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Pancreatic Tumors and Cysts

The pancreas helps in the digestion process by producing enzymes that break down sugars, fats and starches. This small organ located near the liver and intestines helps to regulate the body’s glucose levels.The pancreas can grow cysts or tumors (cancerous or non-cancerous).

Pancreatic Tumors

Cysts and growth on the pancreas may begin as benign, but may often grow cancerous if left untreated. 

About Pancreatic Cancer

Pancreatic cancer begins when abnormal cells in the pancreas grow and divide out of control and form a tumor. Although pancreatic cancer is not considered common, about 60,000 Americans are expected to be diagnosed in 2021. 

Doctors and researchers aren’t exactly sure what causes pancreatic cancer. Only about 10% are considered hereditary, which means oftentimes the rest occur randomly or are caused by factors such as smoking, obesity or age.

Some other causes of pancreatic cancer could be:
-    Long-term diabetes
-    Chronic and hereditary pancreatitis
-    Race (Those of African American or Ashkenazi Jew descent tend to have higher rates)
-    Sex (pancreatic cancer tends to be more common in males)
-    Diets high in red and processed meats

 

Symptoms of Pancreatic Cancer

It is common not to learn about pancreatic cancer due to lack of initial symptoms. Symptoms of pancreatic cancer do not develop until the disease starts to get into its later stages. At that point, symptoms can often be non-specific and with little initial pain, such as lack of appetite or weight loss.  Other conditions or issues can also cause these symptoms so it’s important to see your doctor anytime you experience any new symptoms or health concerns so that you can receive an accurate diagnosis. 

 

Other signs and symptoms of pancreatic cancer can include:
-    Abdominal pain that radiates to your back
-    Jaundice (yellowing of the skin or the whites of your eyes)
-    Light-colored stools
-    Dark-colored urine
-    Itchy skin
-    New diagnosis of diabetes or existing diabetes that starts becoming more difficult to control
-    Blood clots
-    Fatigue

 

Pancreatic Cancer Treatment and our Expertise

Our multidisciplinary team brings together physicians across several specialties to ensure that our patients receive the most comprehensive, customized treatment plan for their type of pancreatic cancer.

 

Specialists in the following disciplines will collaborate on your care:
-    surgical oncology
-    Medical oncology
-    Gastroenterology
-    Radiation oncology
-    Radiology
-    Pathology
-    Pain management
-    Nutrition
-    Oncology social work

This team-based approach allows us to provide the most accurate diagnosis and treatment options, and every person on your case will have the most up-to-date information to treat you efficiently. During your appointments, you may see several doctors at once or just one at a time, depending on the type of appointment. But you will always have access to your entire care team for any questions or concerns that you may have.

Pancreatic Cancer Treatment Options

We understand that receiving a diagnosis of pancreatic cancer can be difficult, but we will work closely with you and your family to offer the best treatment options possible, which could include surgery or the opportunity to participate in clinical trials to benefit from new drugs and therapies.

Chemotherapy
For some patients diagnosed with pancreatic cancer, specialized chemotherapy may be the best treatment. Patients could be given chemotherapy at various stages during the treatment process and is administered either by mouth as a pill or with an IV in a chemotherapy clinic or hospital setting.  

Surgery
The type of surgery patients receive depends on many factors, including location and size of the tumor, the patient’s health and how progressed the cancer is. The most common types of surgery for pancreatic cancer include:

Whipple Procedure
The Whipple procedure is an operation that removes cancerous tumors of the head of the pancreas, the first part of the small intestine, the gallbladder and the bile duct. The remaining organs are attached to allow patients to digest food naturally. 

The Whipple procedure is a difficult and complex operation and should only be performed by surgeons experienced in it. Our team is well-versed in the Whipple procedure. 

Distal Pancreatectomy
In a distal pancreatectomy, the tail and body of the pancreas are removed and the head of the pancreas is preserved. Since the spleen is so close to the tail of the pancreas, sometimes the spleen is also removed during the procedure. A distal pancreatectomy is the standard treatment for pancreatic cancer affecting the tail and body of the pancreas.

A distal pancreatectomy can sometimes be performed laparoscopically, or minimally invasively, using long instruments and a camera inserted through several tiny incisions rather than through one large “open” incision. 

Central Pancreatectomy
During a central pancreatectomy, surgeons will resect, or remove, a portion of the middle of the pancreas, while the remaining healthy parts of the pancreas are preserved. The benefit of central pancreatectomy is that it leaves patients with working pancreatic heads and tails, which preserves some of the pancreas’ functions and usually decreases the chance of a patient developing insulin-dependent diabetes.

Enucleation
Patients with benign or low-grade pancreatic tumors may benefit from enucleation surgery. During this procedure, pancreatic tumors are enucleated, or scooped out from the pancreas, only removing the cancerous tumors without disturbing the healthy parts of the pancreas. This procedure is less invasive than other types of pancreatic cancer surgery. 

Research and Clinical Trials
The benefits of receiving cancer care at an academic medical center like St. Elizabeth’s means that our patients have access to groundbreaking research and clinical trials. Our researchers are always looking for new ways to improve healthcare and treatments. We encourage you to speak with your care team to see what pancreatic cancer clinical trials may benefit you.

Pancreatic Cysts

Not all growths on the pancreas are cancerous tumors. Benign pancreatic cysts, called pseudocysts, are pockets of fluid on or in your pancreas. Typically they’re found during imaging of the abdomen when getting care for another medical issue, but it’s important that your doctor watches them over time or recommends treatment as some can turn into cancer.

 

Symptoms of Pancreatic Cysts

Pancreatic cysts don’t often cause symptoms, but when they do occur, they can include:
-    Persistent abdominal pain which may travel to your back
-    Nausea and vomiting
-    Weight loss
-    Feeling full soon after you start eating

 

Although it’s not often know what causes pancreatic cysts, one main risk factor is pancreatitis, which can be brought on by gallstones or heavy alcohol consumption. If gallstones are triggering pancreatitis, your doctor may suggest having your gallbladder removed.

 

Treatment for Pancreatic Cysts

A benign pseudocyst can be left alone if it’s not bothering you. Your doctor should monitor other types of pancreatic cysts.  Doctors often refer to this as “watchful waiting.”

Pseudocysts that are bothersome and causing discomfort or growing larger can be drained, which is usually done through an endoscopic procedure.

Pre-cancerous cysts or those that a doctor thinks could turn into cancer would likely need surgery.  Large benign pseudocysts that are causing symptoms may also be surgically removed.

 

Recent Research

Asbun HJ, Moekotte AL, Vissers FL, Kunzler F, Cipriani F, Alseidi A, D'Angelica MI, Balduzzi A, Bassi C, Björnsson B, Boggi U, Callery MP, Del Chiaro M, Coimbra FJ, Conrad C, Cook A, Coppola A, Dervenis C, Dokmak S, Edil BH, Edwin B, Giulianotti PC, Han HS, Hansen PD, van der Heijde N, van Hilst J, Hester CA, Hogg ME, Jarufe N, Jeyarajah DR, Keck T, Kim SC, Khatkov IE, Kokudo N, Kooby DA, Korrel M, de Leon FJ, Lluis N, Lof S, Machado MA, Demartines N, Martinie JB, Merchant NB, Molenaar IQ, Moravek C, Mou YP, Nakamura M, Nealon WH, Palanivelu C, Pessaux P, Pitt HA, Polanco PM, Primrose JN, Rawashdeh A, Sanford DE, Senthilnathan P, Shrikhande SV, Stauffer JA, Takaori K, Talamonti MS, Tang CN, Vollmer CM, Wakabayashi G, Walsh RM, Wang SE, Zinner MJ, Wolfgang CL, Zureikat AH, Zwart MJ, Conlon KC, Kendrick ML, Zeh HJ, Hilal MA, Besselink MG; International Study Group on Minimally Invasive Pancreas Surgery (I-MIPS). The Miami International Evidence-based Guidelines on Minimally Invasive Pancreas Resection. Ann Surg. 2020 Jan;271(1):1-14. doi: 10.1097/SLA.0000000000003590. PMID: 31567509.

Joechle K, Conrad C. Cost-effectiveness of minimally invasive pancreatic resection. J Hepatobiliary Pancreat Sci. 2018 Jun;25(6):291-298. doi: 10.1002/jhbp.558. PMID: 29878696.

Salehi O, Vega EA, Kutlu OC, Alarcon Velasco SV, Krishnan S, Ricklan D, Kozyreva O, Conrad C. Combining Appleby with RAMPS - Laparoscopic Radical Antegrade Modular Pancreatosplenectomy with Celiac Trunk Resection. J Gastrointest Surg. 2020 Nov;24(11):2700-2701. doi: 10.1007/s11605-020-04686-4. Epub 2020 Jun 17. PMID: 32557017.

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