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Câncer de pâncreas

  • Обзор
  • Теория
  • Диагноз
  • Лечение
  • Последующее наблюдение
  • Источники
Last reviewed: 16 Aug 2025
Last updated: 07 Mar 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • icterícia
  • dor ou desconforto inespecífico na parte superior do abdome
  • perda de peso e anorexia
  • dorsalgia
Full details

Other diagnostic factors

  • Idade 65-74 anos
  • esteatorreia
  • sede, poliúria, noctúria e perda de peso
  • náuseas, vômitos e saciedade precoce
  • pancreatite aguda inexplicada
  • hepatomegalia
  • massa abdominal epigástrica
  • sinal de Courvoisier positivo
  • petéquia, púrpura, hematoma
  • Sinal de Trousseau (tromboflebite migratória)
Full details

Risk factors

  • tabagismo
  • história familiar de câncer de pâncreas
  • outras síndromes de câncer hereditário
  • pancreatite crônica esporádica
  • diabetes mellitus
  • obesidade
  • fatores alimentares
Full details

Diagnostic investigations

1st investigations to order

  • tomografia computadorizada (TC) com base em protocolo pancreático
  • ultrassonografia abdominal
  • TFHs
Full details

Investigations to consider

  • tempo de protrombina (TP)
  • Hemograma completo
  • biomarcador de antígeno do câncer (CA) 19-9
  • tomografia por emissão de pósitrons
  • colangiopancreatografia retrógrada endoscópica (CPRE)
  • RNM
  • colangiopancreatografia por ressonância magnética
  • ultrassonografia endoscópica
  • laparoscopia de estadiamento (com ultrassonografia laparoscópica)
  • biópsia
Full details

Emerging tests

  • teste genômico

Treatment algorithm

ACUTE

ressecável (estádios 1 e 2)

doença localmente avançada irressecável (estádio 3)

metastática (estádio 4)

Contributors

Authors

Hemant M. Kocher, MBBS, MS, MD, FRCS

Professor of Liver and Pancreas Surgery

Barts Cancer Institute

Barts and The London School of Medicine and Dentistry

London

UK

Disclosures

HMK is an author of a number of references cited in this topic. HMK has received research grants from Bristol-Myers-Squibb (formerly Celgene) for investigator-initiated clinical trials. HMK has unrestricted educational grants from Meril, Mylan, Medtronics, and Ethicon.

Acknowledgements

Dr Hemant M. Kocher wishes to gratefully acknowledge Dr Fieke E.M. Froeling, a previous contributor to this topic.

Disclosures

FEMF is an author of a reference cited in this topic.

Peer reviewers

Ross Carter, FRCS

Consultant Pancreatic Surgeon

West of Scotland Pancreatic Unit

Glasgow Royal Infirmary

Glasgow

UK

Disclosures

Not disclosed.

Nikhil I. Khushalani, MD

Assistant Professor of Oncology

Roswell Park Cancer Institute

Buffalo

NY

Disclosures

NIK has received funding for the conduction of clinical trials and associated translational studies from Merck, Pfizer, and Astra-Zeneca. NIK has a grant from the National Comprehensive Cancer Network (from research support by Roche).

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: pancreatic adenocarcinoma [internet publication].Full text

Conroy T, Pfeiffer P, Vilgrain V, et al. Pancreatic cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2023 Nov;34(11):987-1002.Full text  Abstract

Sohal DPS, Kennedy EB, Cinar P, et al. Metastatic pancreatic cancer: ASCO guideline update. J Clin Oncol. 2020 Aug 5:JCO2001364.Full text  Abstract

Von Hoff DD, Ervin T, Arena FP, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013 Oct 31;369(18):1691-703.Full text  Abstract

Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011 May 12;364(19):1817-25.Full text  Abstract

Balaban EP, Mangu PB, Khorana AA, et al. Locally advanced, unresectable pancreatic cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2016 Aug 1;34(22):2654-68.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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  • Guidelines

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  • Patient information

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    Câncer de pâncreas

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