Surgical Oncology

Surgical Oncology

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Liver, Pancreas and Bile Duct Program (HPB)


Pancreatic Cancer - Basic Information


The pancreas is an approximately 6-8 inch-long gland located behind the stomach. It has two main functions — producing enzymes that aid in digestion and producing hormones that keep blood sugar levels within a normal range.

Approximately 43,000 new cases of pancreatic cancer are diagnosed in the U.S. every year. It is sometimes called a silent disease: Early pancreatic tumors often do not cause any symptoms, and most patients are not diagnosed until the cancer has spread. Common sites of metastatic spread include the liver, the lining of the abdomen and the lungs.

Solid Tumors of the Pancreas

Pancreatic cancers are distinguished by the type of cell in which they arise. There are two main types of solid pancreatic tumors:

  • Adenocarcinoma: Between 85 and 90 percent of all pancreatic cancers are adenocarcinomas that arise in the exocrine glands of the pancreas. The exocrine glands produce enzymes that are released into the intestines, where they help digest fats, proteins and carbohydrates.
     
  • Neuroendocrine tumors: Less common are neuroendocrine tumors that arise in the islet cells of the pancreas. Islet cells produce insulin and glucagon (which regulate blood sugar) and other hormones.

Symptoms of pancreatic cancer can be related to the type of cell in which the tumor arises and the tumor’s location within the organ. The pancreas is composed of the head, the neck, the body and the tail.

  • Lesions in the head of the pancreas can sometimes block the common bile duct, leading to jaundice. Symptoms include the darkening of the skin and urine and the yellowing of the whites of the eyes.
  • Tumors that arise in the exocrine glands sometimes obstruct the pancreatic duct, blocking the flow of digestive enzymes and producing frequent loose bowel movements.
  • Islet cell tumors can produce excessive hormones, leading to a broad range of symptoms. For example, tumors that produce insulin can cause low blood sugar, leading to symptoms such as lightheadedness.
  • Other possible indications of pancreatic cancers include unexplained weight loss, inflammation of the pancreas (pancreatitis) and pain that radiates from the epigastric region to the back.

While there are some genetic conditions that increase a person’s risk for pancreatic cancer, most cases cannot be linked to inheritance. Risk factors for pancreatic cancer include chronic pancreatitis, diabetes, obesity and smoking.

Cystic Tumors of the Pancreas

Many types of cysts can be found in the pancreas. These abnormalities can be benign, but some are pre-malignant or malignant. Cysts are often found incidentally through a CT or MRI scan done for other purposes.

  • Serous cystic neoplasms are spongy, localized cysts that are usually benign. These cysts may be located anywhere in the pancreas. They may be removed surgically if they cause symptoms or if a diagnosis cannot be firmly defined by standard imaging and biopsy/fine needle aspiration.
     
  • Mucinous cystic neoplasms account for 30 percent of pancreatic cysts. They range from benign to malignant, and approximately one-third are associated with invasive cancer of the pancreas. These cysts are made up of cells that produce mucin, a component of mucus. Most are found in the body or tail of the pancreas.
     
  • Intraductal papillary mucinous neoplasms are cysts consisting of mucin-producing tumors. They have a high potential for progressing from benign growths to invasive cancer. These cysts involve the main pancreatic duct or major side branches, and they are usually found in the head and neck of the pancreas.

Pancreatic Cancer Diagnosis and Staging

Patients who present with jaundice usually undergo ultrasound imaging to evaluate suspected bile duct blockage. Pancreatic cancers are diagnosed using CT and MRI scans that provide precise cross-sectional imaging of the tumor and surrounding organs and blood vessels.

To learn how physicians determine the stage of a pancreatic tumor and make basic treatment decisions, read The Importance of Accurate Diagnosis and Multimodality Therapy for Pancreatic Cancer by Douglas Evans, MD, Medical College of Wisconsin surgical oncologist.

The pancreatic cancer team at Froedtert & The Medical College of Wisconsin has developed a standard evaluation process that provides patients with a full diagnosis within days. To schedule an appointment, please call 414-805-0505 or 866-680-0505 today.

Nutrition and Pancreatic Cancer

Patients who have undergone pancreas surgery need special nutritional support. For guidance on post-surgery diet and other information on pancreatic cancer, view Nutrition and Pancreatic Cancer, an audio slideshow narrated by registered dietitian Dena McDowell, MS, RD, CD.

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Page Updated 12/14/2013