Ekzokrin Pankreas Tümörleri Tanı ve Tedavi Yaklaşımları
Özet
Pankreasın ekzokrin hücrelerinden kaynaklanan tümörler, genellikle ileri evrede tanı konulabilen ve sağ kalım süreleri oldukça kısa olan agresif malignitelerdir. En sık karşılaşılan türü %90 oranla duktal adenokarsinom olup; sigara, obezite, diyabet ve genetik yatkınlık gibi faktörler etiyolojisinde önemli rol oynar. Hastalık erken evrelerde genellikle asemptomatik seyretmekle birlikte, ilerleyen dönemlerde karın ağrısı, sarılık ve kilo kaybı gibi semptomlarla kendini gösterir. Tanı ve evreleme süreçlerinde Bilgisayarlı Tomografi (BT), Manyetik Rezonans Görüntüleme (MR), Endoskopik Ultrasonografi (EUS) ve CA 19-9 biyobelirteci aktif olarak kullanılmaktadır. Hastalığın tedavisindeki tek küratif seçenek cerrahi rezeksiyon (Whipple operasyonu veya distal pankreatektomi) olmakla birlikte, hastaların büyük bir kısmı tanı anında cerrahi şansını kaybetmiş durumdadır. Bu nedenle multidisipliner bir yaklaşımla cerrahi, sistemik kemoterapi ve radyoterapi kombinasyonları uygulanır. İleri evre ve metastatik hastalarda ise yaşam kalitesini artırmaya yönelik endoskopik stentleme, safra drenajı ve ağrı yönetimi gibi palyatif tedaviler ön plana çıkmaktadır.
Tumors arising from the exocrine cells of the pancreas are aggressive malignancies that are generally diagnosed at an advanced stage, resulting in significantly short survival times. Ductalkarsinom accounts for 90% of cases, with risk factors including smoking, obesity, diabetes, and genetic predisposition. While the disease is mostly asymptomatic in its early stages, it manifests with abdominal pain, jaundice, and weight loss as it progresses. Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Endoscopic Ultrasonography (EUS), and the CA 19-9 biomarker are utilized for definitive diagnosis and accurate staging. Although surgical resection, such as the Whipple procedure or distal pancreatectomy, represents the only curative treatment variant, the majority of patients lose this option due to advanced disease at presentation. Consequently, a multidisciplinary treatment regimen combining surgery, systemic chemotherapy, and radiotherapy is applied. For advanced or metastatic cases, palliative interventions like endoscopic stenting, biliary drainage, and pain management are prioritized to improve quality of life.
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