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<title>膵癌早期診断実践ガイド | 株式会社文光堂</title>


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<meta name="description" content="膵癌は極めて予後不良な悪性腫瘍で，死亡者数は年々増加しており，予後改善のためには，微小膵癌のうちに早期診断する必要がある．本書では，微小膵癌を発見するための，膵臓の精査を勧めるべき患者を見分けるポイント，画像診断のポイントについて，膵癌早期診断研究会の中心的メンバーが余すところなく解説．実際の早期診断例や各地での早期診断の取り組みも掲載しているので，早期診断の実践に向け，ぜひご活用いただきたい．">

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		<h1 class="catchCopy">かかりつけ医と専門医のための膵癌早期診断の道しるべとなる１冊！</h1>
		

		<h1 class="title titleWidth">膵癌早期診断実践ガイド<span class="version"></span></h1>
		

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					編集：花田敬士（JA尾道総合病院消化器内科部長／内視鏡センター長）
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				<ul class="property"><li class="disc">B5判・152頁・2色刷(一部4色刷)</li><li class="disc">ISBN&nbsp;978-4-8306-2103-1</li><li class="disc">2018年4月6日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">膵癌は極めて予後不良な悪性腫瘍で，死亡者数は年々増加しており，予後改善のためには，微小膵癌のうちに早期診断する必要がある．本書では，微小膵癌を発見するための，膵臓の精査を勧めるべき患者を見分けるポイント，画像診断のポイントについて，膵癌早期診断研究会の中心的メンバーが余すところなく解説．実際の早期診断例や各地での早期診断の取り組みも掲載しているので，早期診断の実践に向け，ぜひご活用いただきたい．</section><section class="preface">はじめに<br><br>　膵癌は「早期癌」の概念がいまだ確立されていない．大半が「進行癌」で，罹患数・死亡数ともに増加しており，その予後は大変厳しい．私は1988年に膵胆道系の専門医を目指して医師となったが，実地臨床で厳しい現実に遭遇するたび，「なぜ膵癌は早期診断が困難なのか」と自問する日々が続いた．<br>　その後，1997年に広島大学病院から故郷のJA尾道総合病院への赴任が契機となり，地元の医療圏から膵癌早期診断の気運を高め，2007年に病診連携を生かした「膵癌早期診断プロジェクト」を発足することができた．2006年に発刊された膵癌診療ガイドラインに記載された危険因子に着目し，該当する症例に対して連携施設の先生方による検査（腹部USなど）の介入後，異常所見があれば中核施設にご紹介いただく流れを定着させた．粘り強い取り組みの結果，私自身ほとんど経験したことがなかったStage 0，Iの症例が増加し，プロジェクト開始から約10年が経過した現在では，尾道市の膵癌患者の5年生存率は約20％と改善してきている．<br>　一方，早期診断症例の増加とともに，診断および治療上の問題点も同時に明らかとなってきた．そこで2014年，膵癌の早期診断に情熱を持って取り組んでいた消化器内科，外科，放射線科，病理の先生方を中心に，また田中雅夫先生を顧問に迎えて「膵癌早期診断研究会（JEDPAC）」を発足した．以降，年2回のペースで研究会は開催されている．貴重なStage 0，I症例の徹底的な討論を通じて，症例の画像（特に膵管像）と病理所見の詳細な対比の重要性，合併症の懸念から近年敬遠されつつあった内視鏡的逆行性膵管造影（ERP）の価値が発信され，若手医師からも大変好評である．<br>　今後，膵癌早期診断体系の確立は，大げさに言えば国民的な課題とも言える．研究会で得られた知見および病診連携を生かした膵癌早期診断の取り組みの重要性を，中核施設のみならず，地域で活動する一般医家の先生方にも啓発したい．その思いをJEDPAC世話人のメンバーを中心に，一冊の手引き書として形にしたものが本書である．超多忙な日常業務の合間にご執筆いただいた先生方の思いを感じ，そして存分に臨床で生かしていただきたい．<br>　最後に，今回非常にタイムリーな企画をご提案いただいた文光堂の小柳　健氏に心から感謝申し上げるとともに，本書の内容が契機となり，膵癌の早期診断体系が確立され，一人でも多くの長期生存が得られることを願ってやまない．<br><br>JA尾道総合病院消化器内科<br>花田敬士</section><section class="indexes">早期の膵癌（上皮内癌）の病理アトラス<br>第1章　膵癌早期診断のために必要な知識<br>　１ 膵癌の疫学<br>　２ 膵癌の危険因子<br>　３ 膵囊胞性病変（IPMNを含めて）と膵癌<br>　４ 早期の膵癌の遺伝子学的特徴<br>　５ 早期診断に関する膵癌診療ガイドライン2016年版のポイント<br>第2章　膵癌早期診断の実践<br>　１ かかりつけ医における実践<br>　　A 気を付けたい臨床徴候<br>　　B 行うべき血液検査<br>　　C 腹部USのポイント<br>　　D 中核病院で精査すべき病態とは？<br>　２ 中核病院での画像検査と所見の特徴<br>　　A 膵精密US<br>　　B CT<br>　　C MRI（MRCP）<br>　　D EUS（観察）<br>　　E EUS-FNA<br>　　F ERCP<br>　コラム 膵液細胞診，EUS-FNA検体の判定<br>　コラム MRI（MRCP）を用いた膵管撮像<br>第3章　早期診断された膵癌症例<br>　１ 造影CTを契機に発見された膵上皮内癌<br>　２ 慢性膵炎の経過観察中に発見された多発性膵上皮内癌<br>　３ 検診でのCTを契機に発見された微小膵癌<br>　４ 検診での腹部USを契機に発見された微小膵癌<br>第4章　膵癌早期診断に向けての病診連携の取り組み<br>　１ 尾道市医師会膵癌早期診断プロジェクト<br>　２ 大阪市北部早期膵癌プロジェクト<br>　３ 山梨県の実践<br>　４ 岸和田葛城プロジェクト<br>索　引</section></article>
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