Câncer de pâncreas
Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- icterícia
- dor ou desconforto inespecífico na parte superior do abdome
- perda de peso e anorexia
- dorsalgia
Outros fatores diagnósticos
- 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)
Fatores de risco
- tabagismo
- história familiar de câncer de pâncreas
- outras síndromes de câncer hereditário
- pancreatite crônica esporádica
- diabetes mellitus
- obesidade
- fatores alimentares
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- tomografia computadorizada (TC) com base em protocolo pancreático
- ultrassonografia abdominal
- TFHs
Investigações a serem consideradas
- 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
Novos exames
- teste genômico
Algoritmo de tratamento
ressecável (estádios 1 e 2)
doença localmente avançada irressecável (estádio 3)
metastática (estádio 4)
Colaboradores
Autores
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
Declarações
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.
Agradecimentos
Dr Hemant M. Kocher wishes to gratefully acknowledge Dr Fieke E.M. Froeling, a previous contributor to this topic.
Declarações
FEMF is an author of a reference cited in this topic.
Revisores
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
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
National Institute for Health and Care Excellence. Pancreatic cancer in adults: diagnosis and management. Feb 2018 [internet publication].Full text
Sohal DPS, Kennedy EB, Cinar P, et al. Metastatic pancreatic cancer: ASCO guideline update. J Clin Oncol. 2020 Aug 5:JCO2001364.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.
Differentials
- Pancreatite crônica
- Cálculos no ducto biliar
- Carcinoma ampular
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: pancreatic adenocarcinoma
- Pancreatic cancer in adults: diagnosis and management
More GuidelinesPatient information
Abandono do hábito de fumar
Câncer de pâncreas
More Patient information
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