Pancreatic Peptide Tumor

　　What are the causes of the onset of pancreatic polypeptideoma?

　　1. Weight loss:The weight loss caused by pancreatic polypeptideoma is the most prominent, with significant weight loss occurring within a short period after onset, with weight loss reaching over 30 jin, accompanied by weakness and fatigue.

　　2. Symptomatic diabetes:A few patients present with symptoms of diabetes at the onset of the disease. Therefore, if diabetic patients have persistent abdominal pain, or elderly patients suddenly develop diabetes, or if patients with pre-existing diabetes suddenly worsen their condition recently, they should be vigilant about the possibility of pancreatic cancer.

　　3. Thrombophlebitis:Patients with pancreatic polypeptideoma may develop migratory thrombophlebitis or arterial thrombosis.

　　4. Psychiatric symptoms:Some patients with pancreatic polypeptideoma may exhibit symptoms such as anxiety, impatience, depression, and personality changes.

　　5. Other:Some patients have hyperparathyroidism and a family history. Some patients develop red spots and have itching symptoms.

　　1. The clinical diagnosis of this disease is relatively difficult, as the clinical symptoms of pancreatic polypeptideoma are rare, making it difficult to be discovered. Particularly, other functional endocrine tumors can also secrete a small amount of pancreatic polypeptide and cause corresponding symptoms, which are easy to be confused with this disease. When patients have the above clinical manifestations, and the serum level of pancreatic polypeptide is also significantly increased, the possibility of this disease should be suspected.

　　2. The plasma level of pancreatic polypeptide is measured by radioimmunoassay. If the baseline PP level is normal, a protein meal or secretin can be used for provocation test. A significantly increased PP level also helps in the diagnosis of the disease.

　　3. Ultrasound, CT, MRI, and selective celiac arteriography and other examinations can help understand the location, number, and presence of metastatic foci of tumors, but cannot make a definitive diagnosis. Intraoperative ultrasound examination can help detect occult lesions with small tumors and deep locations, and the determination of hormones in tumors by immunohistochemical methods shows that the content of pancreatic polypeptide in tumor tissue is significantly increased, and other pancreatic endocrine hormones are rare or absent, which is one of the important bases for the disease.

　　4. Fedorak reported that the combination of percutaneous transhepatic portal vein catheterization for blood sampling (PTPC) and selective arterial injection of methylene blue (SAMBI) is helpful for the qualitative and locational diagnosis of this disease.

　　The etiology of this disease is unclear and difficult to prevent. However, with the discovery of various factors related to tumor occurrence, it is possible to prevent these factors before the onset of the disease. Many tumors can be prevented before they form. In 1988, a report in the United States compared the international situation of malignant tumors in detail and proposed that many known malignant tumors can be prevented by external factors in principle, that is, about 80% of malignant tumors can be prevented by simple lifestyle changes. Tracing back further, in 1969, Dr. Higginson's research summarized that 90% of malignant tumors are caused by environmental factors. "Environmental factors" and "lifestyle" refer to the air we breathe, the water we drink, the food we choose to make, our habits of activity, and social relationships.

　　1. Radioimmunoassay was used to measure the level of plasma pancreatic polypeptide. In this disease, the fasting PP level in the morning is significantly elevated, often 20 to 50 times higher than normal, and some even exceed 700 times. If the baseline PP level is normal, a protein meal or secretin can be used for stimulation test. A significantly increased PP level is also helpful for the diagnosis of this disease.

　　2. Ultrasonography, CT, MRI, intraoperative ultrasound examination, and selective celiac artery angiography, etc.

　　3. The procedure of percutaneous transhepatic portal vein catheterization for blood sampling (PTPC) and selective arterial injection of methylene blue (SAMBI) examination is introduced by the author, who described a case of a 72-year-old male patient complaining of abdominal pain. CT imaging suggested a locoregional mass in the tail of the pancreas, with angiography showing a 2cm-sized tumor with vascular staining in the tail of the pancreas. Serum immunoassay results indicated elevated levels of glucagon and pancreatic polypeptide. Therefore, percutaneous transhepatic catheterization into the hepatic vein and selective catheterization into the splenic artery were performed, and 5ml of 10% calcium gluconate was injected into the splenic artery as a stimulator. Blood was drawn from the hepatic vein before and 30, 60, 90, 120, and 180 seconds after the injection to measure the levels of glucagon and pancreatic polypeptide. The results showed that the level of pancreatic polypeptide increased by 500% compared to the baseline, while the level of glucagon remained unchanged after the injection of calcium. During surgery, after the exploration was completed, 2ml of sterilized methylene blue was injected into the splenic artery catheter. The spleen and the tail of the pancreas turned blue immediately; 2 minutes later, all parts except the 2cm large nodule in the tail of the pancreas had faded. A distal pancreatectomy was performed, and the tumor tissue was confirmed to be rich in pancreatic polypeptide by immunohistochemical examination.

　　1. Foods Good for Pancreatic Cancer Patients After Surgery

　　Diet should first be chosen to be nutritious, easy to digest, less刺激性, and low in fat. High-protein, high-carbohydrate foods such as milk, fish, liver, egg whites, refined flour products, lotus starch, fruit juice, vegetable soup, and粳米 can be consumed. Also, foods with softening hard lumps, dispersing nodules, soothing the liver, and regulating the qi should be included, such as hawthorn, malt, Job's tears, shenqu, red beans, shekuai, ophiopogon, costus, jujube, Astragalus, Codonopsis, honeysuckle, kelp, seaweed, laver, etc. Foods that tonify the Qi and blood, strengthen the spleen and stomach should be commonly used, such as glutinous rice, red beans, broad beans, yam, goji berries, herring, figs, chestnuts, milk, and rice flour.

　　2. Foods to Avoid After Pancreatic Cancer Surgery

　　It is necessary to avoid binge drinking, overeating, alcoholism, and high-fat diets. It is recommended to eat less or limit the intake of foods that are difficult to digest, such as fatty meats, fish roe, brain, greasy, fried foods, etc. Avoid spicy and刺激性 foods such as scallions, ginger, garlic, and chili peppers. Avoid smoking and drinking.

　　1. Surgical Treatment

　　Surgical treatment is the first-line treatment for this disease, especially for early, solitary tumors, and surgical resection should be strived for.

　　1. For tumors located in the body and tail of the pancreas, superficial solitary lesions can be excised; for lesions located deeply or those with multiple occurrences, resection of the body and tail of the pancreas should be performed.

　　2. For pancreatic head tumors, 80% of pancreatic resection with tumor resection can be performed; if the tumor is large and it is difficult to perform simple pancreatic resection, pancreaticoduodenectomy can also be performed.

　　3. For patients with large tumor volume, advanced disease, or with metastasis, tumor volume reduction surgery can also play a relief role.

　　2. Chemotherapy

　　For patients with advanced tumors, chemotherapy can be performed, with streptozotocin (streptozotocin) as the first choice of medication. Some people have used streptozotocin to treat two patients with pancreatic polypeptide tumors, one of whom survived for three and a half years. Octreotide acetate can inhibit the secretion of pancreatic polypeptide by functional endocrine tumors extensively, with an effective rate of up to 90%. Chemotherapy can alleviate symptoms or partially alleviate them, and the serum level of pancreatic polypeptide can even return to normal.