About one fifth of patients with pancreatic cancer are found to be in the early stage, and surgical treatment is the first choice for the treatment of early pancreatic cancer. Due to the high degree of malignancy of pancreatic cancer, more than three-quarters of patients have found that it is in the advanced stage, with multiple spread and metastasis throughout the body, which requires systemic treatment, and local treatments such as surgery and radiotherapy cannot play a role; In addition, the sensitivity of pancreatic cancer to chemotherapy is poor, and the classic western medicine treatment methods for pancreatic cancer are not effective. Traditional Chinese medicine and targeted therapy have achieved initial results. Now, the various methods are described as follows:

First, western medicine treatment for pancreatic cancer

In recent years, pancreatic cancer treatment is increasingly developing in the direction of comprehensive treatment. In addition to being used alone, the following conventional treatment methods are more often and reasonably applied comprehensively to improve the cure chance.

(1) Surgical treatment: Whipple operation (PD) is the main treatment method for pancreatic cancer, pancreaticoduodenectomy (PPPD) can be used for periampullary cancer or ampullary cancer, total pancreatectomy can be used for cancer tissue involving the whole pancreas without liver metastasis and peritoneal implantation, and pancreatectomy (DP) can be used for cancer tissue with extensive infiltration of surrounding organs and distant.

(2) radiotherapy: radiotherapy before, during, after or during chemotherapy can inhibit pancreatic cancer to some extent, improve the therapeutic effect of pancreatic cancer and prolong the survival time of patients;

(3) Chemotherapy: Although pancreatic cancer is not sensitive to chemotherapeutic drugs, chemotherapy can prolong the survival time and alleviate some diseases. For example, raltitrexed-oxaliplatin combined with chemotherapy is used to treat pancreatic cancer metastasis of gemcitabine-resistant patients. Experiments show that trichostatinA combined with other chemotherapeutic drugs has synergistic effect. Other commonly used combined chemotherapy schemes include FAM, FAP and MA.

2. Treatment of pancreatic cancer with traditional Chinese medicine

Traditional Chinese medicine thinks that pancreatic cancer is the manifestation of spleen accumulation, and it is mostly treated from the theory of spleen. Traditional Chinese medicine emphasizes syndrome differentiation in the treatment of pancreatic cancer. Clinical research reports: pancreatic cancer is divided into two types: spleen deficiency and blood stasis, and damp-heat toxin is abundant. 31 cases of advanced pancreatic cancer are treated with "Jianpi Fang" as the main prescription. As a result, 18 cases have survived for 1-2 years, and 7 cases have survived for more than 3 years.

Report of related clinical trials

Objective: To compare the clinical efficacy and value of traditional Chinese medicine in the treatment of pancreatic cancer and arterial infusion chemotherapy through retrospective study after treatment of advanced pancreatic cancer.

experimental method: from may 2112 to July 2114, 61 patients who were admitted to the hospital in turn were divided into two groups (32 cases in the Chinese medicine group and 28 cases in the chemotherapy group), and there was no significant difference in the basic situation between the two groups (P> 1。 15)。 Observe and compare the objective effective rate, survival time, progression-free survival time and adverse drug reactions between the two groups after treatment.

experimental results: after treatment, the objective effective rates in the Chinese medicine group were partial remission (PR)1, stable (SD)53.1% and progressive (PD)46.9%, while in the chemotherapy group, PR7.1%, SD53.6% and PD39.3%, with no significant difference between the two groups (P> 1.15)。 The one-year survival rate of Chinese medicine group was 34.37%, and the median survival rate was 6.17 months, which was significantly better than that of chemotherapy group (one-year survival rate was 11.25%, and the median survival rate was 4.17 months), and the difference was significant (P < 1.15)。 The adverse reactions of Chinese medicine group were obviously lighter than those of chemotherapy group.

experimental conclusion: Chinese medicine in the treatment of advanced pancreatic cancer has the advantages of stabilizing tumor focus, prolonging patients' survival time and less adverse drug reactions, which shows good clinical value and deserves further study.

Third, the treatment of integrated traditional Chinese and western medicine

At present, there is no new breakthrough in the treatment of pancreatic cancer, and early surgical resection is still the first choice, but the surgical resection rate is not high, and most patients are in the middle and late stage at the time of diagnosis, so it is suitable to use individualized treatment of integrated traditional Chinese and western medicine. The common treatment schemes are:

(1) surgery combined with traditional Chinese medicine. After radical surgery, traditional Chinese medicine can strengthen the spleen and stomach, replenish qi and nourish blood, and only palliative surgery can improve the physique and enhance the body's resistance.

(2) Combination of chemotherapy and traditional Chinese medicine. Traditional Chinese medicine for invigorating spleen and benefiting qi can reduce the toxic and side effects of chemotherapy, such as low red blood cells and platelets, and can also reduce symptoms such as shivering and fatigue, which can improve the curative effect.

(3) Combination of surgery, radiotherapy and traditional Chinese medicine. After radical surgery, radiotherapy and long-term treatment with traditional Chinese medicine for soothing the liver and strengthening the spleen are of certain significance to improve long-term survival.

(4) Combination of surgery, chemotherapy and traditional Chinese medicine. It is helpful to improve the quality of life and prolong the survival period by combining traditional Chinese medicine and chemotherapy drugs after palliative surgery.

Related clinical reports:

Objective: To explore the possible mechanism of integrated traditional Chinese and western medicine in preventing hematogenous metastasis of advanced pancreatic cancer.

experimental method: 212 patients with advanced pancreatic cancer were collected and divided into four types according to the principle of syndrome differentiation and treatment of integrated traditional Chinese and western medicine: damp-heat toxin type, blood stasis and qi stagnation type, spleen deficiency and damp-heat type, and positive deficiency and evil solid type. The changes of blood free cancer cells, serum CA19-9, CA125 and CEA were detected by immunohistochemical and serological methods before and after treatment, and the differences of positive rates by different methods were compared.

experimental results: the positive rate of free cancer cells in blood was as high as 85% before treatment for advanced pancreatic cancer, and it was significantly reduced by 62% after treatment. Among the four detection methods, the positive rate of CA19-9 immunohistochemistry was the highest, followed by CA125, routine pathological HE staining and CEA immunohistochemistry. The positive rates of serum CA19-9, CA125 and CEA did not change much before and after treatment.

experimental conclusion: the treatment based on syndrome differentiation of traditional Chinese and western medicine can significantly reduce the positive rate of blood free cancer cells in patients with advanced pancreatic cancer, and play an anti-tumor role through multiple channels and targets. Multidisciplinary comprehensive treatment is an effective way to improve the therapeutic effect of advanced pancreatic cancer.

Fourth, pain treatment

Patients with pancreatic cancer are often accompanied by pain, and the pain is unbearable. The pain often can't lie flat, and it gets worse at night, which affects eating and sleeping. The analgesic methods are:

(1) Aspirin. Suitable for mild to moderate pain;

(2) morphine. Used to relieve moderate to severe pain;

(3) nerve block. Visceral nerve block was performed by percutaneous or intraoperative injection of drugs, and the celiac ganglion was destroyed by chemical methods;

(4) acupuncture in traditional Chinese medicine. Body acupuncture can take Sanyinjiao, Taishen and Gongsun (both sides), and ear acupuncture can take sympathetic, Shenmen, Sanjiao and Spleen (both sides);

(5) Chinese medicine. Both Xu Changqing and Tripterygium wilfordii have analgesic effects and can be decocted with water.

V. Molecular targeted therapy

At present, the most commonly used gene therapy method for pancreatic cancer treatment is to directly inject or introduce targeted gene vectors into tumor tissues in vivo for local gene therapy. In recent years, combined gene therapy has been adopted to enhance the curative effect. Because it can repair the unique gene variation of tumor or promote the death of tumor cells, gene therapy has broad application prospects. Only the efficacy and safety need further clinical verification.

Pancreatic cancer has a low curative rate and a short survival period, and it is almost sentenced to death. Although surgery, radiotherapy and chemotherapy technology are improving day by day, it still fails to control this chronic disease. Treating cancer is like using soldiers, there are positive and strange things, the right ones are statutes, and the strange ones are not bound by statutes. The methods and theories of treating pancreatic cancer based on syndrome differentiation, treating both symptoms and root causes, and balancing yin and yang, if properly integrated into the comprehensive diagnosis and treatment of pancreatic cancer by western medicine, will definitely improve the cure rate and the quality of life of patients. On the other hand, the discovery of oncogenes and the gradual clarification of their functions are undoubtedly an important milestone in the history of oncology, and the research on the treatment of pancreatic cancer has entered a brand-new molecular era. Molecular targeted therapy has flourished in recent years. Although its technology still needs to be improved and its curative effect needs to be improved, it has brought dawn to the treatment of pancreatic cancer. It is not difficult to foresee that the breakthrough in the treatment of pancreatic cancer in the future is likely to depend on the practice of individualized comprehensive treatment of traditional Chinese and western medicine and the mature application of molecular targeted therapy.