large duodenal papilla presents the primary tumor (40%) or other germinating in this area cancers of the bile duct, duodenum, pancreas). To distinguish these tumors is difficult, given the similarity of the histological structure. Clinical symptoms of cancer of the large duodenal papilla occur early, when the tumor is still small. There has been a rapid ulceration of the tumor. Among the clinical symptoms that distinguish this disease - transient mechanical jaundice, loss of blood with the stool, anemia. Other symptoms are characteristic of obstructive jaundice (cholangitis and other). The main diagnostic methods are duodenoscope with biopsy, relaxation duodenography. Perspectives of surgical treatment is favorable, given the possibility of early detection of cancer of the papilla and slow development. After pancreatoduodenectomy 30-40% of patients live for 5 years without signs of disease. Palliative value with inoperable cancer of the gallbladder, biliary tract and major duodenal papilla have different biliodigestive anastomoses or external drainage of the bile ducts to eliminate jaundice. Chemotherapy can cause temporary remission (20 - 30% of cases). Using 5-fluorouracil, Ftorafur, mitomycin C, adriamycin, sometimes combinations of these drugs. Comments on this article yet. Be the first one! Write a comment.

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