Dr Arthur Richardson - Hepato-Biliary, Upper Gastro-Intestinal and General Surgeon Associate Professor,University of Sydney
 
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Liver Cancer  ::  Pancreatic Tumours and Cancer

Pancreatic Tumours and Cancer

1.1 Pancreatic cancer

This is a very serious cancer and mostly starts in the cells of the pancreatic ducts. Nearby blood vessels and nerves may be invaded. Although a minority of patients are suitable for surgery, those patients who are able to have the cancer removed have the best outlook. There is always a risk of relapse (cancer recurring). The causes of pancreatic cancer are unknown but risk factors include:

  • Cigarette smoking
  • Chronic pancreatitis
  • Advancing age (over 65 years)
  • Obesity
  • Genetic factors

Symptoms

The symptoms of pancreatic cancer are often vague and can appear similar to those caused by other conditions. This means that pancreatic cancer is often not diagnosed until it is quite advanced. Some of the common symptoms may include:

  • Persistent pain in the abdomen
  • Loss of appetite
  • Weight loss
  • Jaundice, if the bile duct is blocked
  • Back pain (in some cases)

Diagnosis

If pancreatic cancer is suspected, your doctor will refer you for tests. Diagnosis may require the following:

  • Blood tests
  • CT scan - a special x-ray taken from many different angles, to build a three-dimensional picture of your body. A dye may be injected to further highlight internal organs.
  • Magnetic resonance imaging (MRI) – similar to a CT scan but uses magnetism instead of x-rays to build three-dimensional pictures of your body.
  • Ultrasound – sound waves create a picture of your pancreas.
  • ERCP – this may help in the diagnosis and also a plastic or metal tube can be inserted to relieve jaundice.
  • Laparoscopic surgery – the internal organs are examined with an instrument inserted into the abdomen through a small cut.
  • Tissue biopsy – a small sample of the pancreas is removed. This is usually done with an endoscopic ultrasound.
  • Endoscopic ultrasound – an endoscope with an ultrasound probe is inserted into the stomach and the upper part of the intestine to take images. It may be possible to biopsy some tumours using this technique.
  • PET scan – this is a specialised scan, which may show spread of the cancer. It is not routinely ordered but may be advised by your doctor in certain circumstances.

Treatment

Treatment for pancreatic cancer depends on your age and general health, the size and location of the cancer, and whether it has spread to other parts of the body. Treatment is usually provided by a team of health professionals, which may include surgeons, medical oncologists, radiotherapists, gastroenterologists and a range of allied health personnel (multidisciplinary team). Treatment options may include:

  • Surgery – is used when the cancer has not spread beyond the pancreas.
  • Radiotherapy – radiation may be used to destroy any cancer cells that remain in the body.
  • Chemotherapy – either tablets or injections of anti-cancer drugs may be used.

1.2. Endocrine tumours of the pancreas

Endocrine tumours generally have a better prognosis than cancer of the pancreas. They may secrete hormones that cause symptoms such as flushing, hypoglycaemia and diahorrea.

1.3. Pancreatic cysts

Pancreatic cysts may be cancerous and may need to be removed although some may be able to be monitored. They are more common in women and may be part of a rare condition known as intraductal papilliary mucinous neoplasm, which can also develop into cancer.

2. Pancreatic surgery

Pancreatic surgery is mostly indicated for the removal of cancers or potentially cancerous growths of the pancreas. It can be a very major procedure and may be possible laparoscopically (key hole surgery) or via a conventional open operation.

2.1. Pancreatico-duodenectomy

Pancreatico-duodenectomy (Whipple’s procedure) is a very major and complex procedure to remove the head of the pancreas, part of the stomach, duodenum, gallbladder and part of the bile duct. It is most commonly indicated for cancer involving the pancreas but also occasionally for cancer of the duodenum or lower bile duct.  For patients to have the best outcomes, they should be treated in a major hospital by an experienced surgeon who does the operation regularly.

2.2. Distal pancreatectomy

Distal pancreatectomy is where the tail of the pancreas and usually the spleen are removed. It may be able to be done laparoscopically (key hole surgery).

2.3. Total pancreactectomy

Total pancreactectomy is where all of the pancreas is removed and this procedure is done uncommonly. Patients who have this operation are rendered diabetic and must take insulin as well as tablets to help with digestion.
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