Vårdprogram för pankreascancer - Regionalt cancercentrum syd

INNEHÅLL
1. Inledning
1.1 Bakgrund ......................................................................................... 5
1.2 Arbetssätt ........................................................................................ 5
1.3 Omfattning ...................................................................................... 5
2. Incidens, riskfaktorer och klinik
2.1 Incidens och riskfaktorer ................................................................. 6
2.2 Symtombild ..................................................................................... 6
2.3 Prognos ........................................................................................... 6
3. Diagnostik
3.1 Bilddiagnostik ................................................................................. 7
3.2 Endoskopi ....................................................................................... 7
3.3 Histologi/cytologi............................................................................ 8
3.4 Kemisk och molekylärbiologisk diagnostik, tumörmarkörer.......... 8
3.5 Differentialdiagnoser ...................................................................... 8
3.6 Diagnosschema ............................................................................... 9
3.7 Diagnosbeskedet ............................................................................. 9
Fig 1. Diagnostik- och utredningsschema vid pancreascancer ..... 10
4. Preoperativ utredning och behandling
4.1 Målsättning ....................................................................................11
4.2 Ikterus.............................................................................................11
4.3 Malnutrition ...................................................................................11
4.4 Operabilitet och resektabilitet ........................................................11
4.5 Preoperativ radio- och kemoterapi ................................................ 12
4.6 Skall pankreascancer opereras? .................................................... 12
4.7 Sammanfattning ............................................................................ 13
5. Kurativt syftande kirurgi
5.1 Målsättning ................................................................................... 13
5.2 Val av operationsmetod ................................................................. 13
5.3 Peroperativ resektabilitetsbedömning ........................................... 14
5.4 Metoder för resektion .................................................................... 14
5.5 Metoder för rekonstruktion ........................................................... 15
5.6 Postoperativa komplikationer; profylax ........................................ 16
5.7 Klassificering ................................................................................ 17
5.8 Uppföljning ................................................................................... 17
5.9 Sammanfattning ............................................................................ 17
6. Adjuvant behandling
6.1 Målsättning ................................................................................... 18
6.2 Radio- och/eller kemoterapi .......................................................... 18
6.3 Uppföljning ................................................................................... 19
6.4 Sammanfattning ............................................................................ 19
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