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암 이야기 : 췌장암의 병기 진단방법

작성자 닥터코리아 조회수 1836

췌장암의 발생부위 병기

 

발생부위

 

췌장암은 종양의 발생 부위에 따라서 두부암, 체부암, 미부암, 전체암의 4가지로 분류된다.

 

췌관선암(dutal adenocarcinoma) >90% 거의 모두가 치명적이다

췌도세포암(islet cell tumor) 5~10%

 

종양의 위치: head(70%) > body(20%) > tail(10%)

 

98%(90%) 이상의 사망률 : 제거가 불가능한 상태로 진단되는 경우

 

 

병기

 

종양병기(t stage)

제1기 : 췌장에 국한되어 있으면서 크기가 2cm 미만인 경유

제2기 : 췌장에 있으면서 크기가 2cm 이상인 경우

제3기 : 암이 췌장을 벗어나 십이지장, 담관, 췌장주변조직까지 있는 경우

제4기 : 위,비장,대장 주변의 큰 혈관까지 침번한 경우

 

림프절병기(n stage)

림프절전이가 없으면 n0,있으면 n1기라고 한다.

원격전이병기(m stage)

없으면 m0, 있으면 m1기라고 한다.

 

종합병기(t+n+m)

제1기 : 종양병기 1.2기만 있을 때

제2기 : 종양병기3기

제3기 : 종양병기 1,2,3 기 + 림프절병기 n1

제4기초기 : 종양4기이면서 원격전이가 없으면 4기초기

제4기말기 : 종양이나 림프절 관계없이 원격전이가 있으면 4기말기

 

췌장암은 전후상하로 직접 침윤한다. 전방에서는 위 및 결장, 후방에서는 후복막, 복부대동맥, 문맥, 하대정맥, 상방에서는 간십이지장인대 그리고 하방에서는 후복막, 복부대동맥, 문맥, 하대정맥, 상방에서는 간십이지장인대 그리고 하방에서는 장간막 뿌리부로 침윤한다. 신경주위 임파관으로 직접 침윤하는 빈도가 높고, 동통의 원인이 된다. 전이는 간과 임파절에서 가장 많고, 그 밖에 폐, 부신, 신장, 뼈에도 전이된다.

  

 

 

stages pancreatic cancer(미국 국립 암협회)

 

stage 0 (carcinoma in situ) 

in stage 0, abnormal cells are found in the lining of the pancreas.

these abnormal cells may become cancer and spread into nearby normal tissue. stage 0 is also called carcinoma in situ.

  
stage i 

in stage i, cancer has formed and is found in the pancreas only.

stage i is divided into stage ia and stage ib, based on the size of the tumor.

•stage ia: the tumor is 2 centimeters or smaller.
•stage ib: the tumor is larger than 2 centimeters.


stage ii 

in stage ii, cancer may have spread to nearby tissue and organs, and may have spread to lymph nodes near the pancreas.

stage ii is divided into stage iia and stage iib, based on where the cancer has spread.

•stage iia: cancer has spread to nearby tissue and organs but has not spread to nearby lymph nodes.
•stage iib: cancer has spread to nearby lymph nodes and may have spread to nearby tissue and organs.

 
stage iii 

in stage iii, cancer has spread to the major blood vessels near the pancreas and may have spread to nearby lymph nodes.

  

stage iv 

in stage iv, cancer may be of any size and has spread to distant organs, such as the liver, lung, and peritoneal cavity. it may have also spread to organs and tissues near the pancreas or to lymph nodes.

 

 

 

 

췌장암의 진단

 

 

 

  

 

 

 

 

1) upper gi series

 

 

 

2) 초음파

 

통증이 있거나 황달이 있는 환자에게 담석증을 감별하기 위해 일차적으로 시행하는 검사 

 

가장 유용한 선별검사 방법

 

 

 

3) ct

 

초음파 보다 body, tail의 cancer에 유용하며, 검사자에 따른 오류가 적으며 병변을 객관적 으로 관찰할 수 있고 영상이 더 세밀하여 1cm 정도의 암도 발견할 수 있다는 장점

 

 

 

4) mri

 

ct로 진단이 애매할 경우 mri가 추가적인 도움을 줄 수 있으며, 간 전이를 잘 발견할 수 있는 장점이 있으나 ct 보다 부정확

 

 

 

5) eus(내시경적 초음파 검사) : 췌장 종양과 만성췌장염의 구별,

 

                                                2cm 이하의 작은 종양의 진단, 췌장암의 병기 결정 

 

 

 

6) pet

 

췌장암 세포에서 당대사가 증가되어 있는 것을 이용한 검사방법으로, 췌장암과 췌장염의 감별에 도움이 될 수 있으며, 잠재 전이 병소의 발견이나 수술 후 재발 판정 등에 이용될 수 있다. 그러나 가격이 비싸고, ct에 비해 장점이 월등하지 않기 때문에 사용이 제한적

 

  

 

7) 복강경

 

수술전 stage 결정에 유용함 : 복막 전이, 간전이, 혈관 침범, 림프절 전이

 

 

 

8) ercp

 

식도와 위를 지나 십이지장까지 내시경을 삽입해 담관과 췌관의 협착과 폐쇄 등을 직접 눈으로 확인하고, 췌관의 영상을 얻어 정확한 진단을 내리는 데 유용한 검사이며 정확도 또한 높다.그러나 모든 경우에서 시행해야 하는 것은 아니며 황달 치료로 내시경적 담즙 배액술을 위해 주로 이용되며 ct에서 애매한 경우나 십이지장과 유두부의 관찰이 필요한 경우, 또는 췌액의 채취가 필요한 경우나 췌관 내 생검과 세포진 검사가 필요한 경우에 선택적으로 시행할 수 있다.

 

 

 

9) angiography : 혈관의 침범을 검사하기 위함

 

 

 

10) aspiration cytology : ct나 초음파 guide하에 조직검사(확진) 

 

                                      조작 부위 조직에 암세포가 자리를 잡을 수 있으므로 주의

 

 

 

11) 간기능 검사 수치 증가 : 응고 검사시 지연 

 

cea(carcinoembryonic antigen)와 ca 19-9 증가 

 

 

 

 

 

영문자료

 

 

 

tests that examine the pancreas

 

to detect (find), diagnose, and stage pancreatic cancer.

 

   

 

•physical exam and history:

 

an exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. a history of the patient’s health habits and past illnesses and treatments will also be taken.

 

  

 

•chest x-ray:

 

an x-ray of the organs and bones inside the chest. an x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

 

  

 

•ct scan (cat scan):

 

a procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. the pictures are made by a computer linked to an x-ray machine. a dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. this procedure is also called computed tomography, computerized tomography, or computerized axial tomography. a spiral or helical ct scan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.

 

  

 

•mri (magnetic resonance imaging):

 

a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. this procedure is also called nuclear magnetic resonance imaging (nmri).

 

  

 

•pet scan (positron emission tomography scan):

 

a procedure to find malignant tumor cells in the body. a small amount of radionuclide glucose (sugar) is injected into a vein. the pet scanner rotates around the body and makes a picture of where glucose is being used in the body. malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

 

  

 

•endoscopic ultrasound (eus):

 

a procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. an endoscope is a thin, tube-like instrument with a light and a lens for viewing. a probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. the echoes form a picture of body tissues called a sonogram. this procedure is also called endosonography.

 

  

 

•laparoscopy:

 

a surgical procedure to look at the organs inside the abdomen to check for signs of disease. small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy.

 

  

 

•endoscopic retrograde cholangiopancreatography (ercp):

 

a procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. sometimes pancreatic cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. an endoscope (a thin, lighted tube) is passed through the mouth, esophagus, and stomach into the first part of the small intestine. a catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts. a dye is injected through the catheter into the ducts and an x-ray is taken. if the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. this tube (or stent) may be left in place to keep the duct open. tissue samples may also be taken.

 

  

 

•percutaneous transhepatic cholangiography (ptc):

 

a procedure used to x-ray the liver and bile ducts. a thin needle is inserted through the skin below the ribs and into the liver. dye is injected into the liver or bile ducts and an x-ray is taken. if a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body. this test is done only if ercp cannot be done.

 

  

 

•biopsy:

 

the removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. there are several ways to do a biopsy for pancreatic cancer. a fine needle may be inserted into the pancreas during an x-ray or ultrasound to remove cells. tissue may also be removed during a laparoscopy (a surgical incision made in the wall of the abdomen).