The pancreas is a gland located in the back of the abdomen which serves two principal functions. The first function involves secretion of hormones, such as insulin and glucagon, that regulate the blood sugar level. The other important role served by the pancreas is the production of enzymes to aid in digestion. Pancreatic cancer is the fourth most common cause of cancer-related death in the Western world and adenocarcinoma is the most common type, accounting for more than 80% of pancreatic tumors. Adenocarcinomas are tumors that arise from the glands of the pancreas.
Another type of tumor, called IPMNs, are being increasingly recognized as a result of patients having CT scans for a variety of reasons. IPMNs often appear as pancreatic cysts on CT scans. Neuroendocrine tumors also arise in the pancreas, and these are discussed in a separate section. The location of the pancreatic tumor within the gland has a significant impact on the symptoms and treatment. Most pancreatic tumors are located in the head of the gland, which usually leads to blockage of the bile duct and jaundice or yellow skin discoloration.
Most pancreatic cancers occur in individuals with no identifiable risk factors. In a small minority of cases, pancreatic cancer can occur in families who have an inherited syndrome. Cigarette smoking has been found to increase the risk of developing pancreatic cancer.
Summary of Treatment and Management Strategies
One of the most difficult aspects of pancreatic cancer is that approximately 80% of tumors will be diagnosed at an advanced stage, when curative surgery is not an option. When carefully selected, 10-20% of patients who are able to have an operation will be long-term survivors. These statistics underscore the following points: Surgery is the only curative option but most patients are not candidates when they are initially seen by a physician.
Chemotherapy and radiation therapy play important roles in the management of pancreatic cancer. Carefully chosen surgical or non-surgical interventions to relieve symptoms can often enhance quality of life and minimize discomfort or pain
Complete surgical resection is the only potentially curative treatment for pancreatic adenocarcinoma; however, patient outcome is dependent on tumor type and stage. Various types of pancreatic cancer are recognized, including the more common adenocarcinoma, the rare neuroendocrine tumors, as well as the intraductal papillary mucinous neoplasms (IPMN). Depending on the location of the tumor within the pancreas, surgical removal involves a either a Whipple procedure (pancreaticoduodenectomy) or a distal pancreatectomy.
The Whipple procedure is a complex operation only performed at centers of surgical expertise and involves removing the right side of the pancreas, bile duct, gallbladder, portion of the small intestine, and occasionally part of the stomach. The distal pancreatectomy procedure involves removal of the left side of the pancreas with or without the spleen. As a result of improved surgical and anesthetic techniques during the last two decades, the mortality associated with Whipple procedure have been greatly reduced. The mortality rate for major pancreatic surgery is less than 5% in experiences centers.
Palliation or procedures to minimize symptoms remains a cornerstone of therapy for patients with pancreatic cancer. Symptoms we attempt to address with palliative procedures include pain, jaundice or the inability to eat due to blockage of the stomach or small intestine. Palliative procedures are selected to minimize the risk of complications, provide symptomatic relief, and improve quality of life.